Vladimír Bzdúch, Darina Behúlová, Miriam Kolníková, Martina Skokňová, Katarína Brennerová
Nonketotic hyperglycinemia (McKusick 23830) or glycine encephalopathy is an inborn error of glycine degradation by defects of the glycine cleavage complex, in which large quantities of glycine accumulate in all body fluids, such as plasma, urine, and, particularly, cerebrospinal fluid. It is characterized by rapidly progressing neurological symptoms and despite the treatment with poor prognosis. Diagnosis is based on elevation of glycine level in cerebrospinal fluids and the ratio of CSF to plasma glycine concentration (more than 0.09), while in normal it is below 0.04. NKH is classified into four types based on the onset of disease: neonatal, infantile, late-onset, and transient types. Neonatal type is the most common subtype of nonketotic hyperglycinemia. The standard treatment strategies include sodium benzoate to reduce plasma concentration of glycine and NMDA receptor antagonist dextromethorphan. None of the current treatment strategies changes the neurodevelopmental course or ameliorates the mental retardation. Lately, a new therapy with ketogenic diet has been established showing benefitial effect not only on seizure activity, but on the concentration of cerebrospinal fluid glycine. Experience of other patients are required to confirm effect of ketogenic diet on disease course. There is a special demand for prenatal diagnosis, since no effective treatment has been established to date.