Tatiana Bremova1, Věra Malinová2, Yasmina Amraoui2, Eugen Mengel2, Jörg Reinke2, Miriam Kolníková2, Michael Strupp2. 1. From the German Center for Vertigo and Balance Disorders (T.B., M.S.) and Department of Neurology (T.B., M.S.), Grosshadern Campus, University Hospital Munich; Graduate School of Systemic Neurosciences (T.B.), Ludwig-Maximilians University, Munich, Germany; Department of Pediatrics and Adolescence Medicine (V.M.), First Faculty of Medicine, Charles University, General University Hospital Prague, Czech Republic; Villa Metabolica (Y.A., E.M., J.R.), Center for Paediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Germany; and Department of Child Neurology (M.K.), Comenius University Children's Hospital, Bratislava, Slovakia. Tatiana.Bremova@med.uni-muenchen.de. 2. From the German Center for Vertigo and Balance Disorders (T.B., M.S.) and Department of Neurology (T.B., M.S.), Grosshadern Campus, University Hospital Munich; Graduate School of Systemic Neurosciences (T.B.), Ludwig-Maximilians University, Munich, Germany; Department of Pediatrics and Adolescence Medicine (V.M.), First Faculty of Medicine, Charles University, General University Hospital Prague, Czech Republic; Villa Metabolica (Y.A., E.M., J.R.), Center for Paediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Germany; and Department of Child Neurology (M.K.), Comenius University Children's Hospital, Bratislava, Slovakia.
Abstract
OBJECTIVE: To assess the effects of the modified amino acid acetyl-dl-leucine (AL) on cerebellar ataxia, eye movements, and quality of life of patients with Niemann-Pick type C (NP-C) disease. METHODS: Twelve patients with NP-C disease were treated with AL 3 g/d for 1 week and then with 5 g/d for 3 weeks with a subsequent washout period of 1 month. The Scale for the Assessment and Rating of Ataxia (SARA), the Spinocerebellar Ataxia Functional Index (SCAFI), the modified Disability Rating Scale (mDRS), EuroQol 5Q-5D-5L, and the visual analog scale (VAS) were administered. Measurements took place at baseline, after 1 month of therapy, and after 1 month of washout. RESULTS: The SARA score changed from the baseline (median [±SD, interquartile range]) of 10.8 (11.2, 8-24.6) to 7.0 (10.7, 5.6-19.6) on medication (difference: 3.8 points) and 10.5 (11.5, 7.1-23.9) after washout (difference: 3.5 points) (p = 0.000412; post hoc p = 0.003 between baseline and on medication, and on medication and washout p = 0.005). The SCAFI subscore 9-Hole Peg Test for dominant hand, mDRS score, and VAS score also improved on medication. No side effects except transient dizziness in one patient were reported. CONCLUSIONS: Treatment with AL improved ataxic symptoms in patients with NP-C without relevant side effects, thus showing a reasonable risk-benefit profile. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that AL improves cerebellar symptoms and quality of life in patients with NP-C.
OBJECTIVE: To assess the effects of the modified amino acid acetyl-dl-leucine (AL) on cerebellar ataxia, eye movements, and quality of life of patients with Niemann-Pick type C (NP-C) disease. METHODS: Twelve patients with NP-C disease were treated with AL 3 g/d for 1 week and then with 5 g/d for 3 weeks with a subsequent washout period of 1 month. The Scale for the Assessment and Rating of Ataxia (SARA), the Spinocerebellar Ataxia Functional Index (SCAFI), the modified Disability Rating Scale (mDRS), EuroQol 5Q-5D-5L, and the visual analog scale (VAS) were administered. Measurements took place at baseline, after 1 month of therapy, and after 1 month of washout. RESULTS: The SARA score changed from the baseline (median [±SD, interquartile range]) of 10.8 (11.2, 8-24.6) to 7.0 (10.7, 5.6-19.6) on medication (difference: 3.8 points) and 10.5 (11.5, 7.1-23.9) after washout (difference: 3.5 points) (p = 0.000412; post hoc p = 0.003 between baseline and on medication, and on medication and washout p = 0.005). The SCAFI subscore 9-Hole Peg Test for dominant hand, mDRS score, and VAS score also improved on medication. No side effects except transient dizziness in one patient were reported. CONCLUSIONS: Treatment with AL improved ataxic symptoms in patients with NP-C without relevant side effects, thus showing a reasonable risk-benefit profile. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that AL improves cerebellar symptoms and quality of life in patients with NP-C.
Authors: Sandra Becker-Bense; Lena Kaiser; Regina Becker; Katharina Feil; Carolin Muth; Nathalie L Albert; Marcus Unterrainer; Peter Bartenstein; Michael Strupp; Marianne Dieterich Journal: J Neurol Date: 2022-07-25 Impact factor: 6.682