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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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2
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Fong SL, Utidjian L, Kaur M, Abend NS, Wainwright MS, Grande KM, Foskett N, Roebling R, Guerriero RM, Jain B, Rao S, Stoltenberg M, Williams P, Yuen N, Dickinson K, McDonald J, Maltenfort M, Forrest CB. Safety of intravenous lacosamide in hospitalized children and neonates. Epilepsia 2023; 64:2297-2309. [PMID: 37287398 DOI: 10.1111/epi.17676] [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: 12/23/2022] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Seizures are common in critically ill children and neonates, and these patients would benefit from intravenous (IV) antiseizure medications with few adverse effects. We aimed to assess the safety profile of IV lacosamide (LCM) among children and neonates. METHODS This retrospective multicenter cohort study examined the safety of IV LCM use in 686 children and 28 neonates who received care between January 2009 and February 2020. RESULTS Adverse events (AEs) were attributed to LCM in only 1.5% (10 of 686) of children, including rash (n = 3, .4%), somnolence (n = 2, .3%), and bradycardia, prolonged QT interval, pancreatitis, vomiting, and nystagmus (n = 1, .1% each). There were no AEs attributed to LCM in the neonates. Across all 714 pediatric patients, treatment-emergent AEs occurring in >1% of patients included rash, bradycardia, somnolence, tachycardia, vomiting, feeling agitated, cardiac arrest, tachyarrhythmia, low blood pressure, hypertension, decreased appetite, diarrhea, delirium, and gait disturbance. There were no reports of PR interval prolongation or severe cutaneous adverse reactions. When comparing children who received a recommended versus a higher than recommended initial dose of IV LCM, there was a twofold increase in the risk of rash in the higher dose cohort (adjusted incidence rate ratio = 2.11, 95% confidence interval = 1.02-4.38). SIGNIFICANCE This large observational study provides novel evidence demonstrating the tolerability of IV LCM in children and neonates.
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Affiliation(s)
- Susan L Fong
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Levon Utidjian
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Nicholas S Abend
- Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark S Wainwright
- Division of Pediatric Neurology, Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Krista M Grande
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | - Réjean M Guerriero
- Department of Neurology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Badal Jain
- Department of Neurology, Nemours Children's Health, Wilmington, Delaware, USA
| | - Suchitra Rao
- Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | | | - Nancy Yuen
- UCB Pharma, Raleigh, North Carolina, USA
| | - Kimberley Dickinson
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jill McDonald
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mitchell Maltenfort
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christopher B Forrest
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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3
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Ramantani G, Pisani F. Neonatal seizures—diagnostic options and treatment recommendations. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2022. [DOI: 10.1007/s10309-022-00534-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractSeizures in neonates should prompt rapid evaluation to verify the diagnosis, determine etiology, and initiate appropriate treatment. Neonatal seizure diagnosis requires EEG confirmation and clinical observation alone is insufficient. Although most neonatal seizures are related to acute brain injury, some neonates present early-onset structural or metabolic/genetic epilepsy. Video-EEG monitoring, the gold standard for neonatal seizure detection and quantification, is resource-intensive and often unavailable, with amplitude-integrated EEG offering a reasonable alternative in guiding treatment. Whereas new-generation antiseizure medication (ASM), such as levetiracetam, appear promising, particularly in terms of tolerability, older-generation ASM, such as phenobarbital and phenytoin, are yet to be replaced. Acute treatment should aim at stopping both electroclinical and electrographic-only seizures. In neonates with acute provoked seizures, ASM should be discontinued without tapering after 72 h of seizure freedom and before hospital discharge.
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4
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Kamate M, Reddy AN, Detroja M. KCNQ2 Encephalopathy and Effect of Early Treatment on the Clinical Phenotype. Ann Indian Acad Neurol 2022; 25:289-291. [PMID: 35693682 PMCID: PMC9175412 DOI: 10.4103/aian.aian_335_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/05/2021] [Accepted: 07/18/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mahesh Kamate
- Department of Pediatric Neurology and In-Charge Child Development Clinic, KAHER's J N Medical College, Belagavi, Karnataka State, India
| | - Anuraag N Reddy
- Department of Paediatrics, KAHER's J N Medical College, Belagavi, Karnataka State, India
| | - Mayank Detroja
- Department of Child Development Centre, KLES PK Hospital, Belagavi, Karnataka State, India
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5
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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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6
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Portale A, Comella M, Salomone G, Di Nora A, Marino L, Leonardi R, Praticò AD, Falsaperla R. The Spectrum of KCNQ2- and KCNQ3-Related Epilepsy. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1727099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
KCNQ genes encode for a family of six transmembrane domains, single pore-loop, and K+ channel α-subunits that have a wide range of physiological correlates. In the brain, KCNQ2 and KCNQ3 heteromultimers are thought to underlie the M-current which is essential in raising the threshold for firing an action potential; mutations in these genes may cause several types of infantile epilepsies. KCNQ2-related disorders represent a continuum of overlapping neonatal epileptic phenotypes that range from KCNQ2 benign familial neonatal epilepsy (BFNE), a seizure disorder that occur in children who typically have a normal psychomotor development and are inherited as an autosomal dominant trait, to KCNQ2 early-onset epileptic encephalopathy (EOEE) as the result of a de novo pathogenic variant. KCNQ3-related disorders are rarer and include BFNE, benign familial infantile epilepsy and KCNQ3-related epileptic encephalopathy with intellectual disability with or without seizures and/or cortical visual impairment. For both KCNQ2- and KCNQ3-related disorders, it is possible to use several drugs for different classes of mutations (i.e., gain of function vs. loss of function), and usually their effects vary in relation to the clinical presentation and the phenotype of the patient. However, KCNQ2-EOEE patients have a worse response to treatment than KCNQ2-BFNE patients and usually become drug resistant with multiple daily seizures.
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Affiliation(s)
- Anna Portale
- Unit of Pediatrics, Avola Hospital, Siracusa, Italy
| | - Mattia Comella
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giulia Salomone
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alessandra Di Nora
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Lidia Marino
- Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Roberta Leonardi
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Andrea D. Praticò
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics and Pediatric Emergency, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
- Unit of Neonatal Intensive Care and Neonatology, University Hospital “Policlinico Rodolico-San Marco,” Catania, Italy
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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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8
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Millichap JJ, Harden CL, Dlugos DJ, French JA, Butterfield NN, Grayson C, Aycardi E, Pimstone SN. Capturing seizures in clinical trials of antiseizure medications for KCNQ2-DEE. Epilepsia Open 2021; 6:38-44. [PMID: 33681646 PMCID: PMC7918316 DOI: 10.1002/epi4.12466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 11/16/2022] Open
Abstract
Literature review of patients with KCNQ2 developmental and epileptic encephalopathy (KCNQ2-DEE) reveals, based on 16 reports including 139 patients, a clinical phenotype that includes age- and disease-specific stereotyped seizures. The typical seizure type of KCNQ2-DEE, focal tonic, starts within 0-5 days of life and is readily captured by video-electroencephalography VEEG for clinical and genetic diagnosis. After initial identification, KCNQ2-DEE seizures are clinically apparent and can be clearly identified without the use of EEG or VEEG. Therefore, we propose that the 2019 recommendations from the International League against Epilepsy (ILAE), the Pediatric Epilepsy Research Consortium (PERC), for capturing and recording seizures for clinical trials (Epilepsia Open, 4, 2019, 537) are suitable for use in KCNQ2-DEE‒associated antiseizure medicine (ASM) treatment trials. The ILAE/PERC consensus guidance states that a caregiver-maintained seizure diary, completed by caregivers who are trained to recognize seizures using within-patient historical recordings, accurately captures seizures prospectively in a clinical trial. An alternative approach historically endorsed by the Food and Drug Administration (FDA) compares seizure counts captured on VEEG before and after treatment. A major advantage of the ILAE/PERC strategy is that it expands the numbers of eligible patients who meet inclusion criteria of clinical trials while maintaining accurate seizure counts (Epilepsia Open, 4, 2019, 537). Three recent phase 3 pivotal pediatric trials investigating ASMs to treat syndromic seizures in patients as young as 2 years of age (N Engl J Med, 17, 2017, 699; Lancet, 21, 2020, 2243; Lancet, 17, 2018, 1085); and ongoing phase 2 open-label pediatric clinical trial that includes pediatric epileptic syndromes as young as 1 month of age (Am J Med Genet A, 176, 2018, 773), have already used caregiver-maintained seizure diaries successfully. For determining the outcome of a KCNQ2-DEE ASM treatment trial, the use of a seizure diary to count seizures by trained observers is feasible because the seizures of KCNQ2-DEE are clinically apparent. This strategy is supported by successful precedent in clinical trials in similar age groups and has the endorsement of the international pediatric epilepsy community.
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Affiliation(s)
- John J. Millichap
- Epilepsy Center and Division of NeurologyAnn & Robert H. Lurie Children’s Hospital of ChicagoChicagoILUSA
- Departments of Pediatrics and NeurologyNorthwestern University Feinberg School of MedicineChicagoILUSA
| | | | - Dennis J. Dlugos
- Children's Hospital of PhiladelphiaPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | | | | | - Celene Grayson
- Xenon Pharmaceuticals, Inc.BurnabyBritish ColumbiaCanada
| | | | - Simon N. Pimstone
- Xenon Pharmaceuticals, Inc.BurnabyBritish ColumbiaCanada
- Division of General Internal MedicineUniversity of British ColumbiaBurnabyBritish ColumbiaCanada
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9
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Clinical characteristics of KCNQ2 encephalopathy. Brain Dev 2021; 43:244-250. [PMID: 32917465 DOI: 10.1016/j.braindev.2020.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/18/2020] [Accepted: 08/23/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE KCNQ2 mutations are associated with benign familial neonatal epilepsy (BFNE) or developmental and epileptic encephalopathy (DEE). In this study, we aimed to delineate the phenotype of KCNQ2 encephalopathy and evaluate the treatment response. METHODS Thirteen patients of KCNQ2 encephalopathy were included in the study. Characteristics of KCNQ2 mutations, electroclinical features, clinical course, and response to the treatment were analyzed. RESULTS Age range of the thirteen patients was between 3 months and 20.9 years. The onset of seizures in 11 patients ranged from 1 to 3 days of age, while in the other two patients it was 7 and 40 days, respectively. Most common initial seizure types were tonic seizures. Initial EEGs were suppression burst pattern in seven patients and slow and disorganized background with multifocal epileptiform discharges in six patients. Initial epilepsy syndrome was Ohtahara syndrome in seven patients, neonatal focal seizure in five patients, and focal epilepsy beyond neonatal period in one patient. Sodium channel blockers including oxcarbazepine (OXC) (n = 3), lamotrigine (LTG) (n = 3), phenytoin (PHT) (n = 2), topiramate (TPM) (n = 2), and zonisamide (ZNS) (n = 1) were tried and found effective in eleven patients. Ultimately, 12 of 13 patients became seizure-free. However, developmental outcomes were poor. CONCLUSIONS Sodium channel blockers are effective in seizure control in these patients with KCNQ2 encephalopathy. Early recognition of KCNQ2 encephalopathy and early use of sodium channel blockers might be helpful in seizure control.
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10
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Abstract
Because of next-generation sequencing and the discovery of many new causative genes, genetic testing in epilepsy patients has become widespread. Pathologic variants resulting in epilepsy cause a variety of changes that can be broadly classified into syndromic disorders (i.e., chromosomal abnormalities), metabolic disorders, brain malformations, and abnormal cellular signaling. Here, we review the available genetic testing, reasons to pursue genetic testing, common genetic causes of epilepsy, the data behind what patients are found to have genetic epilepsies based on current testing, and discussing these results with patients. We propose an algorithm for testing patients with epilepsy to maximize yield and limit costs based on their phenotype (including electroencephalography and magnetic resonance imaging findings), age of seizure onset, and presence of other neurologic comorbidities. Being able to discern which type of genetic testing to order, using that information to give targeted and cost-effective patient care, and interpreting results accurately will be a crucial skill for the modern neurologist.
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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
| | - Katherine 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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11
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Miao P, Feng J, Guo Y, Wang J, Xu X, Wang Y, Li Y, Gao L, Zheng C, Cheng H. Genotype and phenotype analysis using an epilepsy‐associated gene panel in Chinese pediatric epilepsy patients. Clin Genet 2018; 94:512-520. [PMID: 30182498 DOI: 10.1111/cge.13441] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/23/2018] [Accepted: 08/29/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Pu Miao
- Department of PediatricsSecond Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
| | - Jianhua Feng
- Department of PediatricsSecond Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
| | - Yufan Guo
- Department of PediatricsSecond Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
| | - Jianda Wang
- Department of PediatricsSecond Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
| | - Xiaoxiao Xu
- Department of PediatricsSecond Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
| | - Ye Wang
- Department of PediatricsSecond Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
| | - Yanfang Li
- Department of PediatricsSecond Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
| | - Liuyan Gao
- Department of PediatricsSecond Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
| | - Chaoguang Zheng
- Department of PediatricsSecond Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
| | - Haiying Cheng
- Department of PediatricsSecond Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China
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