Nonketotic hyperglycinemia: Clinical range and outcome of a rare neurometabolic disease in a single-center

Brain Dev. 2018 Nov;40(10):865-875. doi: 10.1016/j.braindev.2018.06.007. Epub 2018 Jun 19.


Background: Nonketotic hyperglycinemia (NKH) is an autosomal recessive severe life-threatening catostrophic metabolic disorder.

Materials and methods: The present study was conducted in a tertiary reference center in Turkey for six years period. The accurate diagnosis of six NKH patients was based on clinical history of the patients, neurological examinations, seizure semiology, serial electroencephalography (EEG) recordings, neuroimaging findings, metabolic tests and genetic analysis.

Results: The common clinical findings were hypotonia with severe head lag, poor feeding, poor sucking, and intractable seizures. The starting age of the symptoms was between birth and 45 days of age (median: 8 days). The starting age of the seizures was between 30 min of age and 45 days of age (median: 18 days). The age of accurate diagnosis was between 1 month of age and 5.5 months of age (mean: 3.75 ± 1.69 months). The cerebrospinal fluid (CSF) to plasma GLY ratio of the patients was between 0.031 and 0.21 (median: 0.16). The EEG patterns of the patients were suppression-burst, hypsarrhythmia, multifocal epileptic activity, and right centro-occipital epileptic activity on admission. The neuroimaging findings were diffuse hypomyelination, corpus callosum (CC) hypoplasia, CC agenesis and brainstem hypoplasia on the magnetic resonance imaging and glycine peak was evidenced on magnetic resonance spectroscopy. Four of the patients were mutation-positive.

Conclusions: If a child is encephalopathic and/or hypotonic with severe head lag, early evaluation of the EEG records should be made even without a history of clinical seizures. The disease has a heterogenous course and the clinical outcome depends on the mutation type.

Keywords: Glycine encephalopathy; Hiccups; Intractable seizures; Mutation type; Nonketotic hyperglycinemia; Outcome; Severe hypotonia.

MeSH terms

  • Age of Onset
  • Electroencephalography
  • Female
  • Humans
  • Hyperglycinemia, Nonketotic / complications
  • Hyperglycinemia, Nonketotic / diagnosis*
  • Hyperglycinemia, Nonketotic / pathology
  • Hyperglycinemia, Nonketotic / physiopathology
  • Infant
  • Infant, Newborn
  • Magnetic Resonance Imaging
  • Male
  • Muscle Hypotonia / diagnosis*
  • Muscle Hypotonia / etiology
  • Mutation
  • Seizures / diagnosis*
  • Seizures / etiology
  • Seizures / pathology
  • Seizures / physiopathology
  • Turkey