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Succinate-semialdehyde dehydrogenase deficiency(SSADHD)

MedGen UID:
124340
Concept ID:
C0268631
Disease or Syndrome
Synonyms: 4-hydroxybutyric aciduria; Gamma-hydroxybutyricaciduria; SSADHD; Succinic Semialdehyde Dehydrogenase Deficiency
SNOMED CT: Succinic semialdehyde dehydrogenase deficiency (49748000); 4-Hydroxybutyric aciduria (49748000); Gamma-hydroxybutyric acidemia (49748000); Succinate-semialdehyde dehydrogenase deficiency (49748000); GABAuria (49748000); gamma-Hydroxybutyric aciduria (49748000); GABA metabolic defect (49748000)
Modes of inheritance:
Autosomal recessive inheritance
MedGen UID:
141025
Concept ID:
C0441748
Intellectual Product
Source: Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in individuals with two pathogenic alleles, either homozygotes (two copies of the same mutant allele) or compound heterozygotes (whereby each copy of a gene has a distinct mutant allele).
 
Gene (location): ALDH5A1 (6p22.3)
 
Monarch Initiative: MONDO:0010083
OMIM®: 271980
Orphanet: ORPHA22

Disease characteristics

Excerpted from the GeneReview: Succinic Semialdehyde Dehydrogenase Deficiency
Succinic semialdehyde dehydrogenase (SSADH) deficiency is characterized by infantile-onset hypotonia, developmental delay, cognitive impairment, expressive language deficit, and mild ataxia. Epilepsy is present in about half of affected individuals and is more common in adults. Hyperkinetic behavior, aggression, self-injurious behaviors, hallucinations, and sleep disturbances have been reported in nearly half of all affected individuals, more commonly in those who are older. Basal ganglia signs including choreoathetosis, dystonia, and myoclonus have been reported in a few individuals with earlier-onset, more severe disease. Involvement beyond the central nervous system has not been described. Individuals with SSADH deficiency typically have 4-hydroxybutyric aciduria present on urine organic acid analysis. Head MRI reveals T2 hyperintensities in multiple regions, involving the globus pallidi, cerebellar dentate nuclei, subthalamic nuclei, subcortical white matter, and brain stem, as well as cerebral and sometimes cerebellar atrophy. EEG findings include background slowing and spike discharges that are usually generalized. [from GeneReviews]
Authors:
Phillip L Pearl  |  Natrujee Wiwattanadittakul  |  Jean-Baptiste Roullet, et. al.   view full author information

Additional descriptions

From OMIM
Succinic semialdehyde dehydrogenase deficiency (SSADHD) is a rare autosomal recessive neurologic disorder in which an enzyme defect in the GABA degradation pathway causes a consecutive elevation of gamma-hydroxybutyric acid (GHB) and GABA. The clinical features include developmental delay, hypotonia, mental retardation, ataxia, seizures, hyperkinetic behavior, aggression, and sleep disturbances (summary by Reis et al., 2012).  http://www.omim.org/entry/271980
From MedlinePlus Genetics
Succinic semialdehyde dehydrogenase deficiency is a disorder that can cause a variety of neurological problems. People with this condition typically have developmental delays, especially in speech development; intellectual disabilities; and decreased muscle tone (hypotonia) soon after birth. Communication problems may improve over time in people with this disorder.

About half of people with succinic semialdehyde dehydrogenase deficiency experience seizures, difficulty coordinating movements (ataxia), decreased reflexes (hyporeflexia), and behavioral problems.  The most common behavioral problems associated with this condition are sleep disturbances, hyperactivity, difficulty maintaining attention, and anxiety. Other behavioral and psychiatric features, including aggression and obsessive-compulsive disorder (OCD), tend to develop in adolescence and early adulthood.   https://medlineplus.gov/genetics/condition/succinic-semialdehyde-dehydrogenase-deficiency

Clinical features

From HPO
Increased level of gamma-aminobutyric acid in urine
MedGen UID:
338585
Concept ID:
C1848971
Finding
Elevated concentration of gamma-aminobutyric acid in the urine.
Elevated urinary 4-hydroxybutyric acid
MedGen UID:
1697012
Concept ID:
C5139403
Finding
An increased amount of 4-hydroxybutyric acid in the urine.
Aggressive behavior
MedGen UID:
1375
Concept ID:
C0001807
Individual Behavior
Behavior or an act aimed at harming a person, animal, or physical property (e.g., acts of physical violence; shouting, swearing, and using harsh language; slashing someone's tires).
Anxiety
MedGen UID:
1613
Concept ID:
C0003467
Finding
Intense feelings of nervousness, tension, or panic often arise in response to interpersonal stresses. There is worry about the negative effects of past unpleasant experiences and future negative possibilities. Individuals may feel fearful, apprehensive, or threatened by uncertainty, and they may also have fears of falling apart or losing control.
Autism
MedGen UID:
13966
Concept ID:
C0004352
Mental or Behavioral Dysfunction
Autism, the prototypic pervasive developmental disorder (PDD), is usually apparent by 3 years of age. It is characterized by a triad of limited or absent verbal communication, a lack of reciprocal social interaction or responsiveness, and restricted, stereotypic, and ritualized patterns of interests and behavior (Bailey et al., 1996; Risch et al., 1999). 'Autism spectrum disorder,' sometimes referred to as ASD, is a broader phenotype encompassing the less severe disorders Asperger syndrome (see ASPG1; 608638) and pervasive developmental disorder, not otherwise specified (PDD-NOS). 'Broad autism phenotype' includes individuals with some symptoms of autism, but who do not meet the full criteria for autism or other disorders. Mental retardation coexists in approximately two-thirds of individuals with ASD, except for Asperger syndrome, in which mental retardation is conspicuously absent (Jones et al., 2008). Genetic studies in autism often include family members with these less stringent diagnoses (Schellenberg et al., 2006). Levy et al. (2009) provided a general review of autism and autism spectrum disorder, including epidemiology, characteristics of the disorder, diagnosis, neurobiologic hypotheses for the etiology, genetics, and treatment options. Genetic Heterogeneity of Autism Autism is considered to be a complex multifactorial disorder involving many genes. Accordingly, several loci have been identified, some or all of which may contribute to the phenotype. Included in this entry is AUTS1, which has been mapped to chromosome 7q22. Other susceptibility loci include AUTS3 (608049), which maps to chromosome 13q14; AUTS4 (608636), which maps to chromosome 15q11; AUTS6 (609378), which maps to chromosome 17q11; AUTS7 (610676), which maps to chromosome 17q21; AUTS8 (607373), which maps to chromosome 3q25-q27; AUTS9 (611015), which maps to chromosome 7q31; AUTS10 (611016), which maps to chromosome 7q36; AUTS11 (610836), which maps to chromosome 1q41; AUTS12 (610838), which maps to chromosome 21p13-q11; AUTS13 (610908), which maps to chromosome 12q14; AUTS14A (611913), which has been found in patients with a deletion of a region of 16p11.2; AUTS14B (614671), which has been found in patients with a duplication of a region of 16p11.2; AUTS15 (612100), associated with mutation in the CNTNAP2 gene (604569) on chromosome 7q35-q36; AUTS16 (613410), associated with mutation in the SLC9A9 gene (608396) on chromosome 3q24; AUTS17 (613436), associated with mutation in the SHANK2 gene (603290) on chromosome 11q13; AUTS18 (615032), associated with mutation in the CHD8 gene (610528) on chromosome 14q11; AUTS19 (615091), associated with mutation in the EIF4E gene (133440) on chromosome 4q23; and AUTS20 (618830), associated with mutation in the NLGN1 gene (600568) on chromosome 3q26. (NOTE: the symbol 'AUTS2' has been used to refer to a gene on chromosome 7q11 (KIAA0442; 607270) and therefore is not used as a part of this autism locus series.) There are several X-linked forms of autism susceptibility: AUTSX1 (300425), associated with mutations in the NLGN3 gene (300336); AUTSX2 (300495), associated with mutations in NLGN4 (300427); AUTSX3 (300496), associated with mutations in MECP2 (300005); AUTSX4 (300830), associated with variation in the region on chromosome Xp22.11 containing the PTCHD1 gene (300828); AUTSX5 (300847), associated with mutations in the RPL10 gene (312173); and AUTSX6 (300872), associated with mutation in the TMLHE gene (300777). A locus on chromosome 2q (606053) associated with a phenotype including intellectual disability and speech deficits was formerly designated AUTS5. Folstein and Rosen-Sheidley (2001) reviewed the genetics of autism.
Cerebellar ataxia
MedGen UID:
849
Concept ID:
C0007758
Disease or Syndrome
Cerebellar ataxia refers to ataxia due to dysfunction of the cerebellum. This causes a variety of elementary neurological deficits including asynergy (lack of coordination between muscles, limbs and joints), dysmetria (lack of ability to judge distances that can lead to under- or overshoot in grasping movements), and dysdiadochokinesia (inability to perform rapid movements requiring antagonizing muscle groups to be switched on and off repeatedly).
Hallucinations
MedGen UID:
6709
Concept ID:
C0018524
Mental or Behavioral Dysfunction
Perceptions in a conscious and awake state that, in the absence of external stimuli, have qualities of real perception. These perceptions are vivid, substantial, and located in external objective space.
Psychotic disorder
MedGen UID:
19568
Concept ID:
C0033975
Mental or Behavioral Dysfunction
A condition characterized by changes in personality and thought patterns, often accompanied by hallucinations and delusional beliefs, is known as psychosis.
Seizure
MedGen UID:
20693
Concept ID:
C0036572
Sign or Symptom
A seizure is an intermittent abnormality of nervous system physiology characterized by a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.
Status epilepticus
MedGen UID:
11586
Concept ID:
C0038220
Disease or Syndrome
Status epilepticus is a type of prolonged seizure resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms which lead to abnormally prolonged seizures (after time point t1). It is a condition that can have long-term consequences (after time point t2), including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures.
Self-injurious behavior
MedGen UID:
88371
Concept ID:
C0085271
Individual Behavior
Self-aggression.
EEG abnormality
MedGen UID:
56235
Concept ID:
C0151611
Finding
Abnormality observed by electroencephalogram (EEG), which is used to record of the brain's spontaneous electrical activity from multiple electrodes placed on the scalp.
Atypical behavior
MedGen UID:
535345
Concept ID:
C0233514
Mental or Behavioral Dysfunction
Atypical behavior is an abnormality in a person's actions, which can be controlled or modulated by the will of the individual. While abnormal behaviors can be difficult to control, they are distinct from other abnormal actions that cannot be affected by the individual's will.
Hyperactivity
MedGen UID:
98406
Concept ID:
C0424295
Finding
Hyperactivity is a condition characterized by constant and unusually high levels of activity, even in situations where it is deemed inappropriate.
Delayed speech and language development
MedGen UID:
105318
Concept ID:
C0454644
Finding
A degree of language development that is significantly below the norm for a child of a specified age.
Bilateral tonic-clonic seizure
MedGen UID:
141670
Concept ID:
C0494475
Sign or Symptom
A bilateral tonic-clonic seizure is a seizure defined by a tonic (bilateral increased tone, lasting seconds to minutes) and then a clonic (bilateral sustained rhythmic jerking) phase.
Global developmental delay
MedGen UID:
107838
Concept ID:
C0557874
Finding
A delay in the achievement of motor or mental milestones in the domains of development of a child, including motor skills, speech and language, cognitive skills, and social and emotional skills. This term should only be used to describe children younger than five years of age.
Hyporeflexia
MedGen UID:
195967
Concept ID:
C0700078
Finding
Reduction of neurologic reflexes such as the knee-jerk reaction.
Cerebellar atrophy
MedGen UID:
196624
Concept ID:
C0740279
Disease or Syndrome
Cerebellar atrophy is defined as a cerebellum with initially normal structures, in a posterior fossa with normal size, which displays enlarged fissures (interfolial spaces) in comparison to the foliae secondary to loss of tissue. Cerebellar atrophy implies irreversible loss of tissue and result from an ongoing progressive disease until a final stage is reached or a single injury, e.g. an intoxication or infectious event.
Motor delay
MedGen UID:
381392
Concept ID:
C1854301
Finding
A type of Developmental delay characterized by a delay in acquiring motor skills.
Intellectual disability
MedGen UID:
811461
Concept ID:
C3714756
Mental or Behavioral Dysfunction
Intellectual disability, previously referred to as mental retardation, is characterized by subnormal intellectual functioning that occurs during the developmental period. It is defined by an IQ score below 70.
Hyperkinetic movements
MedGen UID:
854367
Concept ID:
C3887506
Disease or Syndrome
Motor hyperactivity with excessive movement of muscles of the body as a whole.
Delayed CNS myelination
MedGen UID:
867393
Concept ID:
C4021758
Anatomical Abnormality
Delayed myelination in the central nervous system.
Generalized myoclonic seizure
MedGen UID:
892704
Concept ID:
C4021759
Disease or Syndrome
A generalized myoclonic seizure is a type of generalized motor seizure characterized by bilateral, sudden, brief (<100 ms) involuntary single or multiple contraction of muscles or muscle groups of variable topography (axial, proximal limb, distal). Myoclonus is less regularly repetitive and less sustained than is clonus.
Generalized non-motor (absence) seizure
MedGen UID:
1385688
Concept ID:
C4316903
Disease or Syndrome
A generalized non-motor (absence) seizure is a type of a type of dialeptic seizure that is of electrographically generalized onset. It is a generalized seizure characterized by an interruption of activities, a blank stare, and usually the person will be unresponsive when spoken to. Any ictal motor phenomena are minor in comparison to these non-motor features.
Elevated CSF gamma-aminobutyric acid concentration
MedGen UID:
1699107
Concept ID:
C5139406
Finding
Elevated CSF 4-hydroxybutyric acid concentration
MedGen UID:
1705299
Concept ID:
C5139407
Finding
Abnormally increased level of 4-hydroxybutyric acid in the cerebrospinal fluid (CSF).
Hypotonia
MedGen UID:
10133
Concept ID:
C0026827
Finding
Hypotonia is an abnormally low muscle tone (the amount of tension or resistance to movement in a muscle). Even when relaxed, muscles have a continuous and passive partial contraction which provides some resistance to passive stretching. Hypotonia thus manifests as diminished resistance to passive stretching. Hypotonia is not the same as muscle weakness, although the two conditions can co-exist.
Generalized hypotonia
MedGen UID:
346841
Concept ID:
C1858120
Finding
Generalized muscular hypotonia (abnormally low muscle tone).
Elevated circulating gamma-aminobutyric acid concentration
MedGen UID:
1643920
Concept ID:
C4703619
Finding
An increase in the level of Gamma-aminobutyric acid (GABA) in the blood circulation.
Decreased tissue succinic semialdehyde dehydrogenase activity
MedGen UID:
1687152
Concept ID:
C5139405
Finding
Reduced level of succinic semialdehyde dehydrogenase (SSADH).
Abnormality of eye movement
MedGen UID:
99227
Concept ID:
C0497202
Finding
An abnormality in voluntary or involuntary eye movements or their control.

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVSuccinate-semialdehyde dehydrogenase deficiency
Follow this link to review classifications for Succinate-semialdehyde dehydrogenase deficiency in Orphanet.

Professional guidelines

PubMed

DiBacco ML, Pop A, Salomons GS, Hanson E, Roullet JB, Gibson KM, Pearl PL
Neurology 2020 Nov 10;95(19):e2675-e2682. Epub 2020 Sep 4 doi: 10.1212/WNL.0000000000010730. PMID: 32887777Free PMC Article
Li X, Ding Y, Liu Y, Zhang Y, Song J, Wang Q, Li M, Qin Y, Huang S, Yang Y
Gene 2015 Dec 10;574(1):41-7. Epub 2015 Jul 26 doi: 10.1016/j.gene.2015.07.078. PMID: 26220405
Hogema BM, Akaboshi S, Taylor M, Salomons GS, Jakobs C, Schutgens RB, Wilcken B, Worthington S, Maropoulos G, Grompe M, Gibson KM
Mol Genet Metab 2001 Mar;72(3):218-22. doi: 10.1006/mgme.2000.3145. PMID: 11243727

Recent clinical studies

Etiology

Matsubara T, Khan S, Sundaram P, Stufflebeam S, Aygun D, DiBacco M, Roullet JB, Pearl PL, Okada Y
Clin Neurophysiol 2024 May;161:52-58. Epub 2024 Feb 16 doi: 10.1016/j.clinph.2024.02.010. PMID: 38447494
Lee HHC, McGinty GE, Pearl PL, Rotenberg A
Int J Mol Sci 2022 Feb 26;23(5) doi: 10.3390/ijms23052606. PMID: 35269750Free PMC Article
Afacan O, Yang E, Lin AP, Coello E, DiBacco ML, Pearl PL, Warfield SK, Consortium SDI
J Child Neurol 2021 Nov;36(13-14):1162-1168. Epub 2021 Feb 9 doi: 10.1177/0883073821991295. PMID: 33557675Free PMC Article
Pearl PL, DiBacco ML, Papadelis C, Opladen T, Hanson E, Roullet JB, Gibson KM
J Child Neurol 2021 Nov;36(13-14):1153-1161. Epub 2021 Jan 4 doi: 10.1177/0883073820981262. PMID: 33393837Free PMC Article
Pearl PL, Schreiber J, Theodore WH, McCarter R, Barrios ES, Yu J, Wiggs E, He J, Gibson KM
Neurology 2014 Mar 18;82(11):940-4. Epub 2014 Feb 12 doi: 10.1212/WNL.0000000000000210. PMID: 24523482Free PMC Article

Diagnosis

Martin K, McConnell A, Elsea SH
J Child Neurol 2021 Nov;36(13-14):1218-1222. doi: 10.1177/08830738211018902. PMID: 34882073
Afacan O, Yang E, Lin AP, Coello E, DiBacco ML, Pearl PL, Warfield SK, Consortium SDI
J Child Neurol 2021 Nov;36(13-14):1162-1168. Epub 2021 Feb 9 doi: 10.1177/0883073821991295. PMID: 33557675Free PMC Article
Kirby T, Walters DC, Shi X, Turgeon C, Rinaldo P, Arning E, Ashcraft P, Bottiglieri T, DiBacco M, Pearl PL, Roullet JB, Gibson KM
Orphanet J Rare Dis 2020 Sep 23;15(1):261. doi: 10.1186/s13023-020-01522-5. PMID: 32967698Free PMC Article
Li X, Ding Y, Liu Y, Zhang Y, Song J, Wang Q, Li M, Qin Y, Huang S, Yang Y
Gene 2015 Dec 10;574(1):41-7. Epub 2015 Jul 26 doi: 10.1016/j.gene.2015.07.078. PMID: 26220405
Pearl PL, Gibson KM, Cortez MA, Wu Y, Carter Snead O 3rd, Knerr I, Forester K, Pettiford JM, Jakobs C, Theodore WH
J Inherit Metab Dis 2009 Jun;32(3):343-52. Epub 2009 Jan 28 doi: 10.1007/s10545-009-1034-y. PMID: 19172412Free PMC Article

Therapy

Colijn MA
Psychiatr Genet 2020 Dec;30(6):153-161. doi: 10.1097/YPG.0000000000000264. PMID: 33165204
Didiášová M, Banning A, Brennenstuhl H, Jung-Klawitter S, Cinquemani C, Opladen T, Tikkanen R
Cells 2020 Feb 19;9(2) doi: 10.3390/cells9020477. PMID: 32093054Free PMC Article
Brown MN, Walters DC, Schmidt MA, Hill J, McConnell A, Jansen EEW, Salomons GS, Arning E, Bottiglieri T, Gibson KM, Roullet JB
J Inherit Metab Dis 2019 Sep;42(5):1030-1039. Epub 2019 May 29 doi: 10.1002/jimd.12107. PMID: 31032972
Vogel KR, Ainslie GR, Walters DC, McConnell A, Dhamne SC, Rotenberg A, Roullet JB, Gibson KM
J Inherit Metab Dis 2018 Jul;41(4):699-708. Epub 2018 Feb 19 doi: 10.1007/s10545-018-0153-8. PMID: 29460030Free PMC Article
Pearl PL, Schreiber J, Theodore WH, McCarter R, Barrios ES, Yu J, Wiggs E, He J, Gibson KM
Neurology 2014 Mar 18;82(11):940-4. Epub 2014 Feb 12 doi: 10.1212/WNL.0000000000000210. PMID: 24523482Free PMC Article

Prognosis

Alfonsi C, Stephan-Otto C, Cortès-Saladelafont E, Palacios NJ, Podzamczer-Valls I, Cruz NG, Jiménez MRD, Micó SI, Vila MT, Jeltsch K, Hübschmann OK, Opladen T, Fragua RV, Gómez T, Fortuny OA, Jiménez IG, Laso EL, Martínez AR, López JM, Garcia-Cazorla À
Neuroradiology 2022 Nov;64(11):2179-2190. Epub 2022 Jun 4 doi: 10.1007/s00234-022-02989-8. PMID: 35662359
Kirby TO, Shi X, Walters D, Roullet JB, Gibson KM
Mol Genet Metab 2022 Jan;135(1):42-46. Epub 2021 Dec 3 doi: 10.1016/j.ymgme.2021.11.355. PMID: 34896003
Pearl PL, DiBacco ML, Papadelis C, Opladen T, Hanson E, Roullet JB, Gibson KM
J Child Neurol 2021 Nov;36(13-14):1153-1161. Epub 2021 Jan 4 doi: 10.1177/0883073820981262. PMID: 33393837Free PMC Article
Brown M, Turgeon C, Rinaldo P, Roullet JB, Gibson KM
Mol Genet Metab 2019 Dec;128(4):397-408. Epub 2019 Oct 31 doi: 10.1016/j.ymgme.2019.10.003. PMID: 31699650
Knerr I, Gibson KM, Jakobs C, Pearl PL
CNS Spectr 2008 Jul;13(7):598-605. doi: 10.1017/s1092852900016874. PMID: 18622364Free PMC Article

Clinical prediction guides

Kirby TO, Shi X, Walters D, Roullet JB, Gibson KM
Mol Genet Metab 2022 Jan;135(1):42-46. Epub 2021 Dec 3 doi: 10.1016/j.ymgme.2021.11.355. PMID: 34896003
Martin K, McConnell A, Elsea SH
J Child Neurol 2021 Nov;36(13-14):1218-1222. doi: 10.1177/08830738211018902. PMID: 34882073
Pearl PL, DiBacco ML, Papadelis C, Opladen T, Hanson E, Roullet JB, Gibson KM
J Child Neurol 2021 Nov;36(13-14):1153-1161. Epub 2021 Jan 4 doi: 10.1177/0883073820981262. PMID: 33393837Free PMC Article
Brown M, Turgeon C, Rinaldo P, Roullet JB, Gibson KM
Mol Genet Metab 2019 Dec;128(4):397-408. Epub 2019 Oct 31 doi: 10.1016/j.ymgme.2019.10.003. PMID: 31699650
Kim KJ, Pearl PL, Jensen K, Snead OC, Malaspina P, Jakobs C, Gibson KM
Antioxid Redox Signal 2011 Aug 1;15(3):691-718. Epub 2011 Apr 10 doi: 10.1089/ars.2010.3470. PMID: 20973619Free PMC Article

Recent systematic reviews

Liu N, Kong XD, Kan QC, Shi HR, Wu QH, Zhuo ZH, Bai QL, Jiang M
J Perinat Med 2016 May 1;44(4):441-51. doi: 10.1515/jpm-2014-0164. PMID: 25431891

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