Brain glucose supply and the syndrome of infantile neuroglycopenia

Objective: To describe neuroglycopenia as a specific syndrome caused by insufficient glucose availability during brain development. Design: Neurologic examinations, neuropsychologic tests, biochemical methods, and functional imaging. Participants: Patients afflicted by genetic mutation of the cerebral glucose transporter type 1 and a patient afflicted by persistent infantile hypoglycemia (hyperinsulinism) matched to her healthy twin. Results: The hallmark of the phenotype is the combination of infantile epilepsy and cerebellar and pyramidal tract dysfunction, together with permanent neuropsychologic abnormalities and reduced thalamocortical glucose uptake despite subsequent supply of energetic substrate. Conclusions: When neuroglycopenia - the lack of adequate glucose supply to the nervous system - occurs in the developing brain, thalamic and cortical metabolism mature aberrantly, causing epilepsy associated with other characteristic neurologic and behavioral disturbances, a pattern also reflected in functional images, as if there were a temporal window during which glucose were crucial for brain development. When maturation is complete, glucose merely serves as a fuel, and then, when deficient, it only causes unrelated disturbances.