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[Inborn errors of metabolism in adult neurology].
[adrenomyeloneuropathy]
Inborn
errors
of
metabolism
(
IEM
)
are
caused
by
mutations
in
genes
coding
for
enzymes
and
other
proteins
involved
in
cell
metabolism
.
Many
IEM
can
be
treated
effectively
.
Although
IEM
have
usually
been
considered
pediatric
diseases
,
they
can
present
at
any
age
,
mostly
with
neurological
and
psychiatric
symptoms
,
and
therefore
constitute
an
integral
subspeciality
of
neurology
.
However
,
although
they
are
increasingly
being
recognized
,
IEM
remain
rare
,
and
the
care
for
patients
should
be
optimized
in
specialized
reference
centers
.
Since
the
number
of
different
diseases
is
very
large
,
the
diagnostic
approach
needs
to
be
rigorous
,
starting
at
the
clinics
and
calling
upon
the
additional
help
of
neuroradiology
,
biochemistry
and
molecular
biology
.
In
practice
,
it
is
important
for
the
neurologist
to
recognize
:
(
1
)
when
to
start
suspecting
an
IEM
;
and
(
2
)
how
to
correlate
a
given
clinical
presentation
with
one
of
the
five
major
groups
of
diseases
affecting
the
nervous
system
.
These
five
groups
may
be
classified
as
:
(
a
)
energy
metabolism
disorders
such
as
respiratory
chain
disorders
,
pyruvate
dehydrogenase
deficiency
,
GLUT
1
deficiency
,
fatty-acid
β-oxidation
defects
,
and
disorders
involving
key
cofactors
such
as
electron
transfer
flavoprotein
,
thiamine
,
biotin
,
riboflavin
,
vitamin
E
and
coenzyme
Q
10
;
(
b
)
intoxication
syndromes
such
as
porphyrias
,
urea-cycle
defects
,
homocystinurias
,
organic
acidurias
and
amino
acidopathies
;
(
c
)
lipid-storage
disorders
such
as
lysosomal
storage
disorders
(
Krabbe
disease
,
metachromatic
leukodystrophy
,
Niemann
-
Pick
disease
type
C
,
Fabry
disease
and
Gaucher
's
disease
)
,
peroxisomal
disorders
(
adrenomyeloneuropathy
,
Refsum
disease
,
disorders
of
pristanic
acid
metabolism
,
peroxisome
biogenesis
disorders
)
,
Tangier
disease
and
cerebrotendinous
xanthomatosis
;
(
d
)
metal-storage
diseases
such
as
iron
,
copper
and
manganese
metabolic
disorders
;
and
(
e
)
neurotransmitter
metabolism
defects
,
including
defects
of
serotonin
,
dopamine
and
glycine
metabolism
.
Diseases
Validation
Diseases presenting
"fatty-acid β-oxidation defects"
symptom
adrenomyeloneuropathy
krabbe disease
pyruvate dehydrogenase deficiency
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