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Biotin-responsive basal ganglia disease(BBTGD)

MedGen UID:
375289
Concept ID:
C1843807
Disease or Syndrome
Synonyms: BBTGD; Biotin-thiamine-responsive basal ganglia disease; THIAMINE METABOLISM DYSFUNCTION SYNDROME 2 (BIOTIN- AND THIAMINE-RESPONSIVE TYPE); Thiamine metabolism dysfunction syndrome 2 (biotin- or thiamine-responsive encephalopathy type 2); Thiamine metabolism dysfunction syndrome type 2; Thiamine Transporter-2 Deficiency; thiamine-responsive encephalopathy
SNOMED CT: Thiamine transporter-2 deficiency (703522009); Thiamine metabolism dysfunction syndrome 2 (703522009); Biotin-responsive basal ganglia disease (703522009); Biotin-thiamine-responsive basal ganglia disease (703522009); Thiamine-responsive encephalopathy (723557004)
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): SLC19A3 (2q36.3)
 
Monarch Initiative: MONDO:0011841
OMIM®: 607483
Orphanet: ORPHA65284

Disease characteristics

Biotin-thiamine-responsive basal ganglia disease (BTBGD) may present in childhood, early infancy, or adulthood. The classic presentation of BTBGD occurs in childhood (age 3-10 years) and is characterized by recurrent subacute encephalopathy manifest as confusion, seizures, ataxia, dystonia, supranuclear facial palsy, external ophthalmoplegia, and/or dysphagia which, if left untreated, can eventually lead to coma and even death. Dystonia and cogwheel rigidity are nearly always present; hyperreflexia, ankle clonus, and Babinski responses are common. Hemiparesis or quadriparesis may be seen. Episodes are often triggered by febrile illness or mild trauma or stress. Simple partial or generalized seizures are easily controlled with anti-seizure medication. An early-infantile Leigh-like syndrome / atypical infantile spasms presentation occurs in the first three months of life with poor feeding, vomiting, acute encephalopathy, and severe lactic acidosis. An adult-onset Wernicke-like encephalopathy presentation is characterized by acute onset of status epilepticus, ataxia, nystagmus, diplopia, and ophthalmoplegia in the second decade of life. Prompt administration of biotin and thiamine early in the disease course results in partial or complete improvement within days in the childhood and adult presentations, but most with the infantile presentation have had poor outcome even after supplementation with biotin and thiamine. [from GeneReviews]
Authors:
Brahim Tabarki  |  Amal Al-Hashem  |  Majid Alfadhel   view full author information

Additional descriptions

From OMIM
Biotin-thiamine-responsive basal ganglia disease (BTBGD), also known metabolism dysfunction syndrome-2 (THMD2) or thiamine-responsive encephalopathy, is an autosomal recessive metabolic disorder characterized by episodic encephalopathy, often triggered by febrile illness, presenting as confusion, seizures, external ophthalmoplegia, dysphagia, and sometimes coma and death. Administration of high doses of biotin, and sometimes thiamine, during these crises results in partial or complete improvement within days. If untreated, encephalopathies can result in permanent dystonia. Brain imaging may show characteristic bilateral lesions of the basal ganglia. It is not known why biotin administration results in clinical improvement, as the molecular basis of the disorder is mutation in a gene encoding a thiamine transporter. However, biotin may increase the gene expression of SLC19A3 (summary by Debs et al., 2010). For a discussion of genetic heterogeneity of disorders due to thiamine metabolism dysfunction, see THMD1 (249270).  http://www.omim.org/entry/607483
From MedlinePlus Genetics
Biotin-thiamine-responsive basal ganglia disease is a disorder that affects the nervous system, including a group of structures in the brain called the basal ganglia, which help control movement. As its name suggests, the condition may improve if the vitamins biotin and thiamine are given as treatment. Without early and lifelong vitamin treatment, people with biotin-thiamine-responsive basal ganglia disease experience a variety of neurological problems that gradually get worse. The occurrence of specific neurological problems and their severity vary even among affected individuals within the same family.

The signs and symptoms of biotin-thiamine-responsive basal ganglia disease usually begin between the ages of 3 and 10, but the disorder can appear at any age. Many of the neurological problems that can occur in biotin-thiamine-responsive basal ganglia disease affect movement, and can include involuntary tensing of various muscles (dystonia), muscle rigidity, muscle weakness on one or both sides of the body (hemiparesis or quadriparesis), problems coordinating movements (ataxia), and exaggerated reflexes (hyperreflexia). Movement problems can also affect the face, and may include the inability to move facial muscles due to facial nerve paralysis (supranuclear facial palsy), paralysis of the eye muscles (external ophthalmoplegia), difficulty chewing or swallowing (dysphagia), and slurred speech. Affected individuals may also experience confusion, loss of previously learned skills, intellectual disability, and seizures. Severe cases may result in coma and become life-threatening.

Typically, the neurological symptoms occur as increasingly severe episodes, which may be triggered by fever, injury, or other stresses on the body. Less commonly, the signs and symptoms persist at the same level or slowly increase in severity over time rather than occurring as episodes that come and go. In these individuals, the neurological problems are usually limited to dystonia, seizure disorders, and delay in the development of mental and motor skills (psychomotor delay).  https://medlineplus.gov/genetics/condition/biotin-thiamine-responsive-basal-ganglia-disease

Clinical features

From HPO
Dysphagia
MedGen UID:
41440
Concept ID:
C0011168
Disease or Syndrome
Difficulty in swallowing.
Vomiting
MedGen UID:
12124
Concept ID:
C0042963
Sign or Symptom
Forceful ejection of the contents of the stomach through the mouth by means of a series of involuntary spasmic contractions.
Chorea
MedGen UID:
3420
Concept ID:
C0008489
Disease or Syndrome
Chorea (Greek for 'dance') refers to widespread arrhythmic involuntary movements of a forcible, jerky and restless fashion. It is a random-appearing sequence of one or more discrete involuntary movements or movement fragments. Movements appear random because of variability in timing, duration or location. Each movement may have a distinct start and end. However, movements may be strung together and thus may appear to flow randomly from one muscle group to another. Chorea can involve the trunk, neck, face, tongue, and extremities.
Coma
MedGen UID:
1054
Concept ID:
C0009421
Disease or Syndrome
The complete absence of wakefulness and consciousness, which is evident through a lack of response to any form of external stimuli.
Confusion
MedGen UID:
3587
Concept ID:
C0009676
Mental or Behavioral Dysfunction
Lack of clarity and coherence of thought, perception, understanding, or action.
Dysarthria
MedGen UID:
8510
Concept ID:
C0013362
Mental or Behavioral Dysfunction
Dysarthric speech is a general description referring to a neurological speech disorder characterized by poor articulation. Depending on the involved neurological structures, dysarthria may be further classified as spastic, flaccid, ataxic, hyperkinetic and hypokinetic, or mixed.
Dystonic disorder
MedGen UID:
3940
Concept ID:
C0013421
Sign or Symptom
An abnormally increased muscular tone that causes fixed abnormal postures. There is a slow, intermittent twisting motion that leads to exaggerated turning and posture of the extremities and trunk.
Lethargy
MedGen UID:
7310
Concept ID:
C0023380
Sign or Symptom
A state of disinterest, listlessness, and indifference, resulting in difficulty performing simple tasks or concentrating.
Mutism
MedGen UID:
6476
Concept ID:
C0026884
Disease or Syndrome
Inability to speak or communicate verbally past the age of typical language development.
Babinski sign
MedGen UID:
19708
Concept ID:
C0034935
Finding
Upturning of the big toe (and sometimes fanning of the other toes) in response to stimulation of the sole of the foot. If the Babinski sign is present it can indicate damage to the corticospinal tract.
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.
Encephalopathy
MedGen UID:
39314
Concept ID:
C0085584
Disease or Syndrome
Encephalopathy is a term that means brain disease, damage, or malfunction. In general, encephalopathy is manifested by an altered mental state.
Opisthotonus
MedGen UID:
56246
Concept ID:
C0151818
Sign or Symptom
Paraparesis
MedGen UID:
113150
Concept ID:
C0221166
Sign or Symptom
Weakness or partial paralysis in the lower limbs.
Abnormal pyramidal sign
MedGen UID:
68582
Concept ID:
C0234132
Sign or Symptom
Functional neurological abnormalities related to dysfunction of the pyramidal tract.
Action tremor
MedGen UID:
65875
Concept ID:
C0234376
Sign or Symptom
A tremor present when the limbs are active, either when outstretched in a certain position or throughout a voluntary movement.
Tetraparesis
MedGen UID:
78731
Concept ID:
C0270790
Finding
Weakness of all four limbs.
Loss of speech
MedGen UID:
107445
Concept ID:
C0542223
Finding
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.
Inability to walk
MedGen UID:
107860
Concept ID:
C0560046
Finding
Incapability to ambulate.
Gait ataxia
MedGen UID:
155642
Concept ID:
C0751837
Sign or Symptom
A type of ataxia characterized by the impairment of the ability to coordinate the movements required for normal walking. Gait ataxia is characteirzed by a wide-based staggering gait with a tendency to fall.
Developmental regression
MedGen UID:
324613
Concept ID:
C1836830
Disease or Syndrome
Loss of developmental skills, as manifested by loss of developmental milestones.
Truncal titubation
MedGen UID:
382380
Concept ID:
C2674512
Finding
Tremor of the trunk in an anterior-posterior plane at 3-4 Hz.
Irritability
MedGen UID:
397841
Concept ID:
C2700617
Mental Process
A proneness to anger, i.e., a tendency to become easily bothered or annoyed.
Abnormal pyramidal tract morphology
MedGen UID:
892809
Concept ID:
C4021761
Anatomical Abnormality
Any structural abnormality of the pyramidal tract, whose chief element, the corticospinal tract, is the only direct connection between the brain and the spinal cord. In addition to the corticospinal tract, the pyramidal system includes the corticobulbar, corticomesencephalic, and corticopontine tracts.
Craniofacial dystonia
MedGen UID:
868612
Concept ID:
C4023011
Disease or Syndrome
A form of focal dystonia affecting the face and especially the jaw that is induced by the act of speaking. It is an involuntary contraction of the masticatory muscles, resulting in dysarthria or dysphagia.
Abnormal basal ganglia morphology
MedGen UID:
1619147
Concept ID:
C4520981
Anatomical Abnormality
Abnormality of the basal ganglia.
Hypertonia
MedGen UID:
10132
Concept ID:
C0026826
Finding
A condition in which there is increased muscle tone so that arms or legs, for example, are stiff and difficult to move.
Rigidity
MedGen UID:
7752
Concept ID:
C0026837
Sign or Symptom
Continuous involuntary sustained muscle contraction. When an affected muscle is passively stretched, the degree of resistance remains constant regardless of the rate at which the muscle is stretched. This feature helps to distinguish rigidity from muscle spasticity.
Cogwheel rigidity
MedGen UID:
57469
Concept ID:
C0151564
Sign or Symptom
A type of rigidity in which a muscle responds with cogwheellike jerks to the use of constant force in bending the limb (i.e., it gives way in little, repeated jerks when the muscle is passively stretched).
Facial palsy
MedGen UID:
87660
Concept ID:
C0376175
Disease or Syndrome
Facial nerve palsy is a dysfunction of cranial nerve VII (the facial nerve) that results in inability to control facial muscles on the affected side with weakness of the muscles of facial expression and eye closure. This can either be present in unilateral or bilateral form.
Frequent falls
MedGen UID:
163408
Concept ID:
C0850703
Finding
Axial hypotonia
MedGen UID:
342959
Concept ID:
C1853743
Finding
Muscular hypotonia (abnormally low muscle tone) affecting the musculature of the trunk.
Fever
MedGen UID:
5169
Concept ID:
C0015967
Sign or Symptom
Body temperature elevated above the normal range.
Ptosis
MedGen UID:
2287
Concept ID:
C0005745
Disease or Syndrome
The upper eyelid margin is positioned 3 mm or more lower than usual and covers the superior portion of the iris (objective); or, the upper lid margin obscures at least part of the pupil (subjective).
Nystagmus
MedGen UID:
45166
Concept ID:
C0028738
Disease or Syndrome
Rhythmic, involuntary oscillations of one or both eyes related to abnormality in fixation, conjugate gaze, or vestibular mechanisms.
External ophthalmoplegia
MedGen UID:
57662
Concept ID:
C0162292
Disease or Syndrome
Paralysis of the external ocular muscles.

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVBiotin-responsive basal ganglia disease
Follow this link to review classifications for Biotin-responsive basal ganglia disease in Orphanet.

Professional guidelines

PubMed

Kassem H, Wafaie A, Alsuhibani S, Farid T
AJNR Am J Neuroradiol 2014 Oct;35(10):1990-5. Epub 2014 May 8 doi: 10.3174/ajnr.A3966. PMID: 24812013Free PMC Article

Recent clinical studies

Etiology

Tabarki B, Alfadhel M, AlShahwan S, Hundallah K, AlShafi S, AlHashem A
Eur J Paediatr Neurol 2015 Sep;19(5):547-52. Epub 2015 Jun 12 doi: 10.1016/j.ejpn.2015.05.008. PMID: 26095097
Kassem H, Wafaie A, Alsuhibani S, Farid T
AJNR Am J Neuroradiol 2014 Oct;35(10):1990-5. Epub 2014 May 8 doi: 10.3174/ajnr.A3966. PMID: 24812013Free PMC Article
Tabarki B, Al-Shafi S, Al-Shahwan S, Azmat Z, Al-Hashem A, Al-Adwani N, Biary N, Al-Zawahmah M, Khan S, Zuccoli G
Neurology 2013 Jan 15;80(3):261-7. Epub 2012 Dec 26 doi: 10.1212/WNL.0b013e31827deb4c. PMID: 23269594
Bindu PS, Noone ML, Nalini A, Muthane UB, Kovoor JM
J Child Neurol 2009 Jun;24(6):750-2. doi: 10.1177/0883073808329525. PMID: 19491117

Diagnosis

Kelsch RD, Nolan DA, Krishnan A
Pediatr Radiol 2021 Mar;51(3):485-488. Epub 2020 Sep 30 doi: 10.1007/s00247-020-04829-4. PMID: 33000323
Alfadhel M, Tabarki B
Neuropediatrics 2018 Apr;49(2):83-92. Epub 2017 Sep 29 doi: 10.1055/s-0037-1607191. PMID: 28962040
Alfadhel M, Almuntashri M, Jadah RH, Bashiri FA, Al Rifai MT, Al Shalaan H, Al Balwi M, Al Rumayan A, Eyaid W, Al-Twaijri W
Orphanet J Rare Dis 2013 Jun 6;8:83. doi: 10.1186/1750-1172-8-83. PMID: 23742248Free PMC Article
Tabarki B, Al-Shafi S, Al-Shahwan S, Azmat Z, Al-Hashem A, Al-Adwani N, Biary N, Al-Zawahmah M, Khan S, Zuccoli G
Neurology 2013 Jan 15;80(3):261-7. Epub 2012 Dec 26 doi: 10.1212/WNL.0b013e31827deb4c. PMID: 23269594
El-Hajj TI, Karam PE, Mikati MA
Neuropediatrics 2008 Oct;39(5):268-71. Epub 2009 Mar 17 doi: 10.1055/s-0028-1128152. PMID: 19294600

Therapy

Oommen AT, Polavarapu K, Christopher R, Netravathi M
Neurol India 2022 Mar-Apr;70(2):733-736. doi: 10.4103/0028-3886.344659. PMID: 35532649
Kelsch RD, Nolan DA, Krishnan A
Pediatr Radiol 2021 Mar;51(3):485-488. Epub 2020 Sep 30 doi: 10.1007/s00247-020-04829-4. PMID: 33000323
Kassem H, Wafaie A, Alsuhibani S, Farid T
AJNR Am J Neuroradiol 2014 Oct;35(10):1990-5. Epub 2014 May 8 doi: 10.3174/ajnr.A3966. PMID: 24812013Free PMC Article
Alfadhel M, Almuntashri M, Jadah RH, Bashiri FA, Al Rifai MT, Al Shalaan H, Al Balwi M, Al Rumayan A, Eyaid W, Al-Twaijri W
Orphanet J Rare Dis 2013 Jun 6;8:83. doi: 10.1186/1750-1172-8-83. PMID: 23742248Free PMC Article
Tabarki B, Al-Shafi S, Al-Shahwan S, Azmat Z, Al-Hashem A, Al-Adwani N, Biary N, Al-Zawahmah M, Khan S, Zuccoli G
Neurology 2013 Jan 15;80(3):261-7. Epub 2012 Dec 26 doi: 10.1212/WNL.0b013e31827deb4c. PMID: 23269594

Prognosis

Tabarki B, Al-Shafi S, Al-Shahwan S, Azmat Z, Al-Hashem A, Al-Adwani N, Biary N, Al-Zawahmah M, Khan S, Zuccoli G
Neurology 2013 Jan 15;80(3):261-7. Epub 2012 Dec 26 doi: 10.1212/WNL.0b013e31827deb4c. PMID: 23269594
Bindu PS, Noone ML, Nalini A, Muthane UB, Kovoor JM
J Child Neurol 2009 Jun;24(6):750-2. doi: 10.1177/0883073808329525. PMID: 19491117
Ozand PT, Gascon GG, Al Essa M, Joshi S, Al Jishi E, Bakheet S, Al Watban J, Al-Kawi MZ, Dabbagh O
Brain 1998 Jul;121 ( Pt 7):1267-79. doi: 10.1093/brain/121.7.1267. PMID: 9679779

Clinical prediction guides

Tabarki B, Alfadhel M, AlShahwan S, Hundallah K, AlShafi S, AlHashem A
Eur J Paediatr Neurol 2015 Sep;19(5):547-52. Epub 2015 Jun 12 doi: 10.1016/j.ejpn.2015.05.008. PMID: 26095097
Kassem H, Wafaie A, Alsuhibani S, Farid T
AJNR Am J Neuroradiol 2014 Oct;35(10):1990-5. Epub 2014 May 8 doi: 10.3174/ajnr.A3966. PMID: 24812013Free PMC Article
Tabarki B, Al-Shafi S, Al-Shahwan S, Azmat Z, Al-Hashem A, Al-Adwani N, Biary N, Al-Zawahmah M, Khan S, Zuccoli G
Neurology 2013 Jan 15;80(3):261-7. Epub 2012 Dec 26 doi: 10.1212/WNL.0b013e31827deb4c. PMID: 23269594

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