Late-Onset Drug-Resistant Epilepsy in Pyridoxamine 5′-Phosphate Oxidase Deficiency: A Case Report Publisher Pubmed



Naghavi E¹ ; Davari A^{2, 3} ; Bahadori AR^{2, 4} ; Razmafrooz M² ; Amirifard H² ; Sabzgolin I² ; Tafakhori A² ; Sheikhvatan M^{5, 6} ; Ranji S² Show Affiliations
Source: Journal of Medical Case Reports Published:2024

Abstract

Background: Pyridoxamine 5′-phosphate oxidase deficiency is a rare inborn error of vitamin B6 metabolism that presents with drug-resistant epileptic seizures. However, the condition is responsive to supplementation with the active vitamin B6 metabolite pyridoxal 5′-phosphate and, in some cases, pyridoxine. Case presentation: In this case report, a 10-year-old Iranian male of Fars ethnicity came to a regional hospital in Tehran, Iran with a chief complaint of tic-like movement. He had a history of unintentional, repetitive, and stereotypic movements of both arms since the age of 4 years. The physical examination depicted facial dimorphism. During admission, the patient experienced habitual hypermotor seizures and generalized tonic–clonic seizures. Ictal electroencephalography demonstrated a generalized background attenuation and bursts of generalized, predominantly left-sided, biphasic spike-wave complexes. Whole-genome sequencing revealed a pyridoxamine 5′-phosphate oxidase deficiency as the underlying cause of the drug-resistant seizures, resulting in a low serum level of pyridoxal 5′-phosphate. The patient underwent pyridoxine supplementation therapy, which ultimately resolved his seizures. At 6 months, he was seizure free. Conclusion: Physicians ought to be aware of manifestations of vitamin B6 deficiency such as mimicking tic and consider it in the differential for drug-resistant epilepsy. © The Author(s) 2024.