- Email: [email protected]
Access to The Journal of Pediatrics Online is reserved for print subscribers!
LETTERS
THE JOURNAL OF PEDIATRICS MARCH 2001
(2.5 mg/kg daily) because intolerable dyskinesia developed. During 20 months of low-dose L-dopa treatment, the girl became more alert and developed more vocalization and facial motility and some voluntary movements (turning and lifting the head from supine). Afterwards, selegiline was added to the treatment (2.5 mg per day). During the following 17 months, voluntary movements improved (grasping, turning from supine to prone, rolling on the floor, speaking of first words). The oculogyric crises decreased in severity and frequency. L-dopa, however, could be increased to 70 mg (3.4 mg/kg daily) during the same time. Our experience seems to confirm that a combined treatment with low-dose L-dopa and selegiline is superior to treatment with L-dopa alone. L-dopa may not be well tolerated in patients with severe tyrosine hydroxylase deficiency when the treatment is started. It may still be a useful drug in
the long run when the dose is very slowly increased. Concerning treatment control, serial measurement of prolactin levels for 24 hours seems to be important.2 In our patient, during several single measurements, serum prolactin levels showed marked fluctuations that could not be attributed to changes in therapy. Serial measurements over 24 hours showed marked fluctuations during the day, which became less during the combined treatment with L-dopa and selegiline, but high nighttime prolactin levels persisted. Martin Häussler, MD Frühdiagnosezentrum Würzburg Center for Developmental Disorders and Disabilities D-97080 Würzburg Germany Georg F. Hoffmann, MD University Children’s Hospital Im Neuenheimer Feld 150
D-69120 Heidelberg Germany Ron A. Wevers, PhD UMC St Radboud Laboratory of Pediatrics and Neurology 6525 GC Nijmegen The Netherlands 9/35/110776 doi:10.1067/mpd.2001.110776
REFERENCES 1. Dionisi-Vici C, Hoffmann GF, Leuzzi V, Hoffken H, Bräutigam C, Rizzo C, et al. Tyrosine hydroxylase deficiency with severe clinical course: clinical and biochemical investigations and optimization of therapy. J Pediatr 2000; 136:560-2. 2. Birnbacher R, Scheibenreiter S, Blau N, Bieglmayer C, Frisch H, Waldhauser F. Hyperprolactinemia, a tool in treatment control of tetrahydrobiopterin deficiency: endocrine studies in an affected girl. Pediatr Res 1998; 43:427-77.
Access to The Journal of Pediatrics Online is reserved for print subscribers! Full-text access to The Journal of Pediatrics Online is available for all print subscribers. To activate your individual online subscription, please visit The Journal of Pediatrics Online, point your browser to http://www.mosby.com/jpeds, follow the prompts to activate online access here, and follow the instructions. To activate your account, you will need your subscriber account number, which you can find on your mailing label (note: the number of digits in your subscriber account number varies from 6 to 10). See the example below in which the subscriber account number has been circled: Sample mailing label
This is your subscription account number
**************************3-DIGIT 001 SJ P1 FEB00 J009 C: 1 1234567-89 U 05/00 Q: 1 J. H. DOE, MD 531 MAIN ST CENTER CITY, NY 10001-001
Personal subscriptions to The Journal of Pediatrics Online are for individual use only and may not be transferred. Use of The Journal of Pediatrics Online is subject to agreement to the terms and conditions as indicated online.
452
THE JOURNAL OF PEDIATRICS MARCH 2001
(2.5 mg/kg daily) because intolerable dyskinesia developed. During 20 months of low-dose L-dopa treatment, the girl became more alert and developed more vocalization and facial motility and some voluntary movements (turning and lifting the head from supine). Afterwards, selegiline was added to the treatment (2.5 mg per day). During the following 17 months, voluntary movements improved (grasping, turning from supine to prone, rolling on the floor, speaking of first words). The oculogyric crises decreased in severity and frequency. L-dopa, however, could be increased to 70 mg (3.4 mg/kg daily) during the same time. Our experience seems to confirm that a combined treatment with low-dose L-dopa and selegiline is superior to treatment with L-dopa alone. L-dopa may not be well tolerated in patients with severe tyrosine hydroxylase deficiency when the treatment is started. It may still be a useful drug in
the long run when the dose is very slowly increased. Concerning treatment control, serial measurement of prolactin levels for 24 hours seems to be important.2 In our patient, during several single measurements, serum prolactin levels showed marked fluctuations that could not be attributed to changes in therapy. Serial measurements over 24 hours showed marked fluctuations during the day, which became less during the combined treatment with L-dopa and selegiline, but high nighttime prolactin levels persisted. Martin Häussler, MD Frühdiagnosezentrum Würzburg Center for Developmental Disorders and Disabilities D-97080 Würzburg Germany Georg F. Hoffmann, MD University Children’s Hospital Im Neuenheimer Feld 150
D-69120 Heidelberg Germany Ron A. Wevers, PhD UMC St Radboud Laboratory of Pediatrics and Neurology 6525 GC Nijmegen The Netherlands 9/35/110776 doi:10.1067/mpd.2001.110776
REFERENCES 1. Dionisi-Vici C, Hoffmann GF, Leuzzi V, Hoffken H, Bräutigam C, Rizzo C, et al. Tyrosine hydroxylase deficiency with severe clinical course: clinical and biochemical investigations and optimization of therapy. J Pediatr 2000; 136:560-2. 2. Birnbacher R, Scheibenreiter S, Blau N, Bieglmayer C, Frisch H, Waldhauser F. Hyperprolactinemia, a tool in treatment control of tetrahydrobiopterin deficiency: endocrine studies in an affected girl. Pediatr Res 1998; 43:427-77.
Access to The Journal of Pediatrics Online is reserved for print subscribers! Full-text access to The Journal of Pediatrics Online is available for all print subscribers. To activate your individual online subscription, please visit The Journal of Pediatrics Online, point your browser to http://www.mosby.com/jpeds, follow the prompts to activate online access here, and follow the instructions. To activate your account, you will need your subscriber account number, which you can find on your mailing label (note: the number of digits in your subscriber account number varies from 6 to 10). See the example below in which the subscriber account number has been circled: Sample mailing label
This is your subscription account number
**************************3-DIGIT 001 SJ P1 FEB00 J009 C: 1 1234567-89 U 05/00 Q: 1 J. H. DOE, MD 531 MAIN ST CENTER CITY, NY 10001-001
Personal subscriptions to The Journal of Pediatrics Online are for individual use only and may not be transferred. Use of The Journal of Pediatrics Online is subject to agreement to the terms and conditions as indicated online.
452