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01-02-2013 | Movement Disorders - Short communication

Refractory epileptic seizures due to vitamin B6 deficiency in a patient with Parkinson’s disease under duodopa^® therapy

Authors: Sabine Skodda, Thomas Müller

Published in: Journal of Neural Transmission | Issue 2/2013

Abstract

Levodopa/carbidopa intestinal gel (LCIG) infusion for the treatment of advanced Parkinson’s disease (PD) has been suspected to provoke polyneuropathy in conjunction with vitamin B6, B12 and folate deficiency and elevated homocysteine levels. We describe a PD patient under LCIG therapy developing refractory epileptic seizures obviously promoted by vitamin B6 deficiency.

Aasheim ET, Hofso D, Hjelmesaeth J, Sandbu R (2008) Peripheral neuropathy and severe malnutrition following duodenal switch. Obes Surg 18:1640–1643PubMedCrossRef

Antonini A, Isaias IU, Canesi M, Zibetti M, Mancini F, Manfredi L, Dal Fante M, Lopiano L, Pezzoli G (2007) Duodenal levodopa infusion for advanced parkinson’s disease: 12-month treatment outcome. Mov Disord 22:1145–1149PubMedCrossRef

Bochyńska A, Lipczyńska-Łojkowska W, Gugała-Iwaniuk M, Lechowicz W, Restel M, Graban A, Lipska B, Ryglewicz D (2012) The effect of vitamin B supplementation on homocysteine metabolism and clinical state of patients with chronic epilepsy treated with carbamazepine and valproic acid. Seizure 21:276–2781PubMedCrossRef

Coppola G, Ingrosso D, Operto FF, Signoriello G, Lattanzio F, Barone E, Matera S, Verrotti A (2012) Role of folic acid depletion on homocysteine serum level in children and adolescents with epilepsy and different MTHFR C677T genotypes. Seizure 21:340–343PubMedCrossRef

Gerlach AT, Thomas S, Stawicki ST, Whitmill ML, Steinberg SM, Cook CH (2011) Vitamin B6 deficiency: a potential cause of refractory seizures in adults. J Parenter Enter Nutr 35:272–275CrossRef

Heiser P, Teepker M, Möller JC, Theisen FM, Friedel S, Hebebrand J, Remschmidt H (2004) Neuropathy due to hypovitaminosis following excessive weight loss. J Am Acad Child Adolesc Psychiatry 43:928–929PubMedCrossRef

Henderson JM, Scott SS, Merrill AH, Hollins B, Kutner MH (1989) Vitamin B6 repletion in cirrhosis with oral pyridoxine: failure to improve amino acid metabolism. Hepatology 9:582–588PubMedCrossRef

Juhasz-Pocsine K, Rudnicki SA, Archer RL, Harik SI (2007) Neurologic complications of gastric bypass surgery for morbid obesity. Neurology 68:1843–1850PubMedCrossRef

Klawans HL, Ringel SP, Shenker DM (1971) Failure of vitamin B6 to reverse the L-dopa effect in patients on a dopa decarboxylase inhibitor. J Neurol Neurosurg Psychiatry 34:682–686PubMedCrossRef

Klostermann T, Jugel C, Müller T, Marzinzik F (2012) Malnutritional neuropathy under intestinal levodopa infusion. J Neural Transm 119:369–372PubMedCrossRef

Lheureux P, Penaloza A, Gris M (2005) Pyridoxine in clinical toxicology: a review. Eur J Emerg Med 12:78–85PubMedCrossRef

Lindh J (2007) Short episode of seizures in a newborn of a mother treated with levodopa/carbidopa/entacapone and bromocriptine. Mov Disord 22:1515PubMedCrossRef

Manca D, Cossu G, Murgia D, Molari A, Ferrigno P, Marcia E, Melis M (2009) Reversible encephalopathy and axonal neuropathy in parkinson’s disease during duodopa therapy. Mov Disord 24:2293–2294PubMedCrossRef

Merrill AH Jr, Henderson JM (1990) Vitamin B6 metabolism by human liver. Ann N Y Acad Sci 585:110–117PubMedCrossRef

Muller T, Kuhn W (2009) Homocysteine levels after acute levodopa intake in patients with Parkinson’s disease. Mov Disord 24:1339–1343PubMedCrossRef

Muller T, Renger K, Kuhn W (2004) Levodopa-associated increase of homocysteine levels and sural axonal neurodegeneration. Arch Neurol 61:657–660PubMedCrossRef

Nyholm D, Nilsson Remahl IM, Dizdar N, Constantinescu R, Holmberg B, Jansson R, Aquilonius SM, Askmark H (2005) Duodenal levodopa infusion monotherapy vs oral polypharmacy in advanced parkinson disease. Neurology 64:216–223PubMedCrossRef

Plecko B, Stöckler S (2009) Vitamin B6 dependent seizures. Can J Neurol Sci 36(Suppl 2):S73–S77PubMed

Prasad AN, Rupar CA, Prasad C (2011) Methylenetetrahydrofolate reductase (MTHFR) deficiency and infantile epilepsy. Brain Dev 33:758–769PubMedCrossRef

Schulze-Bonhage A, Kurthen M, Walger P, Elger CE (2004) Pharmacorefractory status epilepticus due to low vitamin B6 levels during pregnancy. Epilepsia 45:81–84PubMedCrossRef

Sourkes TL (1966) Dopa decarboxylase: substrates, coenzyme, inhibitors. Pharmacol Rev 18:53–60PubMed

Urban PP, Wellach I, Faiss S, Layer P, Rosenkranz T, Knop K, Weis J (2010) Subacute axonal neuropathy in Parkinson’s disease with cobalamin and vitamin B6 deficiency in duodopa therapy. Mov Disord 25:1748–1752PubMedCrossRef

Vanderine RE (1986) Review of pyridoxal phosphate and the transaminases in liver disease. Ann Clin Lab Sci 16:79–93

Yoshida K, Moriwaka F, Matsuura T, Hamada T, Tashiro K (1993) Myoclonus and seizures in a patient with parkinsonism: induction by levodopa and its confirmation on SEPs. Jpn J Psychiatr Neurol 47:621–625

Title: Refractory epileptic seizures due to vitamin B6 deficiency in a patient with Parkinson’s disease under duodopa® therapy
Authors: Sabine Skodda
Thomas Müller
Publication date: 01-02-2013
Publisher: Springer Vienna
Published in: Journal of Neural Transmission / Issue 2/2013
Print ISSN: 0300-9564
Electronic ISSN: 1435-1463
DOI: https://doi.org/10.1007/s00702-012-0856-1

At a glance: The STEP trials

Springer Medicine

Refractory epileptic seizures due to vitamin B6 deficiency in a patient with Parkinson’s disease under duodopa^® therapy

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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