Phenylalanine Effects on Brain Function in Adult Phenylketonuria.


Journal

Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060

Informations de publication

Date de publication:
19 01 2021
Historique:
received: 05 03 2020
accepted: 01 09 2020
pubmed: 24 10 2020
medline: 2 2 2021
entrez: 23 10 2020
Statut: ppublish

Résumé

To evaluate the relationship between circulating phenylalanine and brain function as well as neuropsychiatric symptoms in adults with phenylketonuria. In this prospective cross-sectional study, early-treated patients with phenylketonuria older than 30 years and age- and sex-matched controls were included. Extensive neurologic evaluation, neuropsychological and behavioral testing, sensory and motor evoked potentials, and MRI were performed. CSF concentrations of neurodegenerative markers were evaluated in addition in a subset of 10 patients. Nineteen patients with phenylketonuria (median age 41 years) with different phenylalanine levels (median 873 μmol/L) entered the study. They showed higher prevalence of neurologic symptoms, cognitive and behavioral abnormalities, autonomic dysfunction, alterations in neurophysiologic measures, and atrophy in putamen and right thalamus compared to controls. In CSF, patients with phenylketonuria exhibited higher β-amyloid 1-42 ( Our study provides strong evidence for a correlation between phenylalanine levels and clinical, neuropsychological, neurophysiologic, biochemical, and imaging alterations in adult patients with phenylketonuria.

Identifiants

pubmed: 33093221
pii: WNL.0000000000011088
doi: 10.1212/WNL.0000000000011088
doi:

Substances chimiques

Phenylalanine 47E5O17Y3R

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

e399-e411

Informations de copyright

© 2020 American Academy of Neurology.

Auteurs

Andrea Pilotto (A)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands. pilottoandreae@gmail.com.

Carl M Zipser (CM)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Edytha Leks (E)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Dorothea Haas (D)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Gwendolyn Gramer (G)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Peter Freisinger (P)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Eva Schaeffer (E)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Inga Liepelt-Scarfone (I)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Kathrin Brockmann (K)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Walter Maetzler (W)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Claudia Schulte (C)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Christian Deuschle (C)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Ann Kathrin Hauser (AK)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Georg F Hoffmann (GF)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Klaus Scheffler (K)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Francjan J van Spronsen (FJ)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Alessandro Padovani (A)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Friedrich Trefz (F)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

Daniela Berg (D)

From the Neurology Unit (A. Pilotto, A. Padovani), Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Neurodegeneration (A. Pilotto, I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Hertie Institute of Clinical Brain Research (A. Pilotto, C.M.Z., I.L.-S., K.B., W.M., C.S., C.D., A.K.H., D.B.), Department of Neurology and Stroke (C.M.Z.), Department of Biomedical Magnetic Resonance (E.L., K.S.), and German Center for Neurodegenerative Diseases (I.L.-S., K.B., C.S., C.D., A.K.H., K.S.), University of Tübingen, Germany; Parkinson's Disease Rehabilitation Centre (A. Pilotto), FERB ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy; Department of Pediatrics (D.H., G.G., G.F.H., F.T.), Division for Neuropediatrics and Metabolic Medicine, University of Heidelberg; Department of Pediatrics (P.F., F.T.), Reutlingen Hospital; Department of Neurology (E.S., W.M., D.B.), University-Hospital-Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel; and Division of Metabolic Diseases (F.J.v.S.), Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, the Netherlands.

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