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Severe multisystem symptoms require specialist evaluation Seizures, metabolic strokes, severe weakness, cardiomyopathy, developmental regression, exercise-induced rhabdomyolysis, lactic acidosis, major hearing or vision loss and strong maternal inheritance patterns may require neurological, metabolic or genetic evaluation

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doi: 10.1002/hep.30652 63 GuCZhouZYuZHeMHeLLuoZet al

Future investigations warrant substantially larger sample sizes to increase power to detect potentially clinically relevant differences, especially in pediatric subjects