{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:45:00Z","timestamp":1781639100570,"version":"3.54.5"},"reference-count":23,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Child Neurology Open"],"published-print":{"date-parts":[[2020,1,1]]},"abstract":"<jats:p>This case report describes 2 siblings with myoclonic epilepsy who had novel mutations in the glutamine synthetase ( GLUL) gene: c.316C&gt;T, p.(Arg106*) and c.42G&gt;C, p.(Lys14Asn). Valproic acid improved seizure control, but was associated with hyperammonemic encephalopathy. Addition of carglumic acid reduced ammonia levels but drug coverage was declined. We therefore designed a protocol to measure the reduction in plasma ammonia in response to carglumic acid therapy. After the first dose of carglumic acid, Patient 1 showed a reduction in plasma ammonia levels within 3 hours, from 114 umol\/L to 68 umol\/L (reference 12-47 umol\/L), and Patient 2 from 108 umol\/L to 80 umol\/L, which was sustained over a 2 week period. Overall, there was a strong negative correlation between plasma ammonia levels and carglumic acid levels (r = \u22120.86, p = 0.0013), and recurrence of hyperammonemic encephalopathy was not observed while the patients were taking carglumic acid.<\/jats:p>","DOI":"10.1177\/2329048x20967880","type":"journal-article","created":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T05:15:09Z","timestamp":1603343709000},"page":"2329048X2096788","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Two Siblings With Valproate-Related Hyperammonemia and Novel Mutations in Glutamine Synthetase\n                    <i>(GLUL)<\/i>\n                    Treated With Carglumic Acid"],"prefix":"10.1177","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0701-4002","authenticated-orcid":false,"given":"Jennifer","family":"Bennett","sequence":"first","affiliation":[{"name":"Department of Medical Genetics and 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