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Cognition and Tyrosine Supplementation Among School-Aged Children With Phenylketonuria FREE

MICHELE M. M. MAZZOCCO, PHD; STEVEN YANNICELLI, MMSc, RD; ANN M. NORD, RN, MA; WILLIAM VAN DOORNINCK, PHD; ANNE J. DAVIDSON-MUNDT, RN, MS; CAROL L. GREENE, MD; BRUCE F. PENNINGTON, PHD
Am J Dis Child. 1992;146(11):1261-1264. doi:10.1001/archpedi.1992.02160230019009.
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Sir.—Phenylketonuria (PKU) is an inborn error of metabolism characterized by the inability to hydroxylate phenylalanine (PHE) to tyrosine (TYR). The condition is diagnosed by documentation of elevated serum PHE levels, and typically leads to moderate to severe mental retardation in its untreated form. Individuals with PKU who undergo early dietary PHE restriction usually achieve a full-scale IQ in the normal range.1

Serum PHE levels of 120 to 480 μmol/L are the typical target values in treatment and constitute good dietary control. Current clinical recommendations and research findings support the need to maintain dietary control throughout childhood.2-4 For various reasons, monitoring of serum TYR levels is not routine in many metabolic clinics. In our clinic, approximately 38% of patients with PKU who are younger than age 19 years have below-normal serum TYR concentrations (48 μmol/L). This is not clearly correlated with the kind of medical food or diet

REFERENCES

Dobson JC, Williamson ML, Azen C, Koch R.  Intellectual assessment of 111 four-year-old children with phenylketonuria . Pediatrics . 1977;; 60:822-827.
Azen CG, Koch R, Friedman EG, et al.  Intellectual development in 12-year-old children treated for phenylketonuria . AJDC . 1991;;145:35-39.
Fishler K, Azen C, Henderson R, Friedman EG, Koch R.  Psychoeducational findings among children treated for phenylketonuria . Am J Ment Defic . 1987;;92:65-73.
Lou HC, Guttler F, Lykkelund C, Bruhn P, Niederwieser A.  Decreased vigilance and neurotransmitter synthesis after discontinuation of dietary treatment for phenylketonuria in adolescents . Eur J Pediatr . 1985;;144:17-20.
Lou HC, Lykkelund C, Gerdes MM, Udesen H, Bruhn P.  Increased vigilance and dopamine synthesis by large doses of tyrosine or phenylalanine restriction in phenylketonuria . Acta Paediatr Scand . 1987;;76:560-565.
Mabry CC.  Status report on phenylketonuria treatment: 1990 . AJDC . 1991;;145:33.
Barklay A, Walton O.  Phenylketonuria: implications of initial serum phenylalanine levels on cognitive development . Psychol Rep . 1988;;63: 135-142.
Welsh MC, Pennington BF, Ozonoff S, Rouse B, McCabe ERB.  Neuropsychology of early treated phenylketonuria: specific executive function deficits . Child Dev . 1990;;61:1697-1713.
Brunner RL, Jordan MK, Berry HK.  Early treated phenylketonuria: neuropsychologic consequences . J Pediatr . 1983;;102:831-835.
Pennington BF, van Doorninck WJ, McCabe LL, McCabe ERB.  Neuropsychological deficits in early treated phenylketonuric children . Am J Ment Defic . 1985;;89:467-474.
Ruff R. Ruff Figural Fluency Test Administration Manual. San Diego , Calif: Neuropsychological Resources; 1988;.
Taylor HG.  Learning disabilities . In: Mash EJ, Terdal LG, eds. Behavioral Assessments of Childhood Disorders . 2nd ed. New York, NY: Guilford Press; 1988;:402-405.
Kagan J, Rosman BL, Day L, Albert J, Phillips W.  Information processing in the child: significance of analytical and reflective attitudes . Psychol Monogr . 1964;;78:No. (578) .
Heaton RK. Wisconsin Card Sorting Test Manual . Odessa, Fla: Psychological Assessment Resources Inc; 1981;.
Kaufman AS, Kaufman NL. Kaufman Assessment Battery for Children, Interpretive Manual . Circle Pines, Minn: American Guidance Service; 1983;
Krause WL, Halminski M, McDonald L, et al.  Biochemical and neuropsychological effects of elevated plasma phenylalanine in patients with treated phenylketonuria . J Clin Invest . 1985;;75: 40-48.
Eisenberg J, Asnis GM, van Praag HM, Vela RM.  Effect of tyrosine on attention deficit disorder with hyperactivity . Clin Psychiatry . 1988;;49:193-195.

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References

Dobson JC, Williamson ML, Azen C, Koch R.  Intellectual assessment of 111 four-year-old children with phenylketonuria . Pediatrics . 1977;; 60:822-827.
Azen CG, Koch R, Friedman EG, et al.  Intellectual development in 12-year-old children treated for phenylketonuria . AJDC . 1991;;145:35-39.
Fishler K, Azen C, Henderson R, Friedman EG, Koch R.  Psychoeducational findings among children treated for phenylketonuria . Am J Ment Defic . 1987;;92:65-73.
Lou HC, Guttler F, Lykkelund C, Bruhn P, Niederwieser A.  Decreased vigilance and neurotransmitter synthesis after discontinuation of dietary treatment for phenylketonuria in adolescents . Eur J Pediatr . 1985;;144:17-20.
Lou HC, Lykkelund C, Gerdes MM, Udesen H, Bruhn P.  Increased vigilance and dopamine synthesis by large doses of tyrosine or phenylalanine restriction in phenylketonuria . Acta Paediatr Scand . 1987;;76:560-565.
Mabry CC.  Status report on phenylketonuria treatment: 1990 . AJDC . 1991;;145:33.
Barklay A, Walton O.  Phenylketonuria: implications of initial serum phenylalanine levels on cognitive development . Psychol Rep . 1988;;63: 135-142.
Welsh MC, Pennington BF, Ozonoff S, Rouse B, McCabe ERB.  Neuropsychology of early treated phenylketonuria: specific executive function deficits . Child Dev . 1990;;61:1697-1713.
Brunner RL, Jordan MK, Berry HK.  Early treated phenylketonuria: neuropsychologic consequences . J Pediatr . 1983;;102:831-835.
Pennington BF, van Doorninck WJ, McCabe LL, McCabe ERB.  Neuropsychological deficits in early treated phenylketonuric children . Am J Ment Defic . 1985;;89:467-474.
Ruff R. Ruff Figural Fluency Test Administration Manual. San Diego , Calif: Neuropsychological Resources; 1988;.
Taylor HG.  Learning disabilities . In: Mash EJ, Terdal LG, eds. Behavioral Assessments of Childhood Disorders . 2nd ed. New York, NY: Guilford Press; 1988;:402-405.
Kagan J, Rosman BL, Day L, Albert J, Phillips W.  Information processing in the child: significance of analytical and reflective attitudes . Psychol Monogr . 1964;;78:No. (578) .
Heaton RK. Wisconsin Card Sorting Test Manual . Odessa, Fla: Psychological Assessment Resources Inc; 1981;.
Kaufman AS, Kaufman NL. Kaufman Assessment Battery for Children, Interpretive Manual . Circle Pines, Minn: American Guidance Service; 1983;
Krause WL, Halminski M, McDonald L, et al.  Biochemical and neuropsychological effects of elevated plasma phenylalanine in patients with treated phenylketonuria . J Clin Invest . 1985;;75: 40-48.
Eisenberg J, Asnis GM, van Praag HM, Vela RM.  Effect of tyrosine on attention deficit disorder with hyperactivity . Clin Psychiatry . 1988;;49:193-195.

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