Evidence Table of Systematic Literature Search* According to SIGN Level
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027/018 – Glutarazidurie Typ I aktueller Stand: 06/2016 Evidence table of systematic literature search* according to SIGN Level Listed are published data since January 1st, 2011. For the time period from January 1st 1975 – December 31th 2010, please see the evidence table of systematic literature research generated for the 1st guideline revision in 2011 (page 36). Level 2++, 1++, 1+, 1-. None Level 2+. Evidence from well-conducted case-control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relationship is causal. First Title Study Design Patients (n) Clinical End Results / Conclusions Bias Confounding SIGN Author points (according to (according to Level GRADE) GRADE) Boy et al. A cross-sectional Cross sectional 30 patients Dystonia was BADS scores correlated with Effect of severe 2+ (2015) controlled study diagnosed by categorized using speed tests but not with tests dystonia might be Orphanet developmental study newborn screening the Barry-Albright- measuring stability or higher underestimated; J Rare Dis; of neuropsychological (n = 13), high-risk Dystonia Scale (BADS) cognitive functions 10:163 functions in patients screening (n = 3) or simple reaction time Developmental functions of False negative with glutaric aciduria targeted metabolic (SRT), continuous patients differed from findings are type I testing (n = 14) performance (CP), controls for SRT and VS but possible due to visual working not for VWM. Dystonic unequal sizes of n=13 dystonic memory patients were slower in SRT age groups patients, n=17 (VWM), visual-motor and CP but reached their asymptomatic coordination asymptote of performance patients (Tracking) and visual similar to asymptomatic search (VS). patients and controls in all tests. Asymptomatic patients *Die Evidenztabelle wurde von der Leitliniengruppe gemeinsam erarbeitet und in englischer Sprache erstellt. did not differ from controls. Data across all age groups of patients and controls fitted well to a model of negative exponential development. Conclusion Dystonia results in motor speed impairment, but not in higher cognitive functions. Asymptomatic patients did not differ from controls. Developmental functions were similar in patients and controls. Performance in tests with higher cognitive demand might be preserved in GA-I, even in patients with striatal degeneration. Boy et al. Low lysine diet in Patients 33 Dietary parameters: Diet: Imprecision 2+ (2013) J glutaric aciduria type I identified by (n=29 asymptomatic, Lysine intake, energy Lysine intake 101% (asym.) (low n in dystonic Inherit – effect newborn n=4, dystonic) intake, protein intake, and 103% (dyst.); natural group) Metab Dis: on anthropometric and screening were diagnosed via NBS Anthropometric protein (109 vs 121%), AAS 36:525– biochemical follow-up followed parameters: wheight, protein (108 vs 104%), energy 533 parameters prospectively length, head (106 vs 110%), according to during the first circumference; recommendations. Lysine six years of life, Biochemical intake increases after 6th year parameters of life; L-carnitine prospective supplementation was similar follow-up cohort P in both groups; study Anthropometry: asymptomatic patients showed normal wheight gain and tendency for lower length development. Dystonic patients showed poor wheight and length gain. Biochemistry: no group difference, age effect for MC//Hb, age-dependent changes for calcium, CK and ASAT. SD scores for albumin, 2 ferritin, phosphate and ALAT were normal; Plasma lysine in lower normal range in both groups and not differing, excretor status had no influence on plasma lysine carnitine status was normal in both groups Conclusion: Low lysine diet promotes normal anthropometric development in asymptomatic children up to age 6 year. Individualized recommendations for biochemical monitoring for asymptomatic patients. Garbade Unravelling the Retrospective 180 (n=130 Neuroradiological Neonatal diagnosis was made Selection bias no internal 2+ et al. complex MRI pattern cohort study on symptomatic, n=50 abnormalities, by extended NBS (n=21), high- (many different controls (2014) J in glutaric aciduria MRI patterns asymptomatic or Movement disorder risk family screening (n=18), centres) Inherit type I using statistical using minor neurological (MD), Morbidity score high-risk population screening Indirectness Metab Dis: models-a cohort study questionnaire- signs) (n=2), or due to macrocephaly (Übertragbarkeit) 37, 763- in 180 patients. based survey (n=9). Mean chronical age 773. 10.2 y. n=158 on low lysine diet and carnitine supplementation. MRI pattern and motor function: Patients with severe symptoms had more abnormalities in 5 regions: putamen, caudate, cortex, ventricles and external CSF spaces and more often demonstrated subdural hematoma or hygroma than patients without or with minor neurological symptoms. Abnormalities in globus pallidus were not clearly associated with a movement disorder. Putaminal changes and strongly dilated ventricles 3 predicted movement disorder. Putamen, caudate and pallidal changes remained stable. White matter abnormalities increased with time. Conclusion: complex statistical methods are useful to detect MRI patterns and are helpful to elucidate the clinical relevance Kölker et The phenotypic Prospective n=150 with GA1. Age at diagnosis, time Majority of UCD/OAD patients Patients with 2+ al. (2015a) spectrum of organic cohort study of to diagnosis after diagnosed clinically. Most severe phenotype J Inherit acidurias and urea OAD and UCD n=77 symptomatic, symptom onset; asymptomatic patients in NBS might be missed Metab Dis. cycle disorders. Part 1: patient n=73 asymptomatic problems during group (v.a. GA1 and IVA). due to lack of NBS 38:1155-6 the initial registered in pregnancy, postnatal Diagnosis: Median age at programs presentation. EIMD database problems, diagnosis for GA1=270 days. from 2011-2013. anthropometry, Delay from symptoms to metabolic parameters, diagnosis in 63 LO GA1 clinical parameters at patients 1day->1y. presentation Clinical presentation: GA1 patients at birth more macrocephalic than other OAD. Anthropometry at birth normal. n=51 with encephalopathic crisis (none neonatal). Median age at first symptoms=300 days. 12/74 LO patients showed epilepsy as initial clinical presentation; dystonia without preceding EC in 39 % of LO patients high frequency of insidious- onset type dystonia. Conclusion: initial clinical symptoms are variable. Fetal disease manifestation in GA1. Neonatal crisis in GA1 is rare. Asymptomatic patients mostly in NBS group. Majority of symptomatic patients 4 presents with EC. Epilepsy is a common clinical presentation. High frequency of insidious- onset type dystonia. Kölker et The phenotypic Prospective n=150 with GA1. Anthropometry; Anthropometry: GA1 often Patients with 2+ al. (2015b) spectrum of organic multi-centre clinical parameters presented with macrocephaly. severe phenotype J Inherit acidurias and urea cohort study of n=77 symptomatic, (neurological: Patients with a movement might be missed Metab Dis. cycle disorders. Part 2: OAD and UCD n=73 asymptomatic movement disorder, disorder showed tendency to due to lack of NBS 38: 1059- the evolving clinical patient urogenital, decreased SDS for body programs, 1074 phenotype registered in haematologic, length and significantly EIMD database endocrine, cardiac: decreased SDS for body Only descriptive, from 2011-2013. heart insufficiency, weight no evaluation of QTc time, Neurological signs more therapeutic gastrointestinal), movement disorder in OAD interventions mortality patients (especially GA1). Decreased joint mobility due to dystonia in n=32. Arterial hypertension n=5. Decreased strength 28%. Abnormal gross motor development 40% (fine 46%). Movement disorder 46%. Seizures 7%. EEG abnormalities 34%. Urogenital: moderate increase of chronic renal failure with age, similar in high and low excretors. No association with movement disorder. Other: No increased rate of heart problems Conclusions: intrauterine disease manifestation macrocephaly at birth. Neurologic symptoms are common. Unexpected chronic renal failure in GA1 emphasizes importance of a systematic clinical and biochemical follow-up. No differences in HE and LE. 5 Disease might progress after age 6y. Kölker et Complementary Prospective two- 34 patients Dietary parameters: All patients under guideline- General effect of 2+ al. (2012) dietary treatment armed multi- diagnosed by NBS arginine intake, recommend therapy. Milupa arginine Mol Gen using lysine-free, centre cohort from 2000-2011 LYS/ARG Ratio and SHS arginine contents supplementation Metab arginine-fortified study with (median age, 7.43 (Plasma), biochemical, vary in 1st year only. SHS is on clinical outcome 107, 72- amino acid comparison of years; cumulative anthropometrical; similar to GlutarAde Junior and endpoints is 80. supplements in glutaric two amino acid follow-up period, neurological (Strauss et al 2011). Dietary unknown aciduria type I - a supplements 221.6 patient years). parameters (gross and anthropometric decade of experience. (Milupa motor milestones, parameters of patients similar Metabolics vs Comparison to BADS) to n=12 reported by Strauss et Nutricia) Strauss et al 2011 al. 2011. (n=12) Group 1 (Milupa; n=8): dystonia 12.5%. Group 2 (Nutricia SHS; n=26): higher arginine intake and lower lysine-to-arginine ratio during 1st year. Dystonia 8%. Dietary intake in both groups: Daily arginine intake increased in both groups (137 mg/kg). Similar arginine