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Cerebral lactic acidosis correlates with neurological impairment in MELAS

From the Departments of Neurology (Drs. Kaufmann, Sano, Mitsis, Shanske, Hirano, DiMauro, and De Vivo, and S. Jhung and K. Engelstad), Pediatrics (S. Jhung and K. Engelstad, and Dr. De Vivo), and Radiology (Dr. Shungu and X. Mao), The Gertrude H. Sergievsky Center (Dr. Sano), Columbia University, New York, NY.

Address correspondence and reprint requests to Dr. Darryl C. De Vivo, The Neurological Institute, Columbia University, 710 W 168th Street, New York, NY 10032; e-mail: dcd1{at}columbia.edu

Objective: To evaluate the role of chronic cerebral lactic acidosis in mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS).

Methods: The authors studied 91 individuals from 34 families with MELAS and the A3243G point mutation and 15 individuals from two families with myoclonus epilepsy and ragged red fibers (MERRF) and the A8344G mutation. Subjects were divided into four groups. Paternal relatives were studied as controls (Group 1). The maternally related subjects were divided clinically into three groups: asymptomatic (no clinical evidence of neurologic disease) (Group 2), oligosymptomatic (neurologic symptoms but without the full clinical picture of MELAS or MERRF) (Group 3), and symptomatic (fulfilling MELAS or MERRF criteria) (Group 4). The authors performed a standardized neurologic examination, neuropsychological testing, MRS, and leukocyte DNA analysis in all subjects.

Results: The symptomatic and oligosymptomatic MELAS subjects had significantly higher ventricular lactate than the other groups. There was a significant correlation between degree of neuropsychological and neurologic impairment and cerebral lactic acidosis as estimated by ventricular MRS lactate levels.

Conclusions: High levels of ventricular lactate, the brain spectroscopic signature of MELAS, are associated with more severe neurologic impairment.

Received May 6, 2003. Accepted in final form December 15, 2003.

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