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Cerebrotendinous Xanthomatosis Presenting with Severe Externalized Disorder: Improvement After One Year of Treatment with Chenodeoxycholic Acid

Published online by Cambridge University Press:  07 November 2014

Abstract

Cerebrotendinous xanthomatosis (CTX) is a rare inborn disorder of sterol storage with autosomal recessive inheritance and a variable clinical presentation. We describe two siblings with an early psychiatric presentation of CTX-associated attention-deficit/hyperactivity disorder and oppositional defiant disorder, also associated with a mild intellectual disability and major behavioral impairments. In both cases, treatment with chenodeoxycholic acid improved externalized symptoms and a partial recovery of cognitive impairments was observed. This suggests that CTX is potentially reversible, demonstrating the need for early diagnosis and treatment of this disorder before irreversible neurological lesions can occur.

Type
Case Report
Copyright
Copyright © Cambridge University Press 2010

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References

REFERENCES

1. Moghadasian, MH, Salen, G, Frohlich, JJ, Scudamore, CH. Cerebrotendinous xanthomatosis: a rare disease with diverse manifestations. Arch Neurol. 2002; 59: 527529.CrossRefGoogle ScholarPubMed
2. Gallus, GN, Dotti, MT, Federico, A. Clinical and molecular diagnosis of cerebrotendinous xanthomatosis with a review of the mutations in the CYP27A1 gene. Neurol Sci. 2006; 27: 143149.CrossRefGoogle Scholar
3. Berginer, VM, Foster, NL, Sadowsky, M, Townsend, JA 3rd, Siegel, GJ, Salen, G. Psychiatric disorders in patients with cerebrotendinous xanthomatosis. Am J Psychiatry. 1988; 145: 354357.Google ScholarPubMed
4. Estrov, Y, Scaglia, F, Bodamer, OA. Psychiatric symptoms of inherited metabolic disease. J Inherit Metab Dis. 2000; 23: 26.CrossRefGoogle ScholarPubMed
5. Barkhof, F, Verrips, A, Wesseling, P et al. , Cerebrotendinous xanthomatosis: the spectrum of imaging findings and the correlation with neuropathologic findings. Radiology. 2000; 217: 869876.CrossRefGoogle ScholarPubMed
6. Shaffer, D, Fisher, P, Lucas, CP, Dulcan, MK, Schwab-Stone, ME. NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. J Am Acad Child Adolesc Psychiatry. 2000; 39: 2838.CrossRefGoogle ScholarPubMed
7. Biederman, J, Monuteaux, MC, Kendrick, E, Klein, KL, Faraone, SV. The CBCL as a screen for psychiatric comorbidity in paediatric patients with ADHD. Arch Dis Child. 2005; 90: 10101015.CrossRefGoogle Scholar
8. Buss, AH, Durkee, A. An inventory for assessing different kinds of hostility. J Consult Psychol. 1957; 21: 343349.CrossRefGoogle ScholarPubMed
9. Aman, MG, Tassé, MJ, Rojahn, J, Hammer, D. The Nisonger CBRF: a child behavior rating form for children with developmental disabilities. Res Dev Disabil. 1996; 17: 4157.CrossRefGoogle ScholarPubMed
10. Conners, CK. Conners' Rating Scales-Revised Technical Manual. Cheektowaga, NY: Multi-Health Systems; 1997.Google Scholar
11. Wechsler, D. Wechsler Adult Intelligence Scale-Third Edition (WAIS III). New York, NY: Pearson; 1991.Google Scholar
12. Conners, CK and Staff, MSH. Conners Continuous Performance Test II: Computer Program for Windows Technical Guide and Software Manual. Cheektowaga, NY: Mutli-Health Systems; 2000.Google Scholar
13. Korkman, M, Kirk, U, Kemp, S. Bilan neuropsychologique de l'enfant (NEPSY). Paris, France: Edition du Centre de Psychologie Appliquée; 2003.Google Scholar
14. Kremin, H, Hamerel, M, Dordain, M, De Wilde, M, Perrier, D. Age of acquisition and name agreement as predictors of mean response latencies in picture naming of French adults. Brain Cog. 2000; 43: 286291.Google ScholarPubMed
15. Lecocq, P. (1996). L'ECOSSE: une épreuve de compréhension syntaxico-sémantique. Villeneuve d'Ascq, France: Presses Universitaires du Septentrion; 1996.Google Scholar
16. Mousty, P, Leybaert, J, Alegria, J, Content, A, Moraïs, J. Batterie d'évaluation du langage écrit et de ses troubles (BELEC). Brussels, Belgium: Laboratoire de psychologie expérimentale, Université libre de Bruxelles; 1994.Google Scholar
17. Khomsi, A. Epreuve d'Evaluation de la Compétence en Lecture-Forme Révisée (LMCR). Paris, France: Edition du Centre de Psychologie Appliquée; 1999.Google Scholar
18. Cohen, D, Plaza, M, Perez-Diaz, F et al. , Individual cognitive remediation of reading disability in adults with mild mental retardation. Res Dev Disabil. 2006; 27: 501516.CrossRefGoogle ScholarPubMed
19. Meljac, C, Lemmel, G. UDN-II: Construction et utilisation du nombre. Paris, France: Edition du Centre de Psychologie Appliquée; 1980.Google Scholar
20. Van Nieuwenhoven, C, Grégoire, J, Noël, MP. TEDI-MATH, test diagnostique des compétences de base en mathematiques. Paris, France: Editions du Centre de Psychologie Appliquée; 2001.Google Scholar
21. von Aster, MG. ZAREKI (Neuropsychological Test Battery for Number Processing and Calculation in Children). Amsterdamn, Neth: Swets & Zeitlinger; 2001.Google Scholar
22. Cali, JJ, Hsieh, CL, Francke, U, Russell, DW. Mutations in the bile acid biosynthetic enzyme sterol 27-hydroxylase underlie cerebrotendinous xanthomatosis. J Biol Chem. 1991; 266: 77797783.CrossRefGoogle ScholarPubMed
23. Sedel, F, Baumann, N, Turpin, JC, Lyon-Caen, O, Saudubray, JM, Cohen, D. Psychiatric manifestations revealing inborn errors of metabolism in adolescents and adults. J Inherit Metab Dis. 2007; 30: 631641.CrossRefGoogle ScholarPubMed
24. Turpin, JC, Baumann, N. Presenting psychiatric and cognitive disorders in adult neurolipidoses. Rev Neurol (Paris). 2003; 159: 637647.Google Scholar