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Guanidinoacetate methyltransferase (GAMT) deficiency: a rare but treatable epilepsy
  1. William M Stern1,2,
  2. Joel S Winston3,4,
  3. Elaine Murphy5,
  4. J Helen Cross6,
  5. Josemir W Sander1,2,7
  1. 1 Department of Clinical and Experimental Epilepsy, NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London, UK
  2. 2 Epilepsy Society, London, UK
  3. 3 Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, UK
  4. 4 Department of Neurophysiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  5. 5 Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
  6. 6 Institute of Child Health, UCL, London, UK
  7. 7 Stichting Epilepsie Instellingen Nederland (SEIN), Netherlands, UK
  1. Correspondence to Dr William M Stern, Clinical and Experimental Epilepsy, Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK; williamstern{at}


Epilepsy commonly presents in childhood as part of a syndrome, and some such children may reach adult services without an underlying syndromic diagnosis. For adult neurologists taking over their care, it is often unclear how hard to search for an underlying diagnosis. The diagnostic yield may be small and such a diagnosis may not change management. Young adults with learning difficulties are also challenging to investigate, as they may not tolerate standard epilepsy tests.

We present such a case in which simple tests identified a unifying diagnosis. With the new diagnosis came a new treatment that had a significant impact on seizures and quality of life.

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