Multi-focal Stimulation of the Cortico-cerebellar Loop During the Acquisition of a Novel Hand Motor Skill in Chronic Stroke Survivors.

Impairment of hand motor function is a frequent consequence after a stroke and strongly determines the ability to regain a self-determined life. An influential research strategy for improving motor deficits is the combined application of behavioral training and non-invasive brain stimulation of the motor cortex (M1). However, a convincing clinical translation of the present stimulation strategies has not been achieved yet. One alternative and innovative approach is to target the functionally relevant brain network-based architecture, e.g., the dynamic interactions within the cortico-cerebellar system during learning. Here, we tested a sequential multifocal stimulation strategy targeting the cortico-cerebellar loop. Anodal transcranial direct current stimulation (tDCS) was applied simultaneously to a hand-based motor training in N = 11 chronic stroke survivors during four training sessions on two consecutive days. The tested conditions were: sequential multifocal (M1-cerebellum (CB)-M1-CB) vs. monofocal control stimulation (M1-sham-M1-sham). Additionally, skill retention was assessed 1 and 10 days after the training phase. Paired-pulse transcranial magnetic stimulation data were recorded to characterize stimulation response determining features. The application of CB-tDCS boosted motor behavior in the early training phase in comparison to the control condition. No faciliatory effects on the late training phase or skill retention were detected. Stimulation response variability was related to the magnitude of baseline motor ability and short intracortical inhibition (SICI). The present findings suggest a learning phase-specific role of the cerebellar cortex during the acquisition of a motor skill in stroke and that personalized stimulation strategies encompassing several nodes of the underlying brain network should be considered.

Free asymmetric dimethylarginine (ADMA) is low in children and adolescents with classical phenylketonuria (PKU).

INTRODUCTION: Free asymmetric dimethylarginine (ADMA) is a competitive inhibitor of the nitric oxide synthases (NOS). Suppression of nitric oxide (NO) synthesis increases the risk of atherosclerosis. Nevertheless, in the condition of oxidative stress, NOS blockade by ADMA may exert protective effects. Protein metabolism is altered in patients with phenylketonuria (PKU) on dietary treatment and as shown recently, oxidative stress is high in PKU. Since free ADMA concentrations are determined by both protein metabolism and oxidative stress we hypothesized, that free ADMA levels may be elevated in PKU patients. DESIGN: Sixteen patientswith PKU on dietary treatment (mean age 10.1 ± 5.2 yrs), and 91 healthy children (mean age 11.6 ± 3.7 yrs) participated in a cross sectional study. RESULTS: ADMA, total homocysteine (tHcy) and blood glucose were lower and the L-arginine/ADMA ratio was higher in PKU patients compared to controls. No significant correlation was present between phenylalanine (Phe) concentrations, protein intake, and lipid profile, history of cardiovascular disease or ADMA. DISCUSSION: In contrast to our hypothesis, ADMAwas lower and the L-arginine/ADMA ratio was higher in PKU patients. Therefore, in PKU patients, the regulating function of ADMA on NO synthesis is altered and may thus contribute to oxidative stress.

[Interest and costs of neurorehabilitation of brain injury patients]. / Intérêt et coût de la réadaptation neurologique des patients cérébrolésés.

The severity of the initial deficit and the improvement in the first weeks are the strongest indicators for a favorable outcome after stroke. Meta-analyses attempt to evaluate the efficacy of neurorehabilitation, but the results are unconclusive due to the heterogeinity of the groups of patients and therapies. However, there is sufficient data to conclude that repetitive, high intensity, task orientated training is efficacious. New approaches (mental imagery, robotics, virtual therapies...) are also useful but are not better than physiotherapy. It is as important to individualize the approach in a multidisciplinary well organised and communicative setting and to treat early complications. Cerebral plasticity is an individualized process and limited in time, so therapy should be regularly adapted and stopped if the deficit remains stable.

Comparison of tetrahydrofuran and ethyl acetate as extraction solvents for urinary organic acid analysis.

The analysis of urinary organic acids is crucial for the diagnosis of many inborn errors of metabolism. A vital part of the analytical process is the extraction procedure. The sensitivity and linearity of the analysis of 26 diagnostically important urinary metabolites with tetrahydrofuran (THF) and ethyl acetate (EtOAc) as extraction solvents were determined by gas chromatography-mass spectrometry. Good linearity (r (2) > 0.90) was observed for all of the compounds in the investigated concentration range (290-900 mumol/L) for both solvents. For less polar compounds, THF extraction yielded lower or similar sensitivities as compared with EtOAc (sensitivity ratio: 0.6-1.3). For more polar compounds, however, much higher sensitivities were observed when THF was used (sensitivity ratio: 1.8-17.2). Our results provide information concerning the use of THF for the sensitive quantitative analysis of polar urinary metabolites which are difficult to quantify using EtOAc.

Characterization of seven novel mutations in seven patients with GAMT deficiency.

Guanidinoacetate methyltransferase (GAMT) deficiency is an autosomal recessive error of creatine synthesis characterized by cerebral creatine deficiency, accumulation of guanidinoacetate, mental retardation, epilepsy and extrapyramidal signs. So far, six mutations have been identified in seven patients. We investigated seven new patients by screening the promoter, 3'UTR, and six exons and exon/intron boundaries using direct sequencing and denaturing gradient gel electrophoresis. The clinical and biochemical phenotype was characterized by scoring the degree of main clinical manifestations and by determination of urinary guanidinoacetate concentrations and of GAMT activity in fibroblasts / lymphoblasts, respectively. We identified 7 novel mutations, including c.64dupG (exon 1; 4/14 alleles); c.59G>C (exon 1; 3/14 alleles); c.491delG (exon 5; 2/14 alleles); c.160G>C (exon 1; 2/14 alleles); and c.152A>C (exon 1; 1/14 alleles); c.526dupG (exon 5; 1/14 alleles); c.521G>A (exon 5; 1/14 alleles), and two polymorphisms c.626C>T (exon 6) and c.459+71G>A (intron 4). Frameshift and missense mutations in exon 1 were prevalent in the 4 patients with the severe phenotype, however a clear genotype-phenotype correlation has not been established in the limited number of patients characterized so far.

Molecular characterisation of 34 patients with biotinidase deficiency ascertained by newborn screening and family investigation.

This study characterises the spectrum of biotinidase mutations in 21 patients (17 families) with profound biotinidase deficiency (BD) and 13 unrelated patients with partial BD using a denaturing gradient gel electrophoretic mutation screening and selective sequencing approach. In 29 from 30 unrelated families we found biallelic mutations including four common mutations, D444H (frequency 23.3%), G98:d7i3(20.0%), Q456H(20.0%), T532M (15.0%) and nine rare mutations (V62M, R157H, A171T+D444H, C423W, D543H, L279W, N172S, V109G, 12236G-A) with frequencies less than 5.0%. Only three profound BD patients with G98:d7i3/G98:d7i3 and Q456H/Q456H genotypes and residual biotinidase activities of 0.0%, and 0.9% of normal activity developed clinical symptoms before biotin supplementation at 8 weeks of age. All other patients remained asymptomatic within the first months of life or even longer without treatment. Two patients homozygous for the frameshift mutation G98:d7i3 had no measurable residual enzyme activity. Twelve patients with partial BD had the D444H mutation in at least one allele. We conclude that, based on mutation analysis and biochemical examinations of the enzyme, it is currently not clearly predictable whether an untreated patient will develop symptoms or not, although it seems that patients with activities lower than 1% are at a high risk for developing symptoms of the disease early in life.

Tyrosine: an inhibitor of LDL oxidation and endothelial cell cytotoxicity initiated by superoxide/nitric oxide radicals.

Tyrosyl radicals can catalyze LDL oxidation. In addition to their LDL oxidizing ability, superoxide (O2.-)/nitric oxide (NO.) generate phenoxyl radicals when reacting with tyrosine. Therefore we tested if tyrosine can act as a pro-oxidant in O2.-/NO.-initiated LDL oxidation. When LDL was exposed to O2.-/NO., tyrosine exerted a strong inhibitory effect on O2.-/ NO.-initiated LDL oxidation as measured by TBARS formation and alteration in electrophoretic mobility of LDL. Tyrosine was also able to protect human endothelial cells from the cytotoxic effect of O2.-/NO.. Because O2.-/NO. can occur in vivo, the results may indicate that serum-free tyrosine could act as an efficacious physiological antioxidant in case of O2.-/NO.-initiated LDL oxidation and endothelial cell cytotoxicity.

Guanidinoacetate methyltransferase (GAMT) deficiency: non-invasive enzymatic diagnosis of a newly recognized inborn error of metabolism.

Guanidinoacetate methyltransferase deficiency is a newly recognized inborn error of creatine biosynthesis. Manifestation of neurologic symptoms occurs in infancy and is partly reversible upon oral substitution of creatine. In the first two index patients, enzymatic diagnosis was established in a liver biopsy, and the underlying molecular defect in the GAMT gene has been identified. In order to provide non-invasive biochemical diagnosis, we have developed an enzyme assay based on the formation of radiolabeled creatine from 14C guanidinoacetate and S-adenosylmethionine in concentrated and dialyzed extracts from cultivated skin fibroblasts, Epstein-Barr virus transformed lymphoblasts, and cultivated amniotic cells. Cells were investigated from controls, from 1 index patient with proven GAMT deficiency and from 3 additional patients with clinical and biochemical signs of GAMT deficiency. Separation of 14C guanidinoacetate from 14C creatine in the reaction mixture was accomplished by HPLC on Hypersil ODS column and radioactivity was determined in fractions according to respective UV signals. GAMT activities in control fibroblasts (n = 7), lymphoblasts (n = 8) and in amniotic cells (n = 2) were 0.38-0.56, 0.61-0.84 and 0.38-0.56 nmol/h/mg protein. Apparent Km values were 9.5-14.8 microM for guanidinoacetate and 68-78 microM for S-adenosylmethionine. In the index patient and in the three additional patients at risk, GAMT activity was < 0.1 nmol/h/mg protein. The assay described here allows non-invasive diagnosis of GAMT deficiency in patients at risk.

Changes of tissue creatine concentrations upon oral supplementation of creatine-monohydrate in various animal species.

Creatine is a nutritional supplement with major application as ergogenic and neuroprotective substrate. Varying supplementation protocols differing in dosage and duration have been applied but systematic studies of total creatine (creatine and phosphocreatine) content in the various organs of interest are lacking. We investigated changes of total creatine concentrations in brain, muscle, heart, kidney, liver, lung and venous/portal plasma of guinea pigs, mice and rats in response to 2-8 weeks oral creatine-monohydrate supplementation (1.3-2 g/kg/d; 1.4-2.8% of dietary intake). Analysis of creatine and phosphocreatine content was performed by high performance liquid chromatography. Total creatine was determined as the sum of creatine and phosphocreatine. Presupplementation total creatine concentrations were high in brain, skeletal and heart muscle (10-22 micromol/g wet weight), and low in liver, kidney and lung (5-8 micromol/g wet weight). During creatine supplementation, the relative increase of total creatine was low (15-55% of presupplementation values) in organs with high presupplementation concentrations, and high (260-500% of presupplementation values) in organs with low presupplementation concentrations. The increase of total creatine concentrations was most pronounced after 4 weeks of supplementation. In muscle, brain, kidney and lungs, an additional increase (p<0.01) was observed between 2-4 and 2-8 weeks of supplementation. Absolute concentrations of phosphocreatine increased, but there was no increase of the relative (percentual) proportion of phosphocreatine (14-45%) during supplementation. Statistical comparison of total creatine concentrations across the species revealed no systematically differences in organ distribution and in time points of supplementation. Results suggest that in organs with low presupplementation creatine levels (liver, kidney), a major determinant of creatine uptake is an extra-intracellular concentration gradient. In organs with high presupplementation total creatine levels like brain, skeletal and heart muscle, the maximum capacity of creatine accumulation is low compared to other organs. A supplementation period of 2 to 4 weeks is necessary for significant augmentation of the creatine pool in these organs.

Brain fatty acids in perinatal asphyxia.

In hypoxic or ischemic states the release of fatty acids is proposed to have several harmful effects on brain structure and function. We therefore decided to study brain FFA in a simple, clinically related animal model resembling intrauterine perinatal asphyxia (PA). Cerebral blood flow (CBF), brain fatty acids (C14:0, C16:1, C16:0, C18:1, C1 8:0, sigma C), plasma glucose, lactate, beta-hydroxybutyrate (beta-OHB), non-esterified fatty acids (NEFA) and insulin were determined in PA and compared to the normoxic state. Brain C 14:0 FFA were not significantly different from normoxic rats. Brain FFA C 16:0 were comparable between groups but significantly decreased at 20 min of PA. C 18:0 FFA showed a trend to increase with the length of PA reaching significance at 10 min of asphyxia only and were declining at 20 min, however, not significantly. Brain C 16:1 and C 18:1 FFA concentrations were comparable between groups. The parameters cerebral blood flow, glucose and lactate showed a stepwise and significant increase with the length of PA, whereas beta-HOB, NEFA and insulin showed no changes. CBF, glucose and lactate showed a strong association whereas other parameters failed to correlate with each other. Only inconsistent trends of increased brain FFA were found and the association between brain glucose and brain FFA could be ruled out. Although CBF was manifold and significantly elevated in PA, brain FFA pattern suggests that the increase of CBF is obviously not mediated by brain FFA. We conclude that FFA may not be involved in the early phase-pathogenesis of PA.

Ibuprofen inhibits pyrogen-dependent expression of VCAM-1 and ICAM-1 on human endothelial cells.

Leukocyte adhesion and transmigration through the endothelial cell (EC) layer plays a crucial role in inflammation. IL-1 alpha and TNF alpha increase EC-adhesiveness for leukocytes by stimulating surface expression of ICAM-1 (intercellular adhesion molecule 1, CD54), VCAM-1 (vascular cell adhesion molecule 1, CD106) and E-selectin (CD62E). In this study, the effects of ibuprofen on IL-1 alpha and TNF alpha-induced expression of ICAM-1, VCAM-1 and E-selectin on cultured human umbilical vein EC (HUVEC) were analyzed. Exposure to IL-1 alpha or TNF alpha resulted in an increased expression of VCAM-1, ICAM-1, and E-selectin. Ibuprofen was identified as a potent inhibitor of IL-1 alpha and TNF alpha-induced surface expression of VCAM-1 and a less potent inhibitor of pyrogen-induced expression of ICAM-1, whereas no effect on E-selectin was found. The effects of ibuprofen on VCAM-1 expression were dose-dependent (IC50 [IL-1 alpha]: 0.5 mM; IC50 [TNF alpha]: 0.5 mM) and time-dependent with maximum responses observed after 18 h. Moreover, ibuprofen abrogated pyrogen-dependent adhesion of leukocytes to HUVEC. Ibuprofen also inhibited VCAM-1 mRNA expression in pyrogen activated EC. VCAM-1-downregulation on EC by ibuprofen may contribute to the anti-inflammatory actions of the drug.

Serum homocyst(e)ine levels in women with preeclampsia.

BACKGROUND: Endothelial dysfunction has been described as the final common pathophysiological pathway in the development of preeclampsia. Since it has been suggested that homocyst(e)ine damages endothelial cells, we measured serum homocyst(e)ine levels in women with preeclampsia and in healthy pregnant women in order to find a new prognostic parameter for women with preeclampsia. METHODS: Forty-five women with preeclampsia and 45 healthy women with uncomplicated pregnancies, matched for age and parity, were entered into the study. Serum homocyst(e)ine levels were measured by gas chromatography-mass spectrometry analysis and correlated to clinical data. Logistic regression models were used to analyse the influence of serum homocyst(e)ine levels on the presence of preeclampsia versus healthy pregnant women and on the risk of premature termination of pregnancy due to preeclampsia. RESULTS: Median serum homocyst(e)ine levels in women with preeclampsia and healthy pregnant women were 14.2 (range 5.7-38.1) mumol/L and 15.1 (range 5.2-23.1) mumol/L, respectively (Mann-Whitney U-test, p = 0.8). In univariate logistic regression models, serum homocyst(e)ine levels had no significant influence on the odds of presenting with preeclampsia versus healthy pregnant women (univariate logistic regression model, p = 0.8) and on the odds of premature termination of pregnancy due to preeclampsia (univariate logistic regression model, p = 0.3). CONCLUSIONS: Serum homocyst(e)ine levels are not elevated in women with preeclampsia and are not associated with clinical outcome in women with preeclampsia.

Growth and parameters of microflora in intestinal and faecal samples of piglets due to application of a phytogenic feed additive.

A commercial phytogenic feed additive (PFA), containing the fructopolysaccharide inulin, an essential oil mix (carvacrol, thymol), chestnut meal (tannins) and cellulose powder as carrier substance, was examined for effects on growth and faecal and intestinal microflora of piglets. Two experiments (35 days) were conducted, each with 40 male castrated weaned piglets. In experiment 1, graded levels of the PFA were supplied (A1: control; B1: 0.05% PFA; C1: 0.1% PFA; D1: 0.15% PFA) in diets based on wheat, barley, soybean meal and fish meal with lysine as the limiting amino acid. In experiment 2, a similar diet with 0.1% of the PFA (A2: control; B2: 0.1% PFA; C2: +0.35% lysine; D2: 0.1% PFA + 0.35% lysine) and lysine supplementation was utilized. During experiment 1, no significant effect of the PFA on growth, feed intake and feed conversion rate was observed (p > 0.05). Lysine supplementation in experiment 2 improved growth performance significantly, but no significant effect of the PFA was detected. Microbial counts in faeces (aerobes, Gram negatives, anaerobes and lactobacilli) during the first and fifth week did not indicate any significant PFA effect (p > 0.05). In addition, microflora in intestinal samples was not significantly modified by supplementing the PFA (p > 0.05). Lysine supplementation indicated lysine as limiting amino acid in the basal diet, but did not influence the microbial counts in faeces and small intestine respectively.

No impact of a phytogenic feed additive on digestion and unspecific immune reaction in piglets.

Two 35 day experiments were conducted to examine the influence of a commercial phytogenic feed additive (PFA) on nutrient digestibility and unspecific immune reaction of piglets in the post-weaning period. The PFA composition was inulin, an essential oil mix (carvacrol and thymol), chestnut meal (tannins), and cellulose powder as carrier substance. In each experiment, immediately after weaning 40 male castrated piglets were divided into four experimental groups (n = 10). Diets were based on wheat, barley, soy bean meal and fishmeal using lysine as the first limiting amino acid. In experiment 1, graded levels of the PFA were supplied (A: control; B: 0.05% PFA; C: 0.1% PFA; D: 0.15% PFA). Experiment 2 utilized equal diets with 0.1% of the PFA, but different lysine supply (A: control; B: 0.1% PFA; C: +0.35% lysine; D: 0.1% PFA + 0.35% lysine). At the end of the experimental period, acute phase proteins (APPs) haptoglobin and C-reactive protein were examined in individual blood plasma samples. Following each growth study, 16 animals (n = 4) were taken for sampling of ileal chyme and assessing of praecaecal digestibility of protein and amino acids. In addition, digesta samples of the duodenum and the total pancreatic tissue were utilized for determining the enzyme activity of alpha-amylase and trypsin. APP, praecaecal digestibility and enzyme activities did not significantly respond to the PFA supplementaion in diets.

GAMT deficiency: features, treatment, and outcome in an inborn error of creatine synthesis.

BACKGROUND: Guanidinoactetate methyltransferase (GAMT) deficiency is an autosomal recessive disorder of creatine synthesis. The authors analyzed clinical, biochemical, and molecular findings in 27 patients. METHODS: The authors collected data from questionnaires and literature reports. A score including degree of intellectual disability, epileptic seizures, and movement disorder was developed and used to classify clinical phenotype as severe, moderate, or mild. Score and biochemical data were assessed before and during treatment with oral creatine substitution alone or with additional dietary arginine restriction and ornithine supplementation. RESULTS: Intellectual disability, epileptic seizures, guanidinoacetate accumulation in body fluids, and deficiency of brain creatine were common in all 27 patients. Twelve patients had severe, 12 patients had moderate, and three patients had mild clinical phenotype. Twenty-one of 27 (78%) patients had severe intellectual disability (estimated IQ 20 to 34). There was no obvious correlation between severity of the clinical phenotype, guanidinoacetate accumulation in body fluids, and GAMT mutations. Treatment resulted in almost normalized cerebral creatine levels, reduced guanidinoacetate accumulation, and in improvement of epilepsy and movement disorder, whereas the degree of intellectual disability remained unchanged. CONCLUSION: Guanidinoactetate methyltransferase deficiency should be considered in patients with unexplained intellectual disability, and urinary guanidinoacetate should be determined as an initial diagnostic approach.

Use of denaturing HPLC to provide efficient detection of mutations causing guanidinoacetate methyltransferase deficiency.

Guanidinoacetate methyltransferase (GAMT) deficiency is an autosomal recessive error of creatine synthesis characterized by cerebral creatine deficiency, accumulation of guanidinoacetate, mental retardation, epilepsy, and extrapyramidal symptoms. To date, 14 mutations of the GAMT gene in 27 patients have been reported. Mutation analysis was done using direct sequencing of PCR products and denaturing gradient gel electrophoresis in combination with direct sequencing. In contrast, we evaluated the efficiency of a newly developed DHPLC method to detect mutations in the GAMT gene by analysing DNA from 14 GAMT patients with known mutations. PCR amplification of both patient and control DNA was followed by formation of homoduplices and heteroduplices, and their detection by DHPLC. DHPLC identified all mutations tested and is the preferred choice of analytical method.

Lack of correlation between fatty acid oxidation disorders and haemolysis, elevated liver enzymes, low platelets (HELLP) syndrome?

AIM: Fatty acid beta-oxidation defects comprise a heterogeneous group of disorders that may precipitate acute life threatening metabolic crises particularly during catabolic episodes. Several studies have demonstrated a possible association between fatty acid beta-oxidation defects, including long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency and severe pregnancy complications. However, the precise percentage of women with haemolysis, elevated liver enzymes, low platelets (HELLP) syndrome associated with foetal fatty acid beta-oxidation defects is not known. METHODS: We carried out a multicentre retrospective study on 88 infants, born to women with HELLP syndrome. Acylcarnitine profiles from blood dried on filter paper cards were analysed by tandem mass spectrometry for the diagnosis of fatty acid beta-oxidation defects. In addition, we screened for the common long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency mutation using a standard restriction fragment length polymorphism polymerase chain reaction method. RESULTS: None of the infants studied carried the common long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency mutation. There was no evidence of fatty acid beta-oxidation defects, including long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency, as expected by unremarkable acylcarnitine profiles, while three infants with fatty acid beta-oxidation defects were diagnosed in the control group. CONCLUSIONS: Neither foetal long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency, including heterozygosity for the common long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency mutation, nor fatty acid beta-oxidation defects in general are a major risk factor for HELLP syndrome in Austria.

[The mid-growth spurt--a pre-puberty growth spurt. Review of its significance and biological correlations]. / Der Mid-Growth-Spurt (MGS)--ein präpubertärer Wachstumsschub. Uberblick über seine Bedeutung und mögliche biologische Zusammenhänge.

The MGS is a growth phenomenon during early childhood, expressed by a mild transitory acceleration of growth velocity between five and eight years of age. It appears to be more pronounced in boys than in girls. It is probably caused by the functional maturation of the adrenals ("adrenarche") which leads to an increased androgen production during this age. Interactions with the pituitary growth hormone, also presenting with increased secretion rates at this particular period, are very probable. A hypothesis is offered for the explanation of individual differences and distinctness of the MGS. Although the MGS cannot be interpreted as a very first step of puberty, some additional biochemical facts suggest fundamental changes in the organism. Therefore, the MGS could be regarded as a "marker" within the biological development of the child.

Human granulocyte elastase analysis on a clinical analyser (Greiner G-400) and comparison with the manual IMAC-Elastase method.

The performance of the human granulocyte elastase (EC 3.4.21.37) determination on the clinical analyser Greiner G-400 was evaluated. The detection limit of the assay is 4.68 micrograms/l. With pooled plasma samples, within-run variation (CV) ranged from 1.3 to 6.0%, between-run imprecision was 2.7 to 6.3%. Comparison with the homogenous immunoactivation manual assay using samples from 40 patients resulted in a very good correlation (r = 0.987). This suggests that the adapted instrumental method is able to replace the manual method for routine analyses.

Austrian report on longitudinal outcome in phenylketonuria.

Forty years after Horst Bickel first treated a patient suffering from phenylketonuria (PKU) our aim is to assess the current treatment of Austrian patients. A total of 70 children -60 with PKU and 10 with hyperphenylalaninaemia (HPA)-aged 6-16 years were investigated in terms of somatic and intellectual parameters. Their development is normal (PKU: mean IQ = 95.40; HPA: mean IQ = 101.85) owing to strict dietary control, above all during their first 6 years of life. A comparison of the IQ data of 17 PKU children and their healthy siblings at the age 6 years showed significant correlations in verbal, performance and IQ measurements. Austrian PKU patients do achieve normal IQ values but these measurements fail to guarantee the quality of dietary control. IQ is influenced by a number of variables: genetic, social environment, education and furtherance, motivation for performance, etc., and, in PKU patients, dietary control. The only currently known way of maintaining and improving dietary compliance in PKU patients and their families remains good informative counselling about the disease and psychosocial support.