Metabolic Causes of Epilepsy

  • Laura Papetti
  • Francesco Nicita
  • Stella Maiolo
  • Vincenzo Leuzzi
  • Alberto SpaliceEmail author
Part of the Contemporary Clinical Neuroscience book series (CCNE)


Inborn errors of metabolism comprise a large class of genetic diseases involving disorders of metabolism. Presentation is usually in the neonatal period or infancy but can occur at any time, even in adulthood. Seizures are frequent symptom in inborn errors of metabolism, with no specific seizure types or EEG signatures. The diagnosis of a genetic defect or an inborn error of metabolism often results in requests for a vast array of biochemical and molecular tests leading to an expensive workup. However a specific diagnosis of metabolic disorders in epileptic patients may provide the possibility of specific treatments that can improve seizures. In a few metabolic diseases, epilepsy responds to specific treatments based on diet or supplementation of cofactors (vitamin-responsive epilepsies), but for most of them specific treatment is unfortunately not available, and conventional antiepileptic drugs must be used, often with no satisfactory success. In this review we present an overview of metabolic epilepsies based on various criteria such as treatability, age of onset, seizure type, and pathogenetic background.


Epilepsy Inborn errors of metabolism EEG Antepileptic drugs 


  1. Aicardi J (2007) Epilepsy syndromes. In: Engel J, Pedley TA, Aicardi J (eds) Epilepsy a comprehensive textbook, vol 1. Lippincott Williams & Wilkins, Philadelphia, pp 2608–2609Google Scholar
  2. Applegarth DA, Toone JR (2004) Glycine encephalopathy (nonketotic hyperglycinaemia): review and update. J Inherit Metab Dis 27:417–422PubMedCrossRefGoogle Scholar
  3. Bagci S, Zschocke J, Hoffmann GF, Bast T, Klepper J, Müller A et al (2008) Pyridoxal phosphate-dependent neonatal epileptic encephalopathy. Arch Dis Child Fetal Neonatal Ed 93:151–152CrossRefGoogle Scholar
  4. Bahi-Buisson N, Kaminska A, Nabbout R, Barnerias C, Desguerre I, De Lonlay P et al (2006) Epilepsy in Menkes disease: analysis of clinical stages. Epilepsia 47:380–386PubMedCrossRefGoogle Scholar
  5. Balasubramaniam S, Bowling F, Carpenter K, Earl J, Chaitow J, Pitt J et al (2010) Perinatal hypophosphatasia presenting as neonatal epileptic encephalopathy with abnormal neurotransmitter metabolism secondary to reduced co-factor pyridoxal-5′-phosphate availability. J Inherit Metab Dis.
  6. Barnerias C, Saudubray JM, Touati G et al (2010) Pyruvate dehydrogenase complex deficiency: four neurological phenotypes with differing pathogenesis. Dev Med Child Neurol 52:1–9CrossRefGoogle Scholar
  7. Baxter P (2003) Pyridoxine-dependent seizures: a clinical and biochemical conundrum. Biochim Biophys Acta 1647:36–41PubMedCrossRefGoogle Scholar
  8. Baxter P (2010) Recent insights into pre- and postnatal pyridoxal phosphate deficiency, a treatable metabolic encephalopathy. Dev Med Child Neurol 52:597–598PubMedCrossRefGoogle Scholar
  9. Bhardwaj P, Kaushal RK, Chandel A (2010) Biotinidase deficiency: a treatable cause of infantile seizures. J Pediatr Neurosci 5:82–83PubMedCentralPubMedCrossRefGoogle Scholar
  10. Blau N, van Spronsen FJ, Levy HL (2010) Phenylketonuria. Lancet 376:1417–1427PubMedCrossRefGoogle Scholar
  11. Braissant O (2010) Current concepts in the pathogenesis of urea cycle disorders. Mol Genet Metab 100:3–12CrossRefGoogle Scholar
  12. Brockmann K (2009) The expanding phenotype of GLUT1-deficiency syndrome. Brain Dev 31:545–552PubMedCrossRefGoogle Scholar
  13. Cerisola A, Campistol J, Pérez-Dueñas B, Poo P, Pineda M, García-Cazorla A et al (2009) Seizures versus dystonia in encephalopathic crisis of glutaric aciduria type I. Pediatr Neurol 40:426–431PubMedCrossRefGoogle Scholar
  14. Chemelli AP, Schocke M, Sperl W, Trieb T, Aichner F, Felber S (2000) Magnetic resonance spectroscopy (MRS) in five patients with treated propionic acidemia. J Magn Reson Imaging 11:596–600PubMedCrossRefGoogle Scholar
  15. Ciardo F, Salerno C, Curatolo P (2001) Neurologic aspects of adenylosuccinate lyase deficiency. J Child Neurol 16:301–308PubMedGoogle Scholar
  16. Clague A, Thomas A (2002) Neonatal biochemical screening for disease. Clin Chim Acta 315:99–110PubMedCrossRefGoogle Scholar
  17. Cree LM, Samuels DC, Chinnery PF (2009) The inheritance of pathogenic mitochondrial DNA mutations. Biochim Biophys Acta 1792:1097–1102PubMedCentralPubMedCrossRefGoogle Scholar
  18. de Koning TJ, Klomp LW (2004) Serine-deficiency syndromes. Curr Opin Neurol 17:197–204PubMedCrossRefGoogle Scholar
  19. Dinopoulos A, Matsubara Y, Kure S (2005) Atypical variants of nonketotic hyperglycinemia. Mol Genet Metab 86:61–69PubMedCrossRefGoogle Scholar
  20. Finsterer J (2006) Central nervous system manifestations of mitochondrial disorders. Acta Neurol Scand 114:217–238PubMedCrossRefGoogle Scholar
  21. Friedman JR, Thiele EA, Wang D, Levine KB, Cloherty EK, Pfeifer HH et al (2006) Atypical GLUT1 deficiency with prominent movement disorder responsive to ketogenic diet. Mov Disord 21:241–245PubMedCrossRefGoogle Scholar
  22. Friedman SD, Shaw DWW, Ishak G, Gropman AL, Saneto RP (2010) The use of neuroimaging in the diagnosis of mitochondrial disease. Dev disabil Res rev 16:129–135PubMedCrossRefGoogle Scholar
  23. Gallagher RC, Van Hove JL, Scharer G, Hyland K, Plecko B, Waters PJ et al (2009) Folinic acid-responsive seizures are identical to pyridoxine-dependent epilepsy. Ann Neurol 65:550–556PubMedCrossRefGoogle Scholar
  24. Gospe SM Jr (2010) Neonatal vitamin-responsive epileptic encephalopathies. Chang Gung Med J 33:1–12PubMedGoogle Scholar
  25. Gropman AL, Summar M, Leonard JV (2007) Neurological implications of urea cycle disorders. J Inherit Metab Dis 30:865–879PubMedCentralPubMedCrossRefGoogle Scholar
  26. Grünewald S, Imbach T, Huijben K, Rubio-Gozalbo ME, Verrips A, de Klerk JB et al (2000) Clinical and biochemical characteristics of congenital disorder of glycosylation type Ic, the first recognized endoplasmic reticulum defect in N-glycan synthesis. Ann Neurol 47:776–781PubMedCrossRefGoogle Scholar
  27. Haberlandt E, Canestrini C, Brunner-Krainz M, Möslinger D, Mussner K, Plecko B et al (2009) Epilepsy in patients with propionic acidemia. Neuropediatrics 40:120–125PubMedCrossRefGoogle Scholar
  28. Haeuptle MA, Hennet T (2009) Congenital disorders of glycosylation: an update on defects affecting the biosynthesis of dolichol-linked oligosaccharides. Hum Mutat 30:1628–1641PubMedCrossRefGoogle Scholar
  29. Hamosh A, Scharer G, Van Hove J (2009) Glycine encephalopathy. In: Pagon RA, Bird TD, Dolan CR, Stephens K, Adam MP (eds) GeneReviewse (Internet). University of Washington, Seattle, pp 1993–2002. (Bookshelf ID: NBK1357)Google Scholar
  30. Hoffmann GF, Schmitt B, Windfuhr M, Wagner N, Strehl H, Bagci S et al (2007) Pyridoxal 50-phosphate may be curative in earlyonset epileptic encephalopathy. J Inherit Metab Dis 30:96–99PubMedCrossRefGoogle Scholar
  31. Jaeken J (2002) Genetic disorders of gamma-aminobutyric acid, glycine, and serine as causes of epilepsy. J Child Neurol 17:84–87Google Scholar
  32. Joshi SN, Fathalla M, Koul R, Maney MA, Bayoumi R (2010) Biotin responsive seizures and encephalopathy due to biotinidase deficiency. Neurol India 58:323–324PubMedCrossRefGoogle Scholar
  33. Kang HC, Lee YM, Kim HD (2013) Mitochondrial disease and epilepsy. Brain Dev 35(8):757–761PubMedCrossRefGoogle Scholar
  34. Klepper J (2008) Glucose transporter deficiency syndrome (GLUT1DS) and the ketogenic diet. Epilepsia 49:46–49PubMedCrossRefGoogle Scholar
  35. Klepper J, Leiendecker B (2007) GLUT1 deficiency syndrome-2007 update. Dev Med Child Neurol 49:707–716PubMedCrossRefGoogle Scholar
  36. Klepper J, Engelbrecht V, Scheffer H, van der Knaap MS, Fiedler A (2007) GLUT1 deficiency with delayed myelination responding to ketogenic diet. Pediatr Neurol 37:130–133PubMedCrossRefGoogle Scholar
  37. Korein J, Sansaricq C, Kalmijn M, Honig J, Lange B (1994) Murple syrup urine disease: clinical, EEG and plasma aminoacid correlations with a theoretical mechanism of acute neurotoxicity. Int J Neurosci 79:21–45PubMedGoogle Scholar
  38. Kraoua I, Sedel F, Caillaud C, Froissart R, Stirnemann J, Chaurand G et al (2011) A French experience of type 3 Gaucher disease: phenotypic diversity and neurological outcome of 10 patients. Brain Dev 33(2):131–139PubMedCrossRefGoogle Scholar
  39. Kuo MF, Wang HS (2002) Pyridoxal phosphate-responsive epilepsy with resistance to pyridoxine. Pediatr Neurol 26:146–147PubMedCrossRefGoogle Scholar
  40. Leuzzi V (2002) Inborn errors of creatine metabolism and epilepsy: clinical features, diagnosis, and treatment. J Child Neurol 17(3):89–97Google Scholar
  41. Leuzzi V1, Mastrangelo M, Battini R, Cioni G (2013) Inborn errors of creatine metabolism and epilepsy. Epilepsia 54(2):217–227PubMedCrossRefGoogle Scholar
  42. Martynyuk AE, Ucar DA, Yang DD, Norman WM, Carney PR, Dennis DM et al (2007) Epilepsy in phenylketonuria: a complex dependence on serum phenylalanine levels. Epilepsia 48:1143–1150PubMedCrossRefGoogle Scholar
  43. Matern D, Lehnert W, Gibson KM, Korinthenberg R (1996) Seizures in a boy with succinic semialdehyde dehydrogenase deficiency treated with vigabatrin (gamma-vinyl-GABA). J Inherit Metab Dis 19:313–318PubMedCrossRefGoogle Scholar
  44. McClelland VM, Bakalinova DB, Hendriksz C, Singh RP (2009) Glutaric aciduria type 1 presenting with epilepsy. Dev Med Child Neurol 51:235–239PubMedCrossRefGoogle Scholar
  45. Mignot C, Doummar D, Maire I (2006) French type 2 Gaucher disease study group. Type 2 Gaucher disease: 15 new cases and review of the literature. Brain Dev 28(1):39–48PubMedCrossRefGoogle Scholar
  46. Mills PB, Surtees RAH, Champion MP, Beesley CE, Dalton N, Scambler PK et al (2005) Neonatal epileptic encephalopathy caused by mutations in the PNPO gene encoding pyridox (am)ine 5′-phosphate oxidase. Hum Mol Genet 14:1077–1086PubMedCrossRefGoogle Scholar
  47. Mills PB, Footitt EJ, Mills KA, Tuschl K, Aylett S, Varadkar S et al (2010) Genotypic and phenotypic spectrum of pyridoxine-dependent epilepsy (ALDH7A1 deficiency). Brain 133:2148–2159PubMedCentralPubMedCrossRefGoogle Scholar
  48. Milone M, Massie R (2010) Polymerase gamma 1 mutations: clinical correlations. Neurologist 16:84–91PubMedCrossRefGoogle Scholar
  49. Mole SE, Williams RE (2010) Neuronal Ceroid-Lipofuscinoses. In: Pagon RA, Bird TC, Dolan CR, Stephens K (eds) Gene reviews 2010. University of Washington, Seattle, pp 1993–2001Google Scholar
  50. Monaghan TS, Delanty N (2010) Lafora disease: epidemiology, pathophysiology and management. CNS Drugs 24:549–561PubMedCrossRefGoogle Scholar
  51. Montini G, Malaventura C, Salviati L (2008) Early coenzyme Q10 supplementation in primary coenzyme Q10 deficiency. N Engl J Med 358:2849–2850PubMedCrossRefGoogle Scholar
  52. Nabbout R, Dulac O (2008) Epileptic syndromes in infancy and childhood. Curr Opin Neurol 21:161–166PubMedCrossRefGoogle Scholar
  53. Nasrallah F, Feki M, Kaabachi N (2010) Creatine and creatine deficiency syndromes: biochemical and clinical aspects. Pediatr Neurol 42:163–171PubMedCrossRefGoogle Scholar
  54. Neumaier-Probst E, Harting I, Seitz A, Ding C, Kolker S (2004) Neuroradiological findings in glutaric aciduria type I (glutaryl-CoA dehydrogenase deficiency). J Inherit Metab Dis 27:869–876PubMedCrossRefGoogle Scholar
  55. Overweg-Plandsoen WC, Groener JE, Wang D, Onkenhout W, Brouwer OF, Bakker HD et al (2003) GLUT-1 deficiency without epilepsy—an exceptional case. J Inherit Metab Dis 26:559–563PubMedCrossRefGoogle Scholar
  56. Papetti L, Parisi P, Leuzzi V, Nardecchia F, Nicita F, Ursitti F, Marra F, Paolino MC, Spalice A (2013) Metabolic epilepsy: an update. Brain Dev 35(9):827–841PubMedCrossRefGoogle Scholar
  57. Pascual JM, Campistol J, Gil-Nagel A (2008) Epilepsy in inherited metabolic disorders. Neurologist 14:2–14CrossRefGoogle Scholar
  58. Pearl PL (2009) New treatment paradigms in neonatal metabolic epilepsies. J Inherit Metab Dis 32:204–213PubMedCrossRefGoogle Scholar
  59. Pearl PL, Gibson KM (2004) Clinical aspects of the disorders of GABA metabolism in children. Curr Opin Neurol 17:107–113PubMedCrossRefGoogle Scholar
  60. Pearl PL, Taylor JL, Trzcinski S, Sokohl A (2007) The pediatric neurotransmitter disorders. J Child Neurol 22:606–616PubMedCrossRefGoogle Scholar
  61. Pearl PL, Vezina LG, Saneto RP, McCarter R, Molloy-Wells E, Heffron A et al (2009) Cerebral MRI abnormalities associated with vigabatrin therapy. Epilepsia 50:184–94PubMedCrossRefGoogle Scholar
  62. Pigeon N, Campeau PM, Cyr D, Lemieux B, Clarke JT (2009) Clinical heterogeneity in ethylmalonic encephalopathy. J Child Neurol 24:991–296PubMedCrossRefGoogle Scholar
  63. Pindolia K, Jordan M, Wolf B (2010) Analysis of mutations causing biotinidase deficiency. Hum Mutat 31:983–991PubMedCrossRefGoogle Scholar
  64. Plecko B, Stöckler S (2009) Vitamin B6 dependent seizures. Can J Neurol Sci 36:73–77Google Scholar
  65. Rahman S, Clarke CF, Hirano M (2012) 176th ENMC International Workshop: diagnosis and treatment of coenzyme Q10 deficiency. Neuromuscul Disord 22:76–86PubMedCentralPubMedCrossRefGoogle Scholar
  66. Rahman S, Footitt EJ, Varadkar S, Clayton PT (2013) Inborn errors of metabolism causing epilepsy. Dev Med Child Neurol 55(1):23–36PubMedCrossRefGoogle Scholar
  67. Rossi S, Daniele I, Bastrenta P, Mastrangelo M, Lista G (2009) Early myoclonic encephalopathy and nonketotic hyperglycinemia. Pediatr Neurol 241:371–374CrossRefGoogle Scholar
  68. Rotstein M, Engelstad K, Yang H, Wang D, Levy B et al (2010) Glut1 deficiency: inheritance pattern determined by haploinsufficiency. Ann Neurol 68:955–8PubMedCentralPubMedCrossRefGoogle Scholar
  69. Scharer G, Brocker C, Vasiliou V, Creadon-Swindell G, Gallagher RC, Spector E et al (2010) The genotypic and phenotypic spectrum of pyridoxine-dependent epilepsy due to mutations in ALDH7A1. J Inherit Metab Dis 33:571–581PubMedCentralPubMedCrossRefGoogle Scholar
  70. Schneider SA, Paisan-Ruiz C, Garcia-Gorostiaga I, Quinn NP, Weber YG, Lerche H et al (2009) GLUT1 gene mutations cause sporadic paroxysmal exercise-induced dyskinesias. Mov Disord 24:1684–8PubMedCrossRefGoogle Scholar
  71. Sévin M, Lesca G, Baumann N, Millat G, Lyon-Caen O, Vanier MT et al (2007) The adult form of Niemann–Pick disease type C. Brain 130(Pt 1):120–133PubMedCrossRefGoogle Scholar
  72. Seashore MR (2009) The organic acidemias: an overview. In: Pagon RA, Bird TD, Dolan CR, Stephens K, Adam MP (eds) GeneReviewse (Internet). University of Washington, Seattle, pp 1993–2001. (Bookshelf ID: NBK1134)Google Scholar
  73. Seidner G, Alvarez MG, Yeh JI, O’Driscoll KR, Klepper J, Stump TS et al (1998) GLUT-1 deficiency syndrome caused by haploinsufficiency of the blood–brain barrier hexose carrier. Nat Genet 18:188–191PubMedCrossRefGoogle Scholar
  74. Singh S, Ganesh S (2009) Lafora progressive myoclonus epilepsy: a meta-analysis of reported mutations in the first decade following the discovery of the EPM2A and NHLRC1 genes. Hum Mutat 30:715–723PubMedCrossRefGoogle Scholar
  75. Sparks SE, Krasnewich DM (2011) Congenital disorders of glycosylation overview. In: Pagon RA, Bird TD, Dolan CR, Stephens K, Adam MP (eds) GeneReviewse (Internet). University of Washington, Seattle, pp 1993–2005. (Bookshelf ID: NBK1332)Google Scholar
  76. Spiegel EK, Colman RF, Patterson D (2006) Adenylosuccinate lyase deficiency. Mol Genet Metab 89:19–31PubMedCrossRefGoogle Scholar
  77. Steele PE, Tang PH, DeGrauw AJ, Miles MV (2004) Clinical laboratory monitoring of coenzyme Q10 use in neurologic and muscular diseases. Am J Clin Pathol 121:113–120Google Scholar
  78. Steinberg SJ, Raymond GV, Braverman NE, Moser AB (2003) Peroxisome biogenesis disorders, zellweger syndrome spectrum. In: Pagon RA, Bird TD, Dolan CR, Stephens K, Adam MP (eds) GeneReviewse (Internet). University of Washington, Seattle, pp 1993–2003. (Bookshelf ID:1448)Google Scholar
  79. Stephenson DJ, Bezman L, Raymond GV (2000) Acute presentation of childhood adrenoleukodystrophy. Neuropediatrics 31:293–297PubMedCrossRefGoogle Scholar
  80. Suls A, Dedeken P, Goffin K, Van Esch H, Dupont P, Cassiman D et al (2008) Paroxysmal exercise-induced dyskinesia and epilepsy is due to mutations in SLC2A1, encoding the glucose transporter GLUT1. Brain 131:1831–1844PubMedCentralPubMedCrossRefGoogle Scholar
  81. Summar ML (2005). Urea cycle disorders overview. In: Pagon RA, Bird TD, Dolan CR, Stephens K, Adam MP (eds) GeneReviewse (Internet). University of Washington, Seattle, pp 1993–2002. (Bookshelf ID: NBK1217)Google Scholar
  82. Suzuki Y, Yang X, Aoki Y, Kure S, Matsubara Y (2005) Mutations in the holocarboxylase synthetase gene HLCS. Hum Mutat 26:285–290PubMedCrossRefGoogle Scholar
  83. Tabatabaie L, Klomp LW, Berger R, de Koning TJ (2010) L-serine synthesis in the central nervous system: a review on serine deficiency disorders. Mol Genet Metab 99:256–262PubMedCrossRefGoogle Scholar
  84. Takahashi Y, Suzuki Y, Kumazaki K, Tanabe Y, Akaboshi S, Miura K et al (1997) Epilepsy in peroxisomal diseases. Epilepsia 38(2):182–8PubMedCrossRefGoogle Scholar
  85. Thoene J, Wolf B (1983) Biotinidase deficiency in juvenile multiple carboxylase deficiency. Lancet 2:398PubMedCrossRefGoogle Scholar
  86. Tiranti V, Viscomi C, Hildebrandt T, Di Meo I, Mineri R, Tiveron C et al (2009) Loss of ETHE1, a mitochondrial dioxygenase, causes fatal sulfide toxicity in ethylmalonic encephalopathy. Nat Med 15:200–205PubMedCrossRefGoogle Scholar
  87. Tümer Z, Møller LB (2010) Menkes disease. Eur J Hum Genet 18:511–518PubMedCentralPubMedCrossRefGoogle Scholar
  88. Tylki-Szymańska A, Vellodi A, El-Beshlawy A, Cole JA, Kolodny E (2010) Neuronopathic Gaucher disease: demographic and clinical features of 131 patients enrolled in the International Collaborative Gaucher Group Neurological Outcomes Subregistry. J Inherit Metab Dis 33(4):339–346PubMedCrossRefGoogle Scholar
  89. Van Gosen L (2008) Organic acidemias: a methylmalonic and propionic focus. J Pediatr Nurs 23:225–233PubMedCrossRefGoogle Scholar
  90. Vannucci SJ, Maher F, Simpson IA (1997) Glucose transporter proteins in brain: delivery of glucose to neurons and glia. Glia 21:2–21PubMedCrossRefGoogle Scholar
  91. Verhoeven NM, Salomons GS, Jakobs C (2005) Laboratory diagnosis of defects of creatine biosynthesis and transport. Clin Chim Acta 361:1–9PubMedCrossRefGoogle Scholar
  92. Wang IJ, Chu SY, Wang CY, Wang PJ, Hwu WL (2003) Maple syrup urine disease presenting with neonatal status epilepticus: report of one case. Acta Paediatr Taiwan 44:246–248PubMedGoogle Scholar
  93. Wang D, Pascual JM, De Vivo D (2009) Glucose transporter type 1 deficiency syndrome. In: Pagon RA, Bird TD, Dolan CR, Stephens K, Adam MP (eds) GeneReviewse (Internet). University of Washington, Seattle, pp 1993–2002. (Bookshelf ID: NBK1430)Google Scholar
  94. Wolf B (2011a) Biotinidase deficiency. In: Pagon RA, Bird TC, Dolan CR, Stephens K (eds) Gene reviews 2011. University of Washington, Seattle, pp 1993–2000Google Scholar
  95. Wolf B (2011b) The neurology of biotinidase deficiency. Mol Genet Metab 104:27–34PubMedCrossRefGoogle Scholar
  96. Wolf NI, Bast T, Surtees R (2005) Epilepsy in inborn errors of metabolism. Epileptic Disord 7:67–81PubMedGoogle Scholar
  97. Wolf NI, García-Cazorla A, Hoffmann GF (2009a) Epilepsy and inborn errors of metabolism in children. J Inherit Metab Dis 32:609–617CrossRefGoogle Scholar
  98. Wolf NI, Rahman S, Schmitt B, Taanman JW, Duncan AJ, Harting I et al (2009b) Status epilepticus in children with Alpers disease caused by POLG1 mutations: EEG and MRI features. Epilepsia 50:1596–1607CrossRefGoogle Scholar
  99. Zempleni J, Hassan YI, Wijeratne SS (2008) Biotin and biotinidase deficiency. Expert Rev Endocrinol Metab 3:715–724PubMedCentralPubMedCrossRefGoogle Scholar
  100. Zhongshu Z, Weiming Y, Yukio F, Cheng-LNing Z, Zhixing W (2001) Clinical analysis of West syndrome associated with phenylketonuria. Brain Dev 23:552–557PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Laura Papetti
    • 1
  • Francesco Nicita
    • 1
  • Stella Maiolo
    • 1
  • Vincenzo Leuzzi
    • 1
  • Alberto Spalice
    • 1
    Email author
  1. 1.Department of Pediatrics and Child Neurology and Psychiatry, Division of Child NeurologySapienza University of RomeRomeItaly

Personalised recommendations