Pyridoxine dependent epilepsy (PDE) is caused by mutations in the
ALDH7A1 gene (PDE-ALDH7A1) encoding α-aminoadipic-semialdehydedehydrogenase
enzyme in the lysine catabolic pathway resulting in an
accumulation of α-aminoadipic-acid-semialdehyde (α-AASA).
We present the one-year treatment outcome of a patient on a lysinerestricted
diet. Serial cerebral-spinal-fluid (CSF) α-AASA and CSF
pipecolic-acid levels showed decreased levels but did not normalize.
He had a normal neurodevelopmental outcome on a lysine-restricted diet.
Despite normal CSF and plasma tryptophan levels and normal tryptophan
intake, he developed mild CSF serotonin deficiency at one year of therapy.
Stricter lysine restriction would be necessary to normalize CSF α-AASA
levels, but might increase the risks associated with the diet. Patients are