Biochemical and molecular characteristics of patients with organic acidaemias and urea cycle disorders identified through newborn screening.

BACKGROUND: In recent years it has become clear that newborn screening (NBS) programmes using tandem mass spectrometry identify "patients" with "classical" inborn errors of metabolism who are asymptomatic. This observation raises issues regarding medicalization of "non-diseases," potentially unnecessary treatment and unnecessary anxiety to parents. AIMS: This study aims to identify possible markers that may assist in predicting the need for treatment of infants with "classical" organic acidaemias (OA) and urea cycle disorders (UCD) diagnosed through NBS. METHODS: Medical records of all patients with classical OA and UCD detected through the Victorian NBS programme from February 2002 to January 2014, or diagnosed clinically between 1990 and January 2002 were retrospectively reviewed. RESULTS: Neonatal presentation did not always predict the need for on-going strict treatment. Blood concentrations of amino acids and acyl-carnitines and the changes thereof in follow-up samples correlated with severity in citrullinaemia-I, possibly isovaleric acidaemia but not in argininosuccinic aciduria or propionic acidaemia. Some specific mutations correlate with "attenuated" citrullinaemia-I. Gender may affect clinical outcome in propionic acidaemia. CONCLUSIONS: Changes in blood concentration of certain metabolites (amino acids, acyl-carnitines) in the first weeks of life may be predictive of the need for treatment in some disorders but not in others. Mutation analysis may be predictive in some disorders but whether or not this should be considered as second-tier testing in NBS should be discussed separately.

Patients with cerebellar lesions cannot acquire but are able to retain conditioned eyeblink reflexes.

The purpose of these experiments was to examine the role of the human cerebellum in the acquisition and retention of conditioned reflexes. Normal human subjects and patients with cerebellar lesions were tested for their capacity to acquire, retain and express conditioned eyeblink responses. In acquisition tests, subjects were trained in a delay classical conditioning paradigm using a tone conditioned stimulus and a midline forehead tap as an unconditioned stimulus. While normal subjects developed anticipatory eyeblinks to the tone in one session, patients with cerebellar lesions failed to acquire conditioned responses in four consecutive training sessions. The conditioning deficit was bilateral even in patients with a unilateral cerebellar pathology. The same groups of subjects were tested for the presence of eyeblinks to a visual threat. In these experiments, both normal subjects and patients with cerebellar lesions exhibited a high level of responding when they saw an object approaching their face. These eyeblinks to the visual threat are probably naturally acquired conditioned responses because they extinguish in normal subjects if they are not reinforced by the unconditioned cutaneous stimulus. In addition, the stimulus of seeing an approaching object blocks the acquisition of classically conditioned eyeblinks to a new conditioned stimulus in normal subjects. These data imply that patients with cerebellar lesions who cannot acquire new classically conditioned responses are able to retain and express conditioned eyeblinks which were acquired before the onset of the pathology. Consequently, cerebellum-dependent neural substrates which are involved in learning new conditioned reflexes do not seem to be required for the storage of naturally learned conditioned responses.