Skip to main content
Log in

Movement disorders and inborn errors of metabolism in adults: A diagnostic approach

  • Review
  • Published:
Journal of Inherited Metabolic Disease

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Summary

Inborn errors of metabolism (IEMs) may present in adolescence or adulthood with various movement disorders including parkinsonism, dystonia, chorea, tics or myoclonus. Main diseases causing movement disorders are metal-storage diseases, neurotransmitter synthesis defects, energy metabolism disorders and lysosomal storage diseases. IEMs should not be missed as many are treatable. Here we briefly review IEMs causing movement disorders in adolescence and adults and propose a simple diagnostic approach to guide metabolic investigations based on the clinical course of symptoms, the type of abnormal movements, and brain MRI abnormalities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Ala A, Walker AP, Ashkan K, Dooley JS, Schilsky ML (2007) Wilson’s disease. Lancet 369: 397–408.

    Article  CAS  PubMed  Google Scholar 

  • Baloh RH, Salavaggione E, Milbrandt J, Pestronk A (2007) Familial parkinsonism and ophthalmoplegia from a mutation in the mitochondrial DNA helicase twinkle. Arch Neurol 64: 998–1000.

    Article  PubMed  Google Scholar 

  • Benoist JF, Roze E, Sedel F (2007) Contribution of CSF analysis to the diagnosis of inborn errors of metabolism in adult patients. Rev Neurol (Paris) 163: 950–959.

    CAS  Google Scholar 

  • Berardelli A, Thompson PD, Zaccagnini M, et al (1991) Two sisters with generalized dystonia associated with homocystinuria. Mov Disord 6: 163–165.

    Article  CAS  PubMed  Google Scholar 

  • Berg D, Hoggenmüller U, Hofmann E, Fischer R, Kraus M, Scheurlen M, Becker G (2000) The basal ganglia in haemochromatosis. Neuroradiology 42: 9–13.

    Article  CAS  PubMed  Google Scholar 

  • Berkovic SF, Carpenter S, Andermann F, Andermann E, Wolfe LS (1988) Kufs’ disease: a critical reappraisal. Brain 111: 27–62.

    Article  PubMed  Google Scholar 

  • Berkovic SF, Carpenter S, Evans A, et al (1989) Myoclonus epilepsy and ragged-red fibres (MERRF). 1. A clinical, pathological, biochemical, magnetic resonance spectrographic and positron emission tomographic study. Brain 112: 1231–1260.

    Article  PubMed  Google Scholar 

  • Bressman S, Fahn S, Eisenberg M, Brin M, Maltese W (1986) Biotin-responsive encephalopathy with myoclonus, ataxia, and seizures. Adv Neurol 43: 119–125.

    CAS  PubMed  Google Scholar 

  • Brockmann K, Wang D, Korenke CG, et al (2001) Autosomal dominant glut-1 deficiency syndrome and familial epilepsy. Ann Neurol 50: 476–485.

    Article  CAS  PubMed  Google Scholar 

  • Caer M, Viala K, Levy R, et al (2005) Adult-onset chorea and mitochondrial cytopathy. Mov Disord 20: 490–492.

    Article  PubMed  Google Scholar 

  • Chinnery PF, Crompton DE, Birchall D, et al (2007) Clinical features and natural history of neuroferritinopathy caused by the FTL1 460InsA mutation. Brain 130: 110–119.

    Article  PubMed  Google Scholar 

  • Clarke CE, Alger S, Preece MA, et al (2004) Tremor and deep white matter changes in alpha-methylacyl-CoA racemase deficiency. Neurology 63: 188–189.

    CAS  PubMed  Google Scholar 

  • Costello DJ, Walsh SL, Harrington HJ, Walsh CH (2004) Concurrent hereditary haemochromatosis and idiopathic Parkinson’s disease: a case report series. J Neurol Neurosurg Psychiatry 75: 631–633.

    Article  CAS  PubMed  Google Scholar 

  • Das SK, Ray K (2006) Wilson’s disease: an update. Nat Clin Pract Neurol 2: 482–493.

    Article  PubMed  CAS  Google Scholar 

  • Demarquay G, Setiey A, Morel Y, Trepo C, Chazot G, Broussolle E (2000) Clinical report of three patients with hereditary hemochromatosis and movement disorders. Mov Disord 15: 1204–1209.

    Article  CAS  PubMed  Google Scholar 

  • De Vries DD, Went LN, Bruyn GW, et al (1996) Genetic and biochemical impairment of mitochondrial complex I activity in a family with Leber hereditary optic neuropathy and hereditary spastic dystonia. Am J Hum Genet 58: 703–711.

    PubMed  Google Scholar 

  • Dotti MT, Federico A, Garuti R, Calandra S (2000) Cerebrotendinous xanthomatosis with predominant parkinsonian syndrome: further confirmation of the clinical heterogeneity. Mov Disord 15: 1017–1019.

    Article  CAS  PubMed  Google Scholar 

  • Ekinci B, Apaydin H, Vural M, Ozekmekçi S (2004) Two siblings with homocystinuria presenting with dystonia and parkinsonism. Mov Disord 19: 962–964.

    Article  PubMed  Google Scholar 

  • Evans AH, Costa DC, Gacinovic S, et al (2004) Late pyramidal motor and cognitive decline in adults may occur in some adults who have relaxed their diet. Mov Disord 19: 1232–1236.

    Article  PubMed  Google Scholar 

  • Ewenczyk C, Leroux A, Roubergue A, et al (2008) Recessive hereditary methemoglobinemia, type II: delineation of the clinical spectrum. Brain 131: 760–761.

    Article  CAS  PubMed  Google Scholar 

  • Federico A, Battistini S, Ciacci G, et al (1991) Cherry-red spot myoclonus syndrome (type I sialidosis). Dev Neurosci 13: 320–326.

    Article  CAS  PubMed  Google Scholar 

  • Ferdinandusse S, Kostopoulos P, Denis S, et al (2006) Mutations in the gene encoding peroxisomal sterol carrier protein X (SCPx) cause leukencephalopathy with dystonia and motor neuropathy. Am J Hum Genet 78: 1046–1052.

    Article  CAS  PubMed  Google Scholar 

  • Finsterer J (2002) Parkinson syndrome as a manifestation of mitochondriopathy. Acta Neurol Scand 105: 384–389.

    Article  CAS  PubMed  Google Scholar 

  • Fiori L, Blau N, Zenga A, Giovannini M (2004) Diagnosis of severe PTPS deficiency in a 28-year-old lawyer with normal IQ. J Inherit Metab Dis 27(Supplement 1): 35.

    Google Scholar 

  • Friedman J, Hyland K, Blau N, Maccollin M (2006) l-dopa-responsive hypersmonia and mixed movement disorder due to sepiapterin reductase deficiency. Neurology 67: 2032–2035.

    Article  PubMed  Google Scholar 

  • Grisoli M, Piperno A, Chiapparini L, Mariani R, Savoiardo M (2005) MR imaging of cerebral cortical involvement in aceruloplasminemia. Am J Neuroradiol 26: 657–661.

    PubMed  Google Scholar 

  • Guimaraes J, Amaral O, Sa Miranda MC (2003) Adult-onset neuronopathic form of Gaucher’s disease: a case report. Parkinsonism Relat Disord 9: 261–264.

    CAS  PubMed  Google Scholar 

  • Haemers I, Kono S, Goldman S, Gitlin JD, Pandolfo M (2004) Clinical, molecular, and PET study of a case of aceruloplasminaemia presenting with focal cranial dyskinesia. J Neurol Neurosurg Psychiatry 75: 334–337.

    Article  CAS  PubMed  Google Scholar 

  • Hall DA, Ringel SP (2004) Adult nonketotic hyperglycinemia (NKH) crisis presenting as severe chorea and encephalopathy. Mov Disord 19: 485–486.

    Article  PubMed  Google Scholar 

  • Hanna MG, Bhatia KP (1997) Movement disorders and mitochondrial dysfunction. Curr Opin Neurol 10: 351–356.

    Article  CAS  PubMed  Google Scholar 

  • Hansen FJ, Blau N (2005) Cerebral folate deficiency: life-changing supplementation with folinic acid. Mol Genet Metab 84: 371–373.

    Article  CAS  PubMed  Google Scholar 

  • Hayflick SJ, Westaway SK, Levinson B, et al (2003) Genetic, clinical, and radiographic delineation of Hallervorden–Spatz syndrome. N Engl J Med 348: 33–40.

    Article  CAS  PubMed  Google Scholar 

  • Horvath R, Kley RA, Lochmüller H, Vorgerd M (2007) Parkinson syndrome, neuropathy, and myopathy caused by the mutation A8344G (MERRF) in tRNALys. Neurology 68: 56–58.

    Article  PubMed  Google Scholar 

  • Janavs JL, Aminoff MJ (1998) Dystonia and chorea in acquired systemic disorders. J Neurol Neurosurg Psychiatry 65: 436–445.

    CAS  PubMed  Google Scholar 

  • Jinnah HA, Visser JE, Harris JC, et al (2006) Delineation of the motor disorder of Lesch-Nyhan disease. Brain 129: 1201–1217.

    Article  CAS  PubMed  Google Scholar 

  • Jun AS, Brown MD, Wallace DC (1994) A mitochondrial DNA mutation at nucleotide pair 14459 of the NADH dehydrogenase subunit 6 gene associated with maternally inherited Leber hereditary optic neuropathy and dystonia. Proc Natl Acad Sci U S A 91: 6206–6210.

    Article  CAS  PubMed  Google Scholar 

  • Kipps CM, Fung VS, Grattan-Smith P, de Moore GM, Morris JG (2005) Movement disorder emergencies. Mov Disord 20: 322–334.

    Article  PubMed  Google Scholar 

  • Krim E, Vital A, Macia F, Yekhlef F, Tison F (2005) Atypical parkinsonism combining alpha-synuclein inclusions and polyglucosan body disease. Mov Disord 20: 200–204.

    Article  PubMed  Google Scholar 

  • Kulkens S, Harting I, Sauer S, et al (2005) Late-onset neurologic disease in glutaryl-CoA dehydrogenase deficiency. Neurology 64: 2142–2144.

    Article  CAS  PubMed  Google Scholar 

  • Kumagai R, Ichikawa K, Yasui T, Kageyama Y, Miyabayashi S (1999) Adult leigh syndrome: treatment with intravenous soybean oil for acute central respiratory failure. Eur J Neurol 6: 613–615.

    Article  CAS  PubMed  Google Scholar 

  • Lera G, Bhatia K, Marsden CD (1994) Dystonia as the major manifestation of Leigh’s syndrome. Mov Disord 9: 642–649.

    Article  CAS  PubMed  Google Scholar 

  • Luoma P, Melberg A, Rinne JO (2004) Parkinsonism, premature menopause, and mitochondrial DNA polymerase gamma mutations: clinical and molecular genetic study. Lancet 364: 875–882.

    Article  CAS  PubMed  Google Scholar 

  • Madsen E, Gitlin JD (2007) Copper and iron disorders of the brain. Annu Rev Neurosci 30: 317–337.

    Article  CAS  PubMed  Google Scholar 

  • Marie SK, Carvalho AA, Fonseca LF, Carvalho MS, Reed UC, Scaff M (1999) Kearns–Sayre syndrome ‘plus’. Classical clinical findings and dystonia. Arq Neuropsiquiatr 57: 1017–1023.

    CAS  PubMed  Google Scholar 

  • McFarland R, Chinnery PF, Blakely EL, et al (2007) Homoplasmy, heteroplasmy, and mitochondrial dystonia. Neurology 69: 911–916.

    Article  CAS  PubMed  Google Scholar 

  • Mellick G, Price L, Boyle R (2004) Late-onset presentation of pyruvate dehydrogenase deficiency. Mov Disord 19: 727–729.

    Article  PubMed  Google Scholar 

  • Morimoto N, Nagano I, Deguchi K, et al (2004) Leber hereditary optic neuropathy with chorea and dementia resembling Huntington disease. Neurology 63: 2451–2452.

    CAS  PubMed  Google Scholar 

  • Muthane U, Chickabasaviah Y, Kaneski C, et al (2004) Clinical features of adult GM1 gangliosidosis: report of three Indian patients and review of 40 cases. Mov Disord 19: 1334–1341.

    Article  PubMed  Google Scholar 

  • Navon R (1991) Molecular and clinical heterogeneity of adult GM2 gangliosidosis. Dev Neurosci 13: 295–298.

    Article  CAS  PubMed  Google Scholar 

  • Nelson I, Hanna MG, Alsanjari N, Scaravilli F, Morgan-Hughes JA, Harding AE (1995) A new mitochondrial DNA mutation associated with progressive dementia and chorea: a clinical, pathological, and molecular genetic study. Ann Neurol 37: 400–403.

    Article  CAS  PubMed  Google Scholar 

  • Neudorfer O, Pastores GM, Zeng BJ, Gianutsos J, Zaroff CM, Kolodny EH (2005) Late-onset Tay–Sachs disease: phenotypic characterization and genotypic correlations in 21 affected patients. Genet Med 7: 119–123.

    Article  CAS  PubMed  Google Scholar 

  • Ozand PT, Gascon GG, Al Essa M, et al (1998) Biotin-responsive basal ganglia disease: a novel entity. Brain 121: 1267–1279.

    Article  PubMed  Google Scholar 

  • Pogson D (1997) Issues for consideration in dihydropteridine reductase (DHPR) deficiency: a variant form of hyperphenylalaninaemia. J Intellect Disabil Res 41: 208–214.

    Article  PubMed  Google Scholar 

  • Puig JG, Torres RJ, Mateos F, et al (2001) The spectrum of hypoxanthine-guanine phosphoribosyltransferase (HPRT) deficiency. Clinical experience based on 22 patients from 18 Spanish families. Medicine 80: 102–112.

    Article  CAS  PubMed  Google Scholar 

  • Ramaekers VT, Rothenberg SP, Sequeira JM, et al (2005) Autoantibodies to folate receptors in the cerebral folate deficiency syndrome. N Engl J Med 352: 1985–1991.

    Article  CAS  PubMed  Google Scholar 

  • Roze E, Paschke E, Lopez N, et al (2005) Dystonia and parkinsonism in GM1 type 3 gangliosidosis. Mov Disord 20: 1366–1369.

    Article  PubMed  Google Scholar 

  • Schiller A, Wevers Ra, Steenbergen GC, Blau N, Jung HH (2004) Long-term course of l-dopa-responsive dystonia caused by tyrosine hydroxylase deficiency. Neurology 63: 1524–1526.

    CAS  PubMed  Google Scholar 

  • Sedel F, Ribeiro M, Rémy P, Saudubray JM, Agid Y (2006a) Dihydropteridine reductase deficiency: levodopa’s long-term effectiveness without dyskinesia. Neurology 67: 2243–2245.

    Article  CAS  PubMed  Google Scholar 

  • Sedel F, Friderici K, Nummy K, et al (2006b) Atypical Gilles de la Tourette syndrome with beta-mannosidase deficiency. Arch Neurol 63: 129–131.

    Article  PubMed  Google Scholar 

  • Sedel F, Lyon-Caen O, Saudubray JM (2007) Inborn errors of metabolism in adult neurology—a clinical approach focused on treatable diseases. Nat Clin Pract Neurol 3: 279–290.

    Article  CAS  PubMed  Google Scholar 

  • Segawa M, Nomura Y, Nishiyama N (2003) Autosomal dominant guanosine triphosphate cyclohydrolase I deficiency (Segawa disease). Ann Neurol 54(Supplement 6): S32–45.

    Article  CAS  PubMed  Google Scholar 

  • Sethi KD, Ray R, Roesel RA, et al (1989) Adult-onset chorea and dementia with propionic acidemia. Neurology 39: 1343–1345.

    CAS  PubMed  Google Scholar 

  • Sevin M, Lesca G, Baumann N, et al (2007) The adult form of Niemann–Pick disease type C. Brain 130: 120–133.

    Article  PubMed  Google Scholar 

  • Shoffner JM, Brown MD, Stugard C, et al (1995) Leber’s hereditary optic neuropathy plus dystonia is caused by a mitochondrial DNA point mutation. Ann Neurol 38: 163–169.

    Article  CAS  PubMed  Google Scholar 

  • Simon DK, Pulst SM, Sutton JP, Browne SE, Beal MF, Johns DR (1999) Familial multisystem degeneration with parkinsonism associated with the 11778 mitochondrial DNA mutation. Neurology 53: 1787–1793.

    CAS  PubMed  Google Scholar 

  • Steiner RD, Sweetser DA, Rohrbaugh JR, Dowton SB, Toone JR, Applegarth (1996) Nonketotic hyperglycinemia: atypical clinical and biochemical manifestations. J Pediatr 128: 243–246.

    Article  CAS  PubMed  Google Scholar 

  • Sudarsky L, Plotkin GM, Logigian EL, Johns DR (1999) Dystonia as a presenting feature of the 3243 mitochondrial DNA mutation. Mov Disord 14: 488–491.

    Article  CAS  PubMed  Google Scholar 

  • Tanaka K, Yoneda M, Nakajima T, Miyatake T, Owada M (1987) Dihydrobiopterin synthesis defect: an adult with diurnal fluctuation of symptoms. Neurology 37: 519–522.

    CAS  PubMed  Google Scholar 

  • Tayebi N, Walker J, Stubblefield B, et al (2003) Gaucher disease with parkinsonian manifestations: does glucocerebrosidase deficiency contribute to a vulnerability to parkinsonism? Mol Genet Metab 79: 104–109.

    Article  CAS  PubMed  Google Scholar 

  • Thyagarajan D, Bressman S, Bruno C, et al (2000) A novel mitochondrial 12SrRNA point mutation in parkinsonism, deafness, and neuropathy. Ann Neurol 48: 730–736.

    Article  CAS  PubMed  Google Scholar 

  • Trivedi JR, Wolfe GI, Nations SP, Burns DK, Bryan WW, Dewey RB Jr (2003) Adult polyglucosan body disease associated with lewy bodies and tremor. Arch Neurol 60: 764–766.

    Article  PubMed  Google Scholar 

  • Truong DD, Harding AE, Scaravilli F, Smith SJ, Morgan-Hughes JA, Marsden CD (1990) Movement disorders in mitochondrial myopathies. A study of nine cases with two autopsy studies. Mov Disord 5: 109–117.

    Article  CAS  PubMed  Google Scholar 

  • Tuschl K, Mills PB, Parsons H, et al (2008) Hepatic cirrhosis, dystonia, polycythaemia and hypermanganesaemia - A new metabolic disorder. J Inherit Metab Dis 31(2): 151–163.

    Google Scholar 

  • Van Maldergem L, Trijbels F, DiMauro S, et al (2002) Coenzyme Q-responsive Leigh’s encephalopathy in two sisters. Ann Neurol 52: 750–754.

    Article  PubMed  CAS  Google Scholar 

  • Verrips A, Hoefsloot LH, Steenbergen GC, et al (2000) Clinical and molecular genetic characteristics of patients with cerebrotendinous xanthomatosis. Brain 123: 908–919.

    Article  PubMed  Google Scholar 

  • Wakamatsu N, Hayashi M, Kawai H, et al (1999) Matsumoto mutations producing premature termination of translation and an amino acid substitution in the sterol 27-hydroxylase gene cause cerebrotendinous xanthomatosis associated with parkinsonism. J Neurol Neurosurg Psychiatry 67: 195–198.

    Article  CAS  PubMed  Google Scholar 

  • Winkelman MD, Banker BQ, Victor M, Moser HW (1983) Non-infantile neuronopathic Gaucher’s disease: a clinicopathologic study. Neurology 33: 994–1008.

    CAS  PubMed  Google Scholar 

  • Wong K, Sidransky E, Verma A, et al (2004) Neuropathology provides clues to the pathophysiology of Gaucher disease. Mol Genet Metab 82: 192–207.

    Article  CAS  PubMed  Google Scholar 

  • Yoshida K, Oshima A, Sakuraba H, et al (1992) GM1 gangliosidosis in adults: clinical and molecular analysis of 16 Japanese patients. Ann Neurol 31: 328–332.

    Article  CAS  PubMed  Google Scholar 

  • Zeng WQ, Al-Yamani E, Acierno JS Jr, et al (2005) Biotin-responsive basal ganglia disease maps to 2q36.3 and is due to mutations in SLC19A3. Am J Hum Genet 77: 16–26.

    Article  CAS  PubMed  Google Scholar 

  • Ziemssen F, Sindern E, Schroder JM, et al (2000) Novel missense mutations in the glycogen-branching enzyme gene in adult polyglucosan body disease. Ann Neurol 47: 536–540.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to F. Sedel.

Additional information

Communicating editor: Georg Hoffmann

Competing interests: None declared

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sedel, F., Saudubray, JM., Roze, E. et al. Movement disorders and inborn errors of metabolism in adults: A diagnostic approach. J Inherit Metab Dis 31, 308–318 (2008). https://doi.org/10.1007/s10545-008-0854-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10545-008-0854-5

Keywords

Navigation