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Yu X, Che F, Zhang X, Yang L, Zhu L, Xu N, Qiu S, Li Y. Clinical and genetic analysis of 23 Chinese children with epilepsy associated with KCNQ2 gene mutations. Epilepsia Open 2024. [PMID: 39141400 DOI: 10.1002/epi4.13028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 07/16/2024] [Accepted: 07/26/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE To summarize the clinical features and genetic mutation characteristics of Chinese children with KCNQ2-related epilepsy. METHODS A cohort of children with genetically caused epilepsy was evaluated at Linyi People's Hospital from January 2017 to December 2023. After next-generation sequencing and pathogenicity analysis, we summarized the medical records and genetic testing data of the children who had KCNQ2 gene mutations. RESULTS We identified 23 KCNQ2 gene mutations. 73.9% (n = 17) of the mutation sites were located in S5-S6 segments and the C-terminal region. In addition to the common phenotypes, 2 new phenotypes were identified: infantile convulsion with paroxysmal choreoathetosis (ICCA) and febrile seizure plus (FS+). Of all the cases with abnormal video-electro-encephalography, three cases with self-limited familial infantile epilepsy (SeLNE) exhibited a small number of multifocal discharges. Of the patients who have taken a particular antiepileptic drug, the statistics on the number of patients who have responded to the drug are as follows: oxcarbazepine (8/9, 88.9%), levetiracetam (5/7, 71.4%), phenobarbital (9/16, 56.3%), and topiramate (2/5, 40.0%). However, the efficacy of phenobarbital varied widely in treating SeLNE and KCNQ2-DEE. At the final follow-up, 1 case with SeLNE had a transient developmental regression and 7 cases with KCNQ2-DEE had mild to severe developmental backwardness. SIGNIFICANCE Although clinically rare, we report 10 new KCNQ2 mutations and two new phenotypes: ICCA and FS+. This further expands genetic and phenotypic spectrum of KCNQ2-related epilepsy. The gene mutation sites are mostly located in S5-S6 segments and the C-terminal region, and the former is usually associated with KCNQ2-DEE. Sodium channel blockers (including oxcarbazepine and topiramate) and levetiracetam should be prioritized over phenobarbital for KCNQ2-DEE. Some cases with KCNQ2-related epilepsy may have transient developmental regression during periods of frequent seizures. Early treatment and early seizure control may be beneficial for willing outcomes in children with KCNQ2-DEE. PLAIN LANGUAGE SUMMARY This article reports 23 cases of children with KCNQ2-related epilepsy, including 10 new mutation sites and 2 new phenotypes. It further expands the genetic and phenotypic spectrum of KCNQ2-related epilepsy. In addition, the article summarizes the gene mutation characteristics and clinical manifestations of children with KCNQ2-related epilepsy, with the expectation of providing a certain theoretical basis for the diagnosis and treatment of such patients.
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Affiliation(s)
- Xixi Yu
- Shandong Second Medical University, Weifang, China
- Linyi People's Hospital, Linyi, China
| | - Fengyuan Che
- Central Laboratory of Linyi People's Hospital, Linyi, China
- Key Laboratory of Medical and Health Neurophysiology of Shandong Provincial Health Commission, Linyi, China
| | - Xin Zhang
- Linyi People's Hospital, Linyi, China
| | - Li Yang
- Linyi People's Hospital, Linyi, China
| | | | - Na Xu
- Linyi People's Hospital, Linyi, China
| | | | - Yufen Li
- Linyi People's Hospital, Linyi, China
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Bayat A, Iavarone S, Miceli F, Jakobsen AV, Johannesen KM, Nikanorova M, Ploski R, Szymanska K, Flamini R, Cooper EC, Weckhuysen S, Taglialatela M, Møller RS. Phenotypic and functional assessment of two novel KCNQ2 gain-of-function variants Y141N and G239S and effects of amitriptyline treatment. Neurotherapeutics 2024; 21:e00296. [PMID: 38241158 PMCID: PMC10903081 DOI: 10.1016/j.neurot.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 01/21/2024] Open
Abstract
While loss-of-function (LoF) variants in KCNQ2 are associated with a spectrum of neonatal-onset epilepsies, gain-of-function (GoF) variants cause a more complex phenotype that precludes neonatal-onset epilepsy. In the present work, the clinical features of three patients carrying a de novo KCNQ2 Y141N (n = 1) or G239S variant (n = 2) respectively, are described. All three patients had a mild global developmental delay, with prominent language deficits, and strong activation of interictal epileptic activity during sleep. Epileptic seizures were not reported. The absence of neonatal seizures suggested a GoF effect and prompted functional testing of the variants. In vitro whole-cell patch-clamp electrophysiological experiments in Chinese Hamster Ovary cells transiently-transfected with the cDNAs encoding Kv7.2 subunits carrying the Y141N or G239S variants in homomeric or heteromeric configurations with Kv7.2 subunits, revealed that currents from channels incorporating mutant subunits displayed increased current densities and hyperpolarizing shifts of about 10 mV in activation gating; both these functional features are consistent with an in vitro GoF phenotype. The antidepressant drug amitriptyline induced a reversible and concentration-dependent inhibition of current carried by Kv7.2 Y141N and G239S mutant channels. Based on in vitro results, amitriptyline was prescribed in one patient (G239S), prompting a significant improvement in motor, verbal, social, sensory and adaptive behavior skillsduring the two-year-treatment period. Thus, our results suggest that KCNQ2 GoF variants Y141N and G239S cause a mild DD with prominent language deficits in the absence of neonatal seizures and that treatment with the Kv7 channel blocker amitriptyline might represent a potential targeted treatment for patients with KCNQ2 GoF variants.
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Affiliation(s)
- Allan Bayat
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Filadelfia, Dianalund, Denmark; Department for Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
| | - Stefano Iavarone
- Section of Pharmacology, Department of Neuroscience, University of Naples "Federico II", Naples, Italy
| | - Francesco Miceli
- Section of Pharmacology, Department of Neuroscience, University of Naples "Federico II", Naples, Italy
| | - Anne V Jakobsen
- Department of Pediatrics, Danish Epilepsy Center, Filadelfia, Dianalund, Denmark
| | - Katrine M Johannesen
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Filadelfia, Dianalund, Denmark; Department of Genetics, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Marina Nikanorova
- Department of Pediatrics, Danish Epilepsy Center, Filadelfia, Dianalund, Denmark
| | - Rafal Ploski
- Department of Medical Genetics, Medical University of Warsaw, Warsaw, Poland
| | - Krystyna Szymanska
- Department of Pediatric Neurology, Medical University of Warsaw, Warsaw, Poland
| | | | - Edward C Cooper
- Departments of Neurology, Neuroscience, and Molecular and Human Genetics, Baylor College of Medicine, Houston TX, USA
| | - Sarah Weckhuysen
- Applied and Translational Genomics Group, VIB-Center for Molecular Neurology, VIB, University of Antwerp, Antwerp, Belgium; Neurology Department, University Hospital Antwerp, Antwerp, Belgium; Translational Neurosciences, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium; μNEURO Research Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Maurizio Taglialatela
- Section of Pharmacology, Department of Neuroscience, University of Naples "Federico II", Naples, Italy
| | - Rikke S Møller
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Filadelfia, Dianalund, Denmark; Department for Regional Health Research, University of Southern Denmark, Odense, Denmark
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Falsaperla R, Criscione R, Cimino C, Pisani F, Ruggieri M. KCNQ2-Related Epilepsy: Genotype-Phenotype Relationship with Tailored Antiseizure Medication (ASM)-A Systematic Review. Neuropediatrics 2023; 54:297-307. [PMID: 36948217 DOI: 10.1055/a-2060-4576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Autosomal dominant mutations of the KCNQ2 gene can cause two epileptic disorders: benign familial neonatal seizures (BFNS) and developmental epileptic encephalopathy (DEE). This systematic review aims to identify the best reported therapy for these patients, relating to phenotype, neurodevelopmental outcome, and an eventual correlation between phenotype and genotype. METHODS We searched on PubMed using the search terms "KCNQ2" AND "therapy" and "KCNQ2" AND "treatment"; we found 304 articles. Of these, 29 met our criteria. We collected the data from 194 patients. All 29 articles were retrospective studies. RESULTS In all, 104 patients were classified as DEE and 90 as BFNS. After treatment began, 95% of BFNS patients became seizure free, whereas the seizures stopped only in 73% of those with DEE. Phenobarbital and sodium channel blockers were the most used treatment in BFNS. Most of the DEE patients (95%) needed polytherapy for seizure control and even that did not prevent subsequent developmental impairment (77%).Missense mutations were discovered in 96% of DEE patients; these were less common in BFNS (50%), followed by large deletion (16%), truncation (16%), splice donor site (10%), and frameshift (7%). CONCLUSION Phenobarbital or carbamazepine appears to be the most effective antiseizure medication for children with a "benign" variant. On the contrary, polytherapy is often needed for DEE patients, even if it does not seem to improve neurological outcomes. In DEE patients, most mutations were located in S4 and S6 helix, which could serve as a potential target for the development of more specific treatment in the future.
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Affiliation(s)
- Raffaele Falsaperla
- Neonatal Intensive Care Unit and Neonatal Accompaniment Unit, Azienda Ospedaliero-Universitaria Policlinico "Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy
- Unit of Clinical Paediatrics, Azienda Ospedaliero-Universitaria Policlinico, "Rodolico-San Marco", San Marco Hospital, Catania, Italy
| | - Roberta Criscione
- Neonatal Intensive Care Unit and Neonatal Accompaniment Unit, Azienda Ospedaliero-Universitaria Policlinico "Rodolico-San Marco", Postgraduate Training Program in Pediatrics, University of Catania, Catania, Italy
| | - Carla Cimino
- Neonatal Intensive Care Unit and Neonatal Accompaniment Unit, Azienda Ospedaliero-Universitaria Policlinico "Rodolico-San Marco", San Marco Hospital, University of Catania, Catania, Italy
| | - Francesco Pisani
- Child Neuropsychiatry Unit, Human Neuroscience Department, Sapienza University of Rome, Italy
| | - Martino Ruggieri
- Unit of Clinical Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, AOU "Policlinico", PO "G. Rodolico", Catania, Italy
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Mulkey DK, Milla BM. Perspectives on the basis of seizure-induced respiratory dysfunction. Front Neural Circuits 2022; 16:1033756. [PMID: 36605420 PMCID: PMC9807672 DOI: 10.3389/fncir.2022.1033756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Epilepsy is an umbrella term used to define a wide variety of seizure disorders and sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in epilepsy. Although some SUDEP risk factors have been identified, it remains largely unpredictable, and underlying mechanisms remain poorly understood. Most seizures start in the cortex, but the high mortality rate associated with certain types of epilepsy indicates brainstem involvement. Therefore, to help understand SUDEP we discuss mechanisms by which seizure activity propagates to the brainstem. Specifically, we highlight clinical and pre-clinical evidence suggesting how seizure activation of: (i) descending inhibitory drive or (ii) spreading depolarization might contribute to brainstem dysfunction. Furthermore, since epilepsy is a highly heterogenous disorder, we also considered factors expected to favor or oppose mechanisms of seizure propagation. We also consider whether epilepsy-associated genetic variants directly impact brainstem function. Because respiratory failure is a leading cause of SUDEP, our discussion of brainstem dysfunction focuses on respiratory control.
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Affiliation(s)
- Daniel K. Mulkey
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, CT, United States
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Muacevic A, Adler JR, Aliefendioglu D, Senbil N. A Case of Early Infantile Epileptic Encephalopathy Due to KCNQ2 Gene Mutation Presenting With Episodes of Hiccups. Cureus 2022; 14:e33164. [PMID: 36726904 PMCID: PMC9885515 DOI: 10.7759/cureus.33164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/01/2023] Open
Abstract
Neonatal epilepsy syndromes are responsible for only 15% of the cases of neonatal seizure. An underlying genetic disorder can be detected in approximately 42% of this subgroup. KCNQ2 gene-associated epilepsies are very rare and more common presentations are self-limited familial neonatal epilepsy (SLFNE) and early infantile epileptic encephalopathies (EIEE). The most common initial seizure semiologies are tonic seizures with or without autonomic symptoms in EIEE resulting from KCNQ2 gene mutation. It is characterized by early neonatal onset seizures with suppression burst pattern on electroencephalogram and typically results in severe developmental delay. Therapeutic options for infants with KCNQ2-related EIEE are limited and there is no consensus about it in the literature. Herein, the neonate with EIEE with unexpected episodes of hiccups due to novel mutation of the KCNQ2 gene, which was reported second time, was presented and antiepileptic treatment strategies were discussed in the light of current literature.
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Kazazian V, Selvanathan T, Chau V, Tam EWY, Miller SP. Pearls & Oy-sters: Genetic Epilepsy: An Important Cause of Neonatal Seizures in Infants With Complex Congenital Heart Disease. Neurology 2022; 99:811-814. [PMID: 36041864 DOI: 10.1212/wnl.0000000000201229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
Genetic epilepsies, such as KCNQ2 gene variants, although uncommon, are potential causes of neonatal seizures in infants with complex congenital heart disease (CHD). KCNQ2-related seizures commonly present as tonic posturing with autonomic changes and a distinctive amplitude-integrated EEG (aEEG) pattern with increase in amplitude, immediately followed by background suppression. Seizures are typically refractory to commonly used antiepileptics in this age group and respond best to sodium channel blockers such as carbamazepine and fosphenytoin. We report the cases of 2 neonates with complex CHD who presented with seizures secondary to KCNQ2 gene variation and discuss how early recognition of clinical and EEG features led to early treatment and improved seizure burden. When investigating the etiology of neonatal seizures in the perioperative complex cardiac infant, genetic etiologies such as KCNQ2 variants should be considered, particularly in the absence of clinical examination and neuroimaging features consistent with brain injury. These 2 cases highlight the importance of a precision medicine approach using clinical examination and seizure semiology, bedside aEEG monitoring, genetic testing, and targeted treatments to improve patient care and outcomes.
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Affiliation(s)
- Vanna Kazazian
- From the Divisions of Cardiology (V.K.) and Neurology (T.S., V.C., E.W.Y.T., S.P.M.), Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario; and Division of Neurology (S.P.M.), Department of Pediatrics, BC Children's Hospital and Research Institute, University of British Columbia, Vancouver, Canada
| | - Thiviya Selvanathan
- From the Divisions of Cardiology (V.K.) and Neurology (T.S., V.C., E.W.Y.T., S.P.M.), Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario; and Division of Neurology (S.P.M.), Department of Pediatrics, BC Children's Hospital and Research Institute, University of British Columbia, Vancouver, Canada
| | - Vann Chau
- From the Divisions of Cardiology (V.K.) and Neurology (T.S., V.C., E.W.Y.T., S.P.M.), Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario; and Division of Neurology (S.P.M.), Department of Pediatrics, BC Children's Hospital and Research Institute, University of British Columbia, Vancouver, Canada
| | - Emily W Y Tam
- From the Divisions of Cardiology (V.K.) and Neurology (T.S., V.C., E.W.Y.T., S.P.M.), Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario; and Division of Neurology (S.P.M.), Department of Pediatrics, BC Children's Hospital and Research Institute, University of British Columbia, Vancouver, Canada
| | - Steven P Miller
- From the Divisions of Cardiology (V.K.) and Neurology (T.S., V.C., E.W.Y.T., S.P.M.), Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario; and Division of Neurology (S.P.M.), Department of Pediatrics, BC Children's Hospital and Research Institute, University of British Columbia, Vancouver, Canada.
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Miceli F, Millevert C, Soldovieri MV, Mosca I, Ambrosino P, Carotenuto L, Schrader D, Lee HK, Riviello J, Hong W, Risen S, Emrick L, Amin H, Ville D, Edery P, de Bellescize J, Michaud V, Van-Gils J, Goizet C, Willemsen MH, Kleefstra T, Møller RS, Bayat A, Devinsky O, Sands T, Korenke GC, Kluger G, Mefford HC, Brilstra E, Lesca G, Milh M, Cooper EC, Taglialatela M, Weckhuysen S. KCNQ2 R144 variants cause neurodevelopmental disability with language impairment and autistic features without neonatal seizures through a gain-of-function mechanism. EBioMedicine 2022; 81:104130. [PMID: 35780567 PMCID: PMC9254340 DOI: 10.1016/j.ebiom.2022.104130] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 01/10/2023] Open
Abstract
Background Prior studies have revealed remarkable phenotypic heterogeneity in KCNQ2-related disorders, correlated with effects on biophysical features of heterologously expressed channels. Here, we assessed phenotypes and functional properties associated with KCNQ2 missense variants R144W, R144Q, and R144G. We also explored in vitro blockade of channels carrying R144Q mutant subunits by amitriptyline. Methods Patients were identified using the RIKEE database and through clinical collaborators. Phenotypes were collected by a standardized questionnaire. Functional and pharmacological properties of variant subunits were analyzed by whole-cell patch-clamp recordings. Findings Detailed clinical information on fifteen patients (14 novel and 1 previously published) was analyzed. All patients had developmental delay with prominent language impairment. R144Q patients were more severely affected than R144W patients. Infantile to childhood onset epilepsy occurred in 40%, while 67% of sleep-EEGs showed sleep-activated epileptiform activity. Ten patients (67%) showed autistic features. Activation gating of homomeric Kv7.2 R144W/Q/G channels was left-shifted, suggesting gain-of-function effects. Amitriptyline blocked channels containing Kv7.2 and Kv7.2 R144Q subunits. Interpretation Patients carrying KCNQ2 R144 gain-of-function variants have developmental delay with prominent language impairment, autistic features, often accompanied by infantile- to childhood-onset epilepsy and EEG sleep-activated epileptiform activity. The absence of neonatal seizures is a robust and important clinical differentiator between KCNQ2 gain-of-function and loss-of-function variants. The Kv7.2/7.3 channel blocker amitriptyline might represent a targeted treatment. Funding Supported by FWO, GSKE, KCNQ2-Cure, Jack Pribaz Foundation, European Joint Programme on Rare Disease 2020, the Italian Ministry for University and Research, the Italian Ministry of Health, the European Commission, the University of Antwerp, NINDS, and Chalk Family Foundation.
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Namdari R, Luzon C, Cadieux JA, Leung J, Beatch GN. Pharmacokinetics of XEN496, a Novel Pediatric Formulation of Ezogabine, Under Fed and Fasted Conditions: A Phase 1 Trial. Neurol Ther 2022; 11:781-796. [PMID: 35380370 PMCID: PMC9095778 DOI: 10.1007/s40120-022-00343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/09/2022] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION XEN496 is a novel, granular, immediate-release formulation of ezogabine intended for pediatric use. The objective of this study was to assess the effect of food on the pharmacokinetics (PK) of XEN496 and its N-acetyl metabolite (NAMR) in healthy volunteers. METHODS Twenty-four adult subjects were enrolled in this phase 1, single center, open-label, randomized, single-dose, two-way crossover study. Subjects received 400 mg XEN496 as an oral suspension in both fed and fasted states separated by a 6-day washout period. Serial blood samples were collected up to 48 h post-administration. PK parameters evaluated included maximum observed plasma concentration (Cmax), time of maximum observed plasma concentration (Tmax), and area under the concentration-time curve (AUC(0-t) and AUCinf). Safety was assessed by laboratory evaluations, physical exam, and adverse event monitoring. RESULTS For XEN496, median Tmax was 3 and 2 h in the fed and fasted states, respectively. AUC parameters in the fed and fasted states were equivalent, whereas food decreased Cmax of XEN496 by 32% compared to the fasted state. The ratio of geometric means [90% CI] for Cmax was 72% [64-82%]. For NAMR, food delayed Tmax by 1 h, while Cmax and AUC parameters were equivalent in the fed and fasted states. The safety profile of XEN496 in this study appeared comparable to that previously reported for ezogabine tablets. CONCLUSION The biopharmaceutical performance of XEN496 in this study was as expected for an immediate-release, granular dosage formulation, and generally comparable to that reported for ezogabine tablets. Future studies are needed to characterize the efficacy, safety, and PK of XEN496 in a pediatric population.
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Affiliation(s)
- Rostam Namdari
- Xenon Pharmaceuticals Inc., 200-3650 Gilmore Way, Burnaby, BC, V5G 4W8, Canada.
| | - Constanza Luzon
- Xenon Pharmaceuticals Inc., 200-3650 Gilmore Way, Burnaby, BC, V5G 4W8, Canada
| | - Jay A Cadieux
- Xenon Pharmaceuticals Inc., 200-3650 Gilmore Way, Burnaby, BC, V5G 4W8, Canada
| | - Jennifer Leung
- Xenon Pharmaceuticals Inc., 200-3650 Gilmore Way, Burnaby, BC, V5G 4W8, Canada
| | - Gregory N Beatch
- Xenon Pharmaceuticals Inc., 200-3650 Gilmore Way, Burnaby, BC, V5G 4W8, Canada
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Bai YF, Zeng C, Jia M, Xiao B. Molecular mechanisms of topiramate and its clinical value in epilepsy. Seizure 2022; 98:51-56. [DOI: 10.1016/j.seizure.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022] Open
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Xu Y, Dou YL, Chen X, Dong XR, Wang XH, Wu BB, Cheng GQ, Zhou YF. Early initial video-electro-encephalography combined with variant location predict prognosis of KCNQ2-related disorder. BMC Pediatr 2021; 21:477. [PMID: 34711204 PMCID: PMC8555078 DOI: 10.1186/s12887-021-02946-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The clinical features of KCNQ2-related disorders range from benign familial neonatal seizures 1 to early infantile epileptic encephalopathy 7. The genotype-phenotypic association is difficult to establish. OBJECTIVE To explore potential factors in neonatal period that can predict the prognosis of neonates with KCNQ2-related disorder. METHODS Infants with KCNQ2-related disorder were retrospectively enrolled in our study in Children's Hospital of Fudan University in China from Jan 2015 to Mar 2020. All infants were older than age of 12 months at time of follow-up, and assessed by Bayley Scales of Infant and Toddler Development-Third Edition (BSID-III) or Wechsler preschool and primary scale of intelligence-fourth edition (WPPSI-IV), then divided into three groups based on scores of BSID-III or WPPSI-IV: normal group, mild impairment group, encephalopathy group. We collected demographic variables, clinical characteristics, neuroimaging data. Considered variables include gender, gestational age, birth weight, age of the initial seizures, early interictal VEEG, variant location, delivery type. Variables predicting prognosis were identified using multivariate ordinal logistic regression analysis. RESULTS A total of 52 infants were selected in this study. Early interictal video-electro-encephalography (VEEG) (β = 2.77, 1.20 to 4.34, P = 0.001), and variant location (β = 2.77, 0.03 to 5.5, P = 0.048) were independent risk factors for prognosis. The worse the early interictal VEEG, the worse the prognosis. Patients with variants located in the pore-lining domain or S4 segment are more likely to have a poor prognosis. CONCLUSIONS The integration of early initial VEEG and variant location can predict prognosis. An individual whose KCNQ2 variant located in voltage sensor, the pore domain, with worse early initial VEEG background, often had an adverse outcome.
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Affiliation(s)
- Yan Xu
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, NO.399 Wanyuan Road, Minhang District, Shanghai, 201102, China
| | - Ya-Lan Dou
- Department of clinical Epidemiology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiang Chen
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, NO.399 Wanyuan Road, Minhang District, Shanghai, 201102, China
| | - Xin-Ran Dong
- Molecular Medical Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xin-Hua Wang
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, NO.399 Wanyuan Road, Minhang District, Shanghai, 201102, China
| | - Bing-Bing Wu
- The Molecular Genetic Diagnosis Center, Shanghai Key Lab of Birth Defects, Pediatrics Research Institute, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Guo-Qiang Cheng
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, NO.399 Wanyuan Road, Minhang District, Shanghai, 201102, China.
| | - Yuan-Feng Zhou
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, NO.399 Wanyuan Road, Minhang District, Shanghai, 201102, China.
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Yang SM, Cao CD, Ding Y, Wang MJ, Yue SJ. D-bifunctional protein deficiency caused by HSD17B4 gene mutation in a neonate. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:1058-1063. [PMID: 34719423 DOI: 10.7499/j.issn.1008-8830.2107158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A 15-day-old boy was admitted to the hospital due to repeated convulsions for 14 days. The main clinical manifestations were uncontrolled seizures, hypoergia, feeding difficulties, limb hypotonia, and bilateral hearing impairment. Clinical neurophysiology showed reduced brainstem auditory evoked potential on both sides and burst-suppression pattern on electroencephalogram. Measurement of very-long-chain fatty acids in serum showed that C26:0 was significantly increased. Genetic testing showed a pathogenic compound heterozygous mutation, c.101C>T(p.Ala34Val) and c.1448_1460del(p.Ala483Aspfs*37), in the HSD17B4 gene. This article reports a case of D-bifunctional protein deficiency caused by HSD17B4 gene mutation and summarizes the epidemiological and clinical features, diagnosis, and treatment of this disease, with a focus on the differential diagnosis of this disease from Ohtahara syndrome.
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Affiliation(s)
- Shu-Mei Yang
- Department of Neonatology, Xiangya Hospital, Central South University, Changsha 410008, China (Yue S-J, )
| | - Chuan-Ding Cao
- Department of Neonatology, Xiangya Hospital, Central South University, Changsha 410008, China (Yue S-J, )
| | - Ying Ding
- Department of Neonatology, Xiangya Hospital, Central South University, Changsha 410008, China (Yue S-J, )
| | - Ming-Jie Wang
- Department of Neonatology, Xiangya Hospital, Central South University, Changsha 410008, China (Yue S-J, )
| | - Shao-Jie Yue
- Department of Neonatology, Xiangya Hospital, Central South University, Changsha 410008, China (Yue S-J, )
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12
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Ritter DM, Horn PS, Holland KD. In Silico Predictions of KCNQ Variant Pathogenicity in Epilepsy. Pediatr Neurol 2021; 118:48-54. [PMID: 33784504 PMCID: PMC8076079 DOI: 10.1016/j.pediatrneurol.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/10/2021] [Accepted: 01/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Variants in KCNQ2 and KCNQ3 may cause benign neonatal familial seizures and early infantile epileptic encephalopathy. Previous reports suggest that in silico models cannot predict pathogenicity accurately enough for clinical use. Here we sought to establish a model to accurately predict the pathogenicity of KCNQ2 and KCNQ3 missense variants based on available in silico prediction models. METHODS ClinVar and gnomAD databases of reported KCNQ2 and KCNQ3 missense variants in patients with neonatal epilepsy were accessed and classified as benign, pathogenic, or of uncertain significance. Sensitivity, specificity, and classification accuracy for prediction of pathogenicity were determined and compared for 10 widely used prediction algorithms program. A mathematical model of the variants (KCNQ Index) was created using their amino acid location and prediction algorithm scores to improve prediction accuracy. RESULTS Using clinically characterized variants, the free online tool PROVEAN accurately predicted pathogenicity 92% of the time and the KCNQ Index had an accuracy of 96%. However, when including the gnomAD database as benign variants, only the KCNQ Index was able to predict pathogenicity with an accuracy greater than 90% (sensitivity = 93% and specificity = 98%). No model could accurately predict the phenotype of variants. CONCLUSION We show that KCNQ channel variant pathogenicity can be predicted by a novel KCNQ Index in neonatal epilepsy. However, more work is needed to accurately predict the patient's epilepsy phenotype from in silico algorithms.
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Affiliation(s)
- David M Ritter
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Paul S Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Katherine D Holland
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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13
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Boets S, Johannesen KM, Destree A, Manti F, Ramantani G, Lesca G, Vercueil L, Koenig MK, Striano P, Møller RS, Cooper E, Weckhuysen S. Adult phenotype of KCNQ2 encephalopathy. J Med Genet 2021; 59:528-535. [PMID: 33811133 DOI: 10.1136/jmedgenet-2020-107449] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Pathogenic KCNQ2 variants are a frequent cause of developmental and epileptic encephalopathy. METHODS We recruited 13 adults (between 18 years and 45 years of age) with KCNQ2 encephalopathy and reviewed their clinical, EEG, neuroimaging and treatment history. RESULTS While most patients had daily seizures at seizure onset, seizure frequency declined or remitted during childhood and adulthood. The most common seizure type was tonic seizures (early) infancy, and tonic-clonic and focal impaired awareness seizures later in life. Ten individuals (77%) were seizure-free at last follow-up. In 38% of the individuals, earlier periods of seizure freedom lasting a minimum of 2 years followed by seizure recurrence had occurred. Of the 10 seizure-free patients, 4 were receiving a single antiseizure medication (ASM, carbamazepine, lamotrigine or levetiracetam), and 2 had stopped taking ASM. Intellectual disability (ID) ranged from mild to profound, with the majority (54%) of individuals in the severe category. At last contact, six individuals (46%) remained unable to walk independently, six (46%) had limb spasticity and four (31%) tetraparesis/tetraplegia. Six (46%) remained non-verbal, 10 (77%) had autistic features/autism, 4 (31%) exhibited aggressive behaviour and 4 (31%) destructive behaviour with self-injury. Four patients had visual problems, thought to be related to prematurity in one. Sleep problems were seen in six (46%) individuals. CONCLUSION Seizure frequency declines over the years and most patients are seizure-free in adulthood. Longer seizure-free periods followed by seizure recurrence are common during childhood and adolescence. Most adult patients have severe ID. Motor, language and behavioural problems are an issue of continuous concern.
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Affiliation(s)
- Stephanie Boets
- Neurology Department, University Hospital Antwerp, Antwerp, Belgium
| | - Katrine M Johannesen
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Centre Filadelfia, Dianalund, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anne Destree
- Department of Human Genetics, Institute of Pathology and Genetics, Gosselies, Belgium
| | - Filippo Manti
- Department of Human Neuroscience, University of Rome La Sapienza, Roma, Lazio, Italy
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital, Zurich, Switzerland
| | - Gaetan Lesca
- Department of Genetics, University Hospitals of Lyon, Lyon, France.,Neuroscience Research Center, Claude Bernard Lyon I University, Lyon, France
| | - Laurent Vercueil
- Grenoble Institute of Neurosciences (GIN), University Grenoble Alpes, La Tronche, France
| | - Mary Kay Koenig
- Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, "G Gaslini" Institute, Genova, Italy.,Pediatric Neurology and Muscular Diseases Unit, IRCCS' G Gaslini" Institute, Genova, Italy
| | - Rikke Steensbjerre Møller
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Centre Filadelfia, Dianalund, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Edward Cooper
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Sarah Weckhuysen
- Neurology Department, University Hospital Antwerp, Antwerp, Belgium .,Applied & Translational Neurogenomics Group, VIB-Center for Molecular Neurology, VIB, Antwerp, Belgium.,Translational Neuroscience Group, University of Antwerp, Antwerp, Belgium
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