Decreased α-KGDH activity can develop within 4 days of thiamine deficiency.1 Decreased α-KGDH activity results in increased oxidative stress, lactate acidosis, excitotoxicity, for instance through glutamate accumulation, inflammation and disturbed blood brain barrier (BBB) permeability, cerebral edema, and, ultimately, neuronal death.71,79 Decreased TK can develop within 1 week of thiamine deficiency.1 Here, OGDH is linked to Thiamine deficiency.