Authors: Mekka R. Garcia, MD, NYU Grossman School of Medicine; Alison L. Christy, MD, PhD, Providence Pediatric Neurology at St. Vincent Medical Center – Portland, Oregon
Reviewed: August 2021
SUMMARY
Aromatic L-amino acid decarboxylase deficiency (AADC deficiency) is a rare genetic disorder. It affects the brain. It causes problems with:
- Walking
- Eating
- Behavior
- Sleep
This is a rare disorder. Therefore, a thorough history, clinical examination, blood tests, and imaging are all key to diagnosis. There is no cure. However, supportive care is available.
Understanding AADC Deficiency
An enzyme is a protein that aids chemical reactions in the body. Aromatic L-amino acid decarboxylase (AADC) is an enzyme that helps produce neurotransmitters. These are chemical messengers. They help neurons, cells in the nervous system, communicate with each other.
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Disorder Overview
DESCRIPTION
AADC deficiency occurs when there is an abnormality in a gene called DDC. This gene produces AADC. When the DDC gene is different, AADC may not work as usual. There may be a decrease in AADC activity. This makes it harder for neurons to communicate.
Children with this disorder look normal at birth. However, they usually develop signs and symptoms of the deficiency within the first year of life.
SIGNS AND SYMPTOMS
Signs and symptoms of AADC deficiency often begin shortly after birth.
They may include:
Hypotonia
Oculogyric crises
Autonomic nervous system dysfunction
Seizures
Sleep disturbances
Diagnosis
A diagnosis of AADC deficiency requires:
- A complete medical history of birth, early life, and development
- A thorough physical examination in the clinic
- Blood testing
- Imaging of the nervous system
CAUSES
AADC deficiency occurs when there is an abnormal difference in a certain gene in the body. The gene is called the dopa decarboxylase gene or DDC gene. An abnormal DDC gene produces abnormal AADC enzymes. AADC enzymes are important for the formation of neurotransmitters. AADC deficiency affects two neurotransmitters in particular—dopamine and serotonin.
These are responsible for:
- Motor control
- Behavior
- Sleep
- The autonomic nervous system
Disease Inheritance
AADC deficiency is an autosomal recessive disorder. This means that a child with this disorder must inherit one abnormal gene from the mother and one abnormal gene from the father.
If a child inherits one abnormal gene and one normal gene:
- They will usually not have symptoms
- They will instead be called a “carrier” of the disorder
If both parents carry the abnormal gene:
- The risk of a child having the disorder is 25%, or 1 in 4, with each pregnancy
The risk of inheriting this disorder is the same for males and females. It is more common in people of Asian descent.
LABORATORY INVESTIGATIONS
There are a few ways to learn more about a child’s AADC deficiency.
Genetic Testing
Plasma AADC enzyme activity testing
Magnetic resonance imaging (MRI)
TREATMENT AND THERAPIES
There is no cure for AADC deficiency. Therefore, therapies are aimed at symptomatic and supportive care.
Medications used for this disorder include:
Supplements that are useful include:
Other forms of support include:
OUTLOOK
Most children with this disorder present with severe symptoms. As a result, many do not live through childhood. A small number of children have milder forms of the disease. They may reach adulthood. Usually, after infancy, signs and symptoms do not worsen with time.
RELATED DISORDERS
Conditions with similar symptoms include:
- Epilepsy
- Cerebral palsy
- Mitochondrial disease
- Neuromuscular disorders
Resources
ORGANIZATIONS/GROUPS
AADC Family Network
The ALADD Foundation, Inc. (now known as AADC Family Network) was established in 1998 and was the first foundation for AADC (Aromatic L Amino Acid Decarboxylase Deficiency). The foundation was established for the charitable and educational purposes of providing research, medical assistance, support, and awareness, and to participate in all services and activities designed to carry out and find a cure for AADC. You will find resources for physicians, helpful instructional care videos, and more to help you answer the question of “what now” on the website. Families can register with the foundation and apply for funding. AADC Family Network hosts a private Facebook group for families and caregivers.
ADDITIONAL RESOURCES
PTC Pinpoint Neurotransmitter Disorders Program
For children with symptoms of neurotransmitter disorders, such as AADC deficiency, PTC Therapeutics and Invitae are offering no-cost genetic testing, post-test genetic counseling, and family screening through the PTC Pinpoint Neurotransmitter Disorders Program.
One of the most common symptoms of AADC deficiency is involuntary eye movements called oculogyric crisis (see video here). These are moments when a child’s eyes suddenly roll upward or to the side involuntarily.
Talk to your doctor about testing with PTC Pinpoint if your child is experiencing symptoms of AADC deficiency. Also, check out this video to learn more about the Patient Engagement Team at PTC Therapeutics.
Child Neurology Foundation (CNF) solicits resources from the community to be included on this webpage through an application process. CNF reserves the right to remove entities at any time if information is deemed inappropriate or inconsistent with the mission, vision, and values of CNF.
Research
ClincalTrials.gov for Aromatic L-Amino Acid Decarboxylase Deficiency (AADC) are clinical trials that are recruiting or will be recruiting. Updates are made daily, so you are encouraged to check back frequently.
ClinicalTrials.gov is a database of privately and publicly funded clinical studies conducted around the world. This is a resource provided by the U.S. National Library of Medicine (NLM), which is an institute within the National Institutes of Health (NIH). Listing a study does not mean it has been evaluated by the U.S. Federal Government. Please read the NLM disclaimer for details.
Before participating in a study, you are encouraged to talk to your health care provider and learn about the risks and potential benefits.
Additional clinical trial information for AADC can be found here:
The information in the CNF Child Neurology Disorder Directory is not intended to provide diagnosis, treatment, or medical advice and should not be considered a substitute for advice from a healthcare professional. Content provided is for informational purposes only. CNF is not responsible for actions taken based on the information included on this webpage. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options.
References
Himmelreich N, Montioli R, Bertoldi M, et al. Aromatic amino acid decarboxylase deficiency: Molecular and metabolic basis and therapeutic outlook. Molecular Genetics and Metabolism. 2019; 127(1):12-22. https://doi.org/10.1016/j.ymgme.2019.03.009
Hyland K and Reott M. Prevalence of aromatic L-amino acid decarboxylase deficiency in at-risk populations. Pediatric Neurology. 2020; 106:38-42. https://doi.org/10.1016/j.pediatrneurol.2019.11.022
Wassenberg T, Molero-Luis M, Jeltsch K, et al. Consensus guideline for the diagnosis and treatment of aromatic L-amino acid decarboxylase (AADC) deficiency. Orphanet J Rare Dis. 2017;12:12. https://doi.org/10.1186/s13023-016-0522-z