Folinic acid therapy in treatment of dihydropteridine reductase deficiency

Mira Irons*, Harvey L. Levy, Margaret E. O'Flynn, Cynthia V. Stack, Philip J. Langlais, Ian J. Butler, Sheldon Milstien, Seymour Kaufman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

We gave folinic acid to three siblings, and to a fourth child, who have or had dihydropteridine reductase (DHPR) deficiency. The youngest began folinic acid therapy in addition to neurotransmitter precursors and a phenylalanine-restricted diet at age 2 months, and at 2 years of age has near normal development without evidence of neurologic impairment. His older brother began similar treatment at 51/2 months of age, when early neurologic findings were evident. At age 6 years his mental retardation and neurologic impairment are less severe than reported in most patients with DHPR deficiency. Little improvement occurred in their sister, who first received treatment at 2 years of age, when she already had severe neurologic impairment. An unrelated boy with profound neurologic impairment showed subtle signs of improvement after he began treatment with folinic acid alone at age 9 years. These results provide evidence that folinic acid is important in the treatment of DHPR deficiency and, if begun early in infancy, may prevent irreversible neurologic damage. The mechanism of folinic acid action in DHPR deficiency may be to increase indirectly the synthesis of 5-methyltetrahydrofolate.

Original languageEnglish (US)
Pages (from-to)61-67
Number of pages7
JournalThe Journal of pediatrics
Volume110
Issue number1
DOIs
StatePublished - Jan 1987

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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