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Porphyria and dementia: a case report

Published online by Cambridge University Press:  13 June 2014

Dympna Gibbons
Affiliation:
St Anne's Day Hospital, Roxboro Road, Limerick, Ireland
Anne Cullen
Affiliation:
Roscommon County Hospital, Roscommon, Ireland
Malcom Garland
Affiliation:
Beaumont Hospital, Ireland

Abstract

The porphyrias are a group of rare hereditary metabolic disorders where there is an excess formation and excretion of porphyrins or their precursors. Type IIA, acute intermittent porphyria (AIP), has an estimated prevalence of one to eight per 100,000 in the general population but is thought to have a higher prevalence in psychiatric patients. AIP can present with a variety of psychiatric symptoms, often misdiagnosed. Associated neuropathological changes including focal cerebral ischaemic lesions have been found. However, to our knowledge, no case of dementia and AIP has been described. We present the case of a 56 year old man with a five-year history of progressive cognitive decline, diagnosed with AIP at an advanced stage of dementia. Whether AIP contributed to the dementia or is a coincidental finding is unknown. However treatment of AIP in this case resulted in some improvement in the patient's cognitive state.

Type
Case reports
Copyright
Copyright © Cambridge University Press 2003

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References

1.Thadani, H, Deacon, A, Peters, T. Diagnosis and management of porphyria. BMJ 2000; 320: 1647–51.CrossRefGoogle ScholarPubMed
2.Patience, DA, Blackwood, DH, McColl, KE, Moore, MR. Acute intermittent porphyria and mental illness – A family study. Acta Psychiatr Scand 1994 Apr; 89(4): 262–7CrossRefGoogle ScholarPubMed
3.Deybach, JC, Puy, H. Porphobilinogen gene structure and molecular defects. J Bioenerg Biomembr 1995; 27: 197205CrossRefGoogle ScholarPubMed
4.Puy, H, Deybach, JC, Lamoril, Jet al.Molecular epidemiology and diagnosis of PBG deaminase gene defects in acute intermittent porphyria. Am J Hum Genet 1997 Jun; 45(6): 1216–7.Google Scholar
5.Goldberg, A. Acute intermittent porphyria: A study of 50 cases. Q J Med 1959; 28: 183209.Google ScholarPubMed
6.Ackner, B, Cooper, JE, Gray, CH, Kelly, M. Acute porphyria. A neuropsychiatry and biochemical study. J Psychom Res 1962; 6: 124.CrossRefGoogle Scholar
7.Santosh, PJ, Malhotra, S. Varied psychiatric manifestations of acute intermittent porphyria. Biol Psychiatry 1994; 36: 744–7.CrossRefGoogle ScholarPubMed
8.Elder, GH, Hift, RJ, Meissner, PN. The acute porphyrias. Lancet 1997; May 349: 1613–7.CrossRefGoogle ScholarPubMed
9.Tishler, PV, Woodward, B, O'Conner, Jet al.High prevalence of intermittent acute porphyria in a psychiatric population. Am J Psychiatry 1985 142: 1430–6.Google Scholar
10.Crimlisk, HL. The little imitator – porphyria: a neuropsychiatric disorder. J Neurol Neurosurg Psychiatry 1997 Apr; 62(4): 319–28.CrossRefGoogle ScholarPubMed
11.Moore, MR, McColl, KEL, Rimington, C, Goldberg, A. Disorders of porphyrin metabolism. New York: Plenum Press, 1987.CrossRefGoogle Scholar
12.Kauppinen, R, Mustajoki, P. Prognosis of acute porphyria :occurrence of acute attacks, precipitating factors and associated diseases. Medicine 1992; 71: 113.CrossRefGoogle ScholarPubMed
13.Disler, PB, Moore, MR. Drug therapy in acute porphyrias. Clin Dermatol 1985; 3: 112–24.CrossRefGoogle ScholarPubMed
14.Holroyd, S, Seward, RL. Psychotropic drugs in acute intermittent porphyria. Clin Pharmocol Ther 1999 Sep; 66(3): 323–5.CrossRefGoogle ScholarPubMed
15.Lip, GYH, McColl, KEL, Goldberg, A, Moore, RA. Smoking and recurrent attacks of acute intermittent porphyria. BMJ 1991; 302: 507–8.CrossRefGoogle ScholarPubMed
16.Massey, E. Neuropsychiatric Manifestations of Porphyria. J Clin Psychiatry 1980 Jun; 41(6): 208–13.Google ScholarPubMed
17.Bylesjo, I, Forsgren, C, Lithner, F, Bowman, K. Epidemiology and clinical characteristics of seizures in patients with acute intermittent porphyria. Epilepsia 1996 Mar; 37(3): 230–5.CrossRefGoogle ScholarPubMed
18.Zadra, M, Grandi, R, Erli, LC, Mirabile, D, Brambilla, A. Treatment of seizures in acute intermittent porphyria – safety and efficacy of gabapentin. Seizure 1998 Oct; 7(5): 415–6.CrossRefGoogle ScholarPubMed
19.Yandel, ML, Watters, MR. Treatment of complex partial status epilepticus unmasking acute intermittent porphyria in a patient with resected anaplastic glioma. Clin Neurol Neurosurg 1995 Aug; 97(3): 261–3.CrossRefGoogle Scholar
20.Tatum, WO 4th, Zachariah, SB. Gabapentin treatment of seizures in acute intermittent porphyria. Neurology 1995 Jun; 45(6): 1216–7.CrossRefGoogle ScholarPubMed
21.Yeung Laiwah, AA, Rapeport, WG, Thompson, GGet al.Carbamazepine- induced non-hereditary acute porphyria. Lancet 1983 Apr 9; 1(8328): 790–2.CrossRefGoogle ScholarPubMed
22.Burgovne, K, Swartz, R, Ananth, J. Porphyria: reexamination of psychiatric implications. Psychother Psychosom 1995; 64(3-4): 121–30CrossRefGoogle ScholarPubMed
23.Denny-Brown, D, Sciara, D. Changes in the nervous system in acute porphyria. Brain 1957; 80: 176–92.Google Scholar
24.Berg, M. Acute porphyria: clinical and pathological observations. Arch Intern Med 1945; 76: 335–40.CrossRefGoogle Scholar
25.Hierons, R. Changes in the nervous system in acute porphyria. Brain 1957; 80: 176–92.CrossRefGoogle ScholarPubMed
26.Lai, C-W, Hung, T-P, Lin, WSJ. Blindness of cerebral origin in acute intermittent porphyria: report of a case and postmortem examination. Arch Neurol 1977; 34: 310–2.CrossRefGoogle ScholarPubMed
27.King, PH, Bragdon, AC. MRI reveals multiple reversible cerebral lesions in an attack of acute intermittent porphyria. Neurology 1991 Aug; 41(8): 1300–2.CrossRefGoogle Scholar
28.Susa, S, Daimon, M, Morita, Yet al.Acute intermittent porphyria with central pontine myelolysis and cortical laminar necrosis. Neuroradiology 1999 Nov; 41(11): 835–9.CrossRefGoogle Scholar
29.Yeung Laiwah, AC, Moore, MRGoldberg, A. Pathogenesis of acute porphyria. Q J Med 1987 May; 63(241): 377–92.Google ScholarPubMed
30.De Verneuil, H, Ged, C, Boulechfar, S, Moreau-Gaudry, F. Porphyria: animal models and prospects for cellular and gene therapy. J Bioenerg Biomemb 1995 Apr; 27(2): 239–48.CrossRefGoogle ScholarPubMed
31.Lindberg, RLP, Porcher, C, Grandchamp, Bet al.Porphobilinogen deaminase deficiency in mice causes a neuropathy resembling that of human hepatic porphyria. Nat Genet 1996; 12: 195–99.CrossRefGoogle ScholarPubMed
32.Kauppinen, R. Management of the acute porphyrias. Photodermatol Photoimmunol Photomed 1998 Apr; 14(2): 48CrossRefGoogle ScholarPubMed
33.Badminton, MN, Elder, GH. Management of acute and cutaneous porphyrias. Int J Clin Pract 2002 May; 56(4): 272–8.CrossRefGoogle ScholarPubMed
34.Zadra, M, Grandi, R, Erli, LC, Mirabile, D, Brambilla, A. Treatment of seizures in acute intermittent porphyria: safety and efficacy of gabapentin. Seizure 1998 Oct; 7(5): 415–6.CrossRefGoogle ScholarPubMed
35.Tatum, WO 4th, Zachariah, SB. Gabapentin treatment of seizures in acute intermittent porphyria. Neurology 1995 Jun; 45(6): 1216–7.CrossRefGoogle ScholarPubMed
36.Holroyd, S, Seward, RL. Psychotropic drugs in acute intermittent porphyria. Clin Pharmacol Ther 1999 Sep; 66(3): 323–5.CrossRefGoogle ScholarPubMed
37.Tshudy, DP, Welland, FH, Collins, Aet al.The effect if carbohydrate feeding on the inductors of aminovallinic acid synthetase. Metabolism 1964; 13: 396406.CrossRefGoogle Scholar
38.Folstein, et al.Mini Mental State. J Psychiatr Res 1975: 12: 189–96.CrossRefGoogle ScholarPubMed