3
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Nobili L, de Weerd A, Rubboli G, Beniczky S, Derry C, Eriksson S, Halasz P, Högl B, Santamaria J, Khatami R, Ryvlin P, Rémi J, Tinuper P, Bassetti C, Manni R, Koutroumanidis M, Vignatelli L. Standard procedures for the diagnostic pathway of sleep-related epilepsies and comorbid sleep disorders: A European Academy of Neurology, European Sleep Research Society and International League against Epilepsy-Europe consensus review. J Sleep Res 2020; 29:e13184. [PMID: 32959468 DOI: 10.1111/jsr.13184] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Some epilepsy syndromes (sleep-related epilepsies [SRE]) have a strong link with sleep. Comorbid sleep disorders are common in patients with SRE and can exert a negative impact on seizure control and quality of life. PURPOSES To define the standard procedures for the diagnostic pathway of patients with possible SRE (scenario 1) and the general management of patients with SRE and comorbidity with sleep disorders (scenario 2). METHODS The project was conducted under the auspices of the European Academy of Neurology (EAN), the European Sleep Research Society (ESRS) and the International League against Epilepsy (ILAE) Europe. The framework of the document entailed the following phases: conception of the clinical scenarios; literature review; statements regarding the standard procedures. For literature search a step-wise approach starting from systematic reviews to primary studies was applied. Published studies were identified from the National Library of Medicine's MEDLINE database and Cochrane Library. RESULTS Scenario 1: despite a low quality of evidence, recommendations on anamnestic evaluation, tools for capturing the event at home or in the laboratory are provided for specific SRE. Scenario 2: Early diagnosis and treatment of sleep disorders (especially respiratory disorders) in patients with SRE are likely to be beneficial for seizures control. CONCLUSIONS Definitive procedures for evaluating patients with SRE are lacking. We provide advice that could be of help for standardising and improving the diagnostic approach of specific SRE. The importance of identifying and treating specific sleep disorders for the management and outcome of patients with SRE is underlined.
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Affiliation(s)
- Lino Nobili
- Child Neuropsychiatry, IRCCS G. Gaslini Institute, Genoa, Italy.,Department of Neuroscience - Rehabilitation-Ophthalmology - Genetics - Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Al de Weerd
- Stichting Epilepsie Instellingen Nederland, Zwolle, Netherlands
| | - Guido Rubboli
- Danish Epilepsy Centre, Dianalund, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark.,Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christopher Derry
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.,Department of Clinical Neurosciences and Sleep Medicine, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Sofia Eriksson
- Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery and Institute of Neurology, University College London, London, UK
| | - Peter Halasz
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Joan Santamaria
- Multidisciplinary Sleep Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
| | - Ramin Khatami
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.,Barmelweid Academy, Center of Sleep Medicine, Sleep Research and Epilepsy, Klinik Barmelweid, Barmelweid, Switzerland
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Jan Rémi
- Epilepsy Center, Department of Neurology, University of Munich Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
| | - Claudio Bassetti
- Neurology Department, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
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4
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Nobili L, de Weerd A, Rubboli G, Beniczky S, Derry C, Eriksson S, Halasz P, Högl B, Santamaria J, Khatami R, Ryvlin P, Rémi J, Tinuper P, Bassetti C, Manni R, Koutroumanidis M, Vignatelli L. Standard procedures for the diagnostic pathway of sleep-related epilepsies and comorbid sleep disorders: an EAN, ESRS and ILAE-Europe consensus review. Eur J Neurol 2020; 28:15-32. [PMID: 32959446 DOI: 10.1111/ene.14468] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/01/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Some epilepsy syndromes (sleep-related epilepsies, SREs) have a strong link with sleep. Comorbid sleep disorders are common in patients with SRE and can exert a negative impact on seizure control and quality of life. Our purpose was to define the standard procedures for the diagnostic pathway of patients with possible SRE (scenario 1) and the general management of patients with SRE and comorbidity with sleep disorders (scenario 2). METHODS The project was conducted under the auspices of the European Academy of Neurology, the European Sleep Research Society and the International League Against Epilepsy Europe. The framework entailed the following phases: conception of the clinical scenarios; literature review; statements regarding the standard procedures. For the literature search a stepwise approach starting from systematic reviews to primary studies was applied. Published studies were identified from the National Library of Medicine's MEDLINE database and Cochrane Library. RESULTS Scenario 1: Despite a low quality of evidence, recommendations on anamnestic evaluation and tools for capturing the event at home or in the laboratory are provided for specific SREs. Scenario 2: Early diagnosis and treatment of sleep disorders (especially respiratory disorders) in patients with SRE are likely to be beneficial for seizure control. CONCLUSIONS Definitive procedures for evaluating patients with SRE are lacking. Advice is provided that could be of help for standardizing and improving the diagnostic approach of specific SREs. The importance of identifying and treating specific sleep disorders for the management and outcome of patients with SRE is underlined.
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Affiliation(s)
- L Nobili
- Child Neuropsychiatry, IRCCS G. Gaslini Institute, Genoa, Italy.,Department of Neuroscience - Rehabilitation - Ophthalmology - Genetics - Child and Maternal Health (DINOGMI), University of Genoa, Italy
| | - A de Weerd
- Stichting Epilepsie Instellingen Nederland, Zwolle, The Netherlands
| | - G Rubboli
- Danish Epilepsy Centre, Dianalund, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - S Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark.,Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - C Derry
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.,Department of Clinical Neurosciences and Sleep Medicine, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - S Eriksson
- Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery and Institute of Neurology, University College London, London, UK
| | - P Halasz
- National Institute of Clinical Neuroscience, Budapest, Hungary
| | - B Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Santamaria
- Multidisciplinary Sleep Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
| | - R Khatami
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.,Barmelweid Academy, Center of Sleep Medicine, Sleep Research and Epilepsy, Klinik Barmelweid AG, Barmelweid, Switzerland
| | - P Ryvlin
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - J Rémi
- Epilepsy Center, Department of Neurology, University of Munich Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - P Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
| | - C Bassetti
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.,Neurology Department, Sechenov First Moscow State Medical University, Moscow, Russia
| | - R Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - M Koutroumanidis
- Department of Neurology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
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Syrbe S, Hedrich UB, Riesch E, Djémié T, Müller S, Møller RS, Maher B, Hernandez-Hernandez L, Synofzik M, Caglayan HS, Arslan M, Serratosa JM, Nothnagel M, May P, Krause R, Löffler H, Detert K, Dorn T, Vogt H, Krämer G, Schöls L, Mullis PE, Linnankivi T, Lehesjoki AE, Sterbova K, Craiu DC, Hoffman-Zacharska D, Korff CM, Weber YG, Steinlin M, Gallati S, Bertsche A, Bernhard MK, Merkenschlager A, Kiess W, Gonzalez M, Züchner S, Palotie A, Suls A, De Jonghe P, Helbig I, Biskup S, Wolff M, Maljevic S, Schüle R, Sisodiya SM, Weckhuysen S, Lerche H, Lemke JR. De novo loss- or gain-of-function mutations in KCNA2 cause epileptic encephalopathy. Nat Genet 2015; 47:393-399. [PMID: 25751627 PMCID: PMC4380508 DOI: 10.1038/ng.3239] [Citation(s) in RCA: 188] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 02/06/2015] [Indexed: 02/07/2023]
Abstract
Epileptic encephalopathies are a phenotypically and genetically heterogeneous group of severe epilepsies accompanied by intellectual disability and other neurodevelopmental features. Using next-generation sequencing, we identified four different de novo mutations in KCNA2, encoding the potassium channel KV1.2, in six isolated patients with epileptic encephalopathy (one mutation recurred three times independently). Four individuals presented with febrile and multiple afebrile, often focal seizure types, multifocal epileptiform discharges strongly activated by sleep, mild to moderate intellectual disability, delayed speech development and sometimes ataxia. Functional studies of the two mutations associated with this phenotype showed almost complete loss of function with a dominant-negative effect. Two further individuals presented with a different and more severe epileptic encephalopathy phenotype. They carried mutations inducing a drastic gain-of-function effect leading to permanently open channels. These results establish KCNA2 as a new gene involved in human neurodevelopmental disorders through two different mechanisms, predicting either hyperexcitability or electrical silencing of KV1.2-expressing neurons.
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Affiliation(s)
- Steffen Syrbe
- Department of Women and Child Health, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.
| | - Ulrike B.S. Hedrich
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
| | - Erik Riesch
- Center for Genomics and Transcriptomics (CeGaT) GmbH, Tübingen, Germany.
- Division of Human Genetics, University Children’s Hospital Inselspital, Bern, Switzerland.
- Swiss Epilepsy Center, Zürich, Switzerland.
| | - Tania Djémié
- Neurogenetics group, Department of Molecular Genetics, VIB, Antwerp, Belgium.
- Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.
| | - Stephan Müller
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
| | - Rikke S. Møller
- Danish Epilepsy Center, Dianalund, Denmark
- Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark.
| | - Bridget Maher
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- Epilepsy Society, Chalfont-St-Peter, Bucks, SL9 0RJ, UK.
| | - Laura Hernandez-Hernandez
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- Epilepsy Society, Chalfont-St-Peter, Bucks, SL9 0RJ, UK.
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
- German Research Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Hande S. Caglayan
- Department of Molecular Biology and Genetics, Bogazici University, Istanbul, Turkey.
| | - Mutluay Arslan
- Gulhane Military Medical School, Division of Child Neurology, Ankara, Turkey.
| | - José M. Serratosa
- Neurology Lab and Epilepsy Unit, Department of Neurology, IIS — Fundación Jiménez Díaz, UAM, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain.
| | - Michael Nothnagel
- Cologne Center for Genomics, University of Colgone, Cologne, Germany
| | - Patrick May
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Roland Krause
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Heidrun Löffler
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
| | - Katja Detert
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
| | | | | | | | - Ludger Schöls
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
- German Research Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Primus E. Mullis
- Division of Pediatric Endocrinology, University Children’s Hospital Inselspital, Bern, Switzerland.
| | - Tarja Linnankivi
- Pediatric Neurology, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Anna-Elina Lehesjoki
- Folkhälsan Institute of Genetics, Helsinki, Helsinki, Finland.
- Neuroscience Center, University of Helsinki, Helsinki, Finland
- Research Program’s Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland
| | - Katalin Sterbova
- Child Neurology Department, 2nd Faculty of Medicine, Charles University, Motol Hospital, Prague, Czech Republic.
| | - Dana C. Craiu
- Pediatric Neurology Clinic II, Department of Neurology, Pediatric Neurology, Psychiatry, and Neurosurgery, “Carol Davila” University of Medicine, Sector 4, Bucharest, Romania.
- Pediatric Neurology Clinic, “Professor Doctor Alexandru Obregia” Clinical Hospital, Sector 4, Bucharest, Romania.
| | | | - Christian M. Korff
- Child and Adolescent Department, Pediatric Neurology, University Hospitals, Geneva, Switzerland.
| | - Yvonne G. Weber
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
| | - Maja Steinlin
- Division of Neuropediatrics, University Children’s Hospital Inselspital, Bern, Switzerland.
| | - Sabina Gallati
- Division of Human Genetics, University Children’s Hospital Inselspital, Bern, Switzerland.
| | - Astrid Bertsche
- Department of Women and Child Health, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.
| | - Matthias K. Bernhard
- Department of Women and Child Health, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.
| | - Andreas Merkenschlager
- Department of Women and Child Health, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.
| | - Wieland Kiess
- Department of Women and Child Health, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.
| | | | - Michael Gonzalez
- Dr. JT MacDonald Department for Human Genetics, Hussman Institute for Human Genomics, University of Miami, Miami, USA
| | - Stephan Züchner
- Dr. JT MacDonald Department for Human Genetics, Hussman Institute for Human Genomics, University of Miami, Miami, USA
| | - Aarno Palotie
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, UK.
- Psychiatric & Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Arvid Suls
- Neurogenetics group, Department of Molecular Genetics, VIB, Antwerp, Belgium.
- Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.
| | - Peter De Jonghe
- Neurogenetics group, Department of Molecular Genetics, VIB, Antwerp, Belgium.
- Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.
- Department of Neurology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Ingo Helbig
- Department of Neuropediatrics, Christian-Albrechts-University of Kiel, Germany.
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Saskia Biskup
- Center for Genomics and Transcriptomics (CeGaT) GmbH, Tübingen, Germany.
| | - Markus Wolff
- Department of Neuropediatrics, University of Tübingen, Tübingen, Germany.
| | - Snezana Maljevic
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
| | - Rebecca Schüle
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
- German Research Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Division of Neuropediatrics, University Children’s Hospital Inselspital, Bern, Switzerland.
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental Epilepsy, University College London Institute of Neurology, Queen Square, London, WC1N 3BG, UK
- Epilepsy Society, Chalfont-St-Peter, Bucks, SL9 0RJ, UK.
| | - Sarah Weckhuysen
- Neurogenetics group, Department of Molecular Genetics, VIB, Antwerp, Belgium.
- Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
| | - Johannes R. Lemke
- Department of Women and Child Health, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.
- Division of Human Genetics, University Children’s Hospital Inselspital, Bern, Switzerland.
- Department of Diagnostics, Institute of Human Genetics, University of Leipzig, Leipzig, Germany.
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