The Utility of CSF for the Diagnosis of Primary and Secondary Monoamine Neurotransmitter Deficiencies

Abstract

Biogenic amine defects constitute a complex and expanding group of neurotransmitter disorders affecting cognitive, motor and autonomic system development, mostly in the pediatric age. In recent years different enzymatic defects have been identified impairing the tetrahydrobiopterin cofactor pathway and/or biogenic amine synthesis, catabolism and transport, with subsequent new disease entities described. The lumbar puncture, with subsequent withdrawal of cerebrospinal fluid (CSF), remains a key step in the diagnostic procedure. Due to the specific nature of CSF, timing of analysis, sample collection and storage, technical issues of the analytic process are still crucial for the diagnosis and follow-up of patients. A progressive approach to the diagnosis of biogenic amine defects is presented, pointing out criticalities and difficulties concerning sample collection and results interpretation, especially due to the increasing reports of secondary neurotransmitter alterations that, at present, constitute a challenge.

Keywords: cerebrospinal fluid; monoamine neurotransmitter deficiencies; tetrahydrobiopterin defects.

Figure 1

Biochemical pathways involving dopamine, serotonin, epinephrine, norepinephrine, and the cofactor BH4

Figure 2

Example chromatograms