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Zuberi SM, Wirrell E, Yozawitz E, Wilmshurst JM, Specchio N, Riney K, Pressler R, Auvin S, Samia P, Hirsch E, Galicchio S, Triki C, Snead OC, Wiebe S, Cross JH, Tinuper P, Scheffer IE, Perucca E, Moshé SL, Nabbout R. ILAE classification and definition of epilepsy syndromes with onset in neonates and infants: Position statement by the ILAE Task Force on Nosology and Definitions. Epilepsia 2022; 63:1349-1397. [PMID: 35503712 DOI: 10.1111/epi.17239] [Citation(s) in RCA: 226] [Impact Index Per Article: 113.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 12/20/2022]
Abstract
The International League Against Epilepsy (ILAE) Task Force on Nosology and Definitions proposes a classification and definition of epilepsy syndromes in the neonate and infant with seizure onset up to 2 years of age. The incidence of epilepsy is high in this age group and epilepsy is frequently associated with significant comorbidities and mortality. The licensing of syndrome specific antiseizure medications following randomized controlled trials and the development of precision, gene-related therapies are two of the drivers defining the electroclinical phenotypes of syndromes with onset in infancy. The principal aim of this proposal, consistent with the 2017 ILAE Classification of the Epilepsies, is to support epilepsy diagnosis and emphasize the importance of classifying epilepsy in an individual both by syndrome and etiology. For each syndrome, we report epidemiology, clinical course, seizure types, electroencephalography (EEG), neuroimaging, genetics, and differential diagnosis. Syndromes are separated into self-limited syndromes, where there is likely to be spontaneous remission and developmental and epileptic encephalopathies, diseases where there is developmental impairment related to both the underlying etiology independent of epileptiform activity and the epileptic encephalopathy. The emerging class of etiology-specific epilepsy syndromes, where there is a specific etiology for the epilepsy that is associated with a clearly defined, relatively uniform, and distinct clinical phenotype in most affected individuals as well as consistent EEG, neuroimaging, and/or genetic correlates, is presented. The number of etiology-defined syndromes will continue to increase, and these newly described syndromes will in time be incorporated into this classification. The tables summarize mandatory features, cautionary alerts, and exclusionary features for the common syndromes. Guidance is given on the criteria for syndrome diagnosis in resource-limited regions where laboratory confirmation, including EEG, MRI, and genetic testing, might not be available.
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Affiliation(s)
- Sameer M Zuberi
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Institute of Health & Wellbeing, Collaborating Centre of European Reference Network EpiCARE, University of Glasgow, Glasgow, UK
| | - Elaine Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elissa Yozawitz
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology, Montefiore Medical Center, Bronx, New York, USA
| | - Jo M Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesu' Children's Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy
| | - Kate Riney
- Neurosciences Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Ronit Pressler
- Clinical Neuroscience, UCL- Great Ormond Street Institute of Child Health, London, UK.,Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Member of European Reference Network EpiCARE, London, UK
| | - Stephane Auvin
- AP-HP, Hôpital Robert-Debré, INSERM NeuroDiderot, DMU Innov-RDB, Neurologie Pédiatrique, Member of European Reference Network EpiCARE, Université de Paris, Paris, France
| | - Pauline Samia
- Department of Paediatrics and Child Health, Aga Khan University, Nairobi, Kenya
| | - Edouard Hirsch
- Neurology Epilepsy Unit "Francis Rohmer", INSERM 1258, FMTS, Strasbourg University, Strasbourg, France
| | - Santiago Galicchio
- Child Neurology Department, Victor J Vilela Child Hospital of Rosario, Santa Fe, Argentina
| | - Chahnez Triki
- Child Neurology Department, LR19ES15 Neuropédiatrie, Sfax Medical School, University of Sfax, Sfax, Tunisia
| | - O Carter Snead
- Pediatric Neurology, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - J Helen Cross
- Programme of Developmental Neurosciences, UCL NIHR BRC Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, Member of European Reference Network EpiCARE, London, UK.,Young Epilepsy, Lingfield, UK
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Ingrid E Scheffer
- Austin Health and Royal Children's Hospital, Florey Institute, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Emilio Perucca
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Solomon L Moshé
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology, Bronx, New York, USA.,Departments of Neuroscience and Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA.,Montefiore Medical Center, Bronx, New York, USA
| | - Rima Nabbout
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker-Enfants Malades University Hospital, APHP, Member of European Reference Network EpiCARE, Institut Imagine, INSERM, UMR 1163, Université Paris cité, Paris, France
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2
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Gong P, Xue J, Jiao X, Zhang Y, Yang Z. Genetic Etiologies in Developmental and/or Epileptic Encephalopathy With Electrical Status Epilepticus During Sleep: Cohort Study. Front Genet 2021; 12:607965. [PMID: 33897753 PMCID: PMC8060571 DOI: 10.3389/fgene.2021.607965] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Recently, the electroencephalogram pattern of electrical status epilepticus during sleep (ESES) had been reported in some genetic disorders, and most of them were noted with developmental and epileptic encephalopathy (DEE) or epileptic encephalopathy (EE). This study aimed to determine the genetic etiologies and clinical characteristics of ESES in DEE/EE. Methods We performed a cohort study in cases of DEE or EE with ESES. Tio-based genetic testing was performed in 74 cases and was analyzed to identify underlying variants. Results Pathogenic or likely pathogenic variants were identified in 17/74 cases, including KCNQ2 (n = 6), KCNA2 (n = 5), GRIN2A (n = 3), SLC9A6 (n = 1), HIVEP2 (n = 1), and RARS2 (n = 1). Eleven were boys. The median age at seizure onset was 6 months. ESES occurred at the mean age of 2.0 ± 1.2 years, predominant in the Rolandic region in 14 years. Twelve of 17 cases had the first stage of different epilepsy preceding ESES: 2/12 were diagnosed as Ohtahara syndrome, 2/12 were diagnosed as infantile spasms, 3/12 were diagnosed as DEE, and 5/12 were diagnosed as EE without the epileptic syndrome. Conclusion Monogenic variants explained over 20% of DEE/EE with ESES. ESES could be an age-related feature in genetic disorders and occurred after the first stage of different epilepsy. Both age-related factors and genetic etiology were suggested to play a role in the occurrence of ESES in genetic DEE/EE.
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Affiliation(s)
- Pan Gong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jiao Xue
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xianru Jiao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yuehua Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Zhixian Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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Xiong W, Zhou D. Progress in unraveling the genetic etiology of rolandic epilepsy. Seizure 2017; 47:99-104. [PMID: 28351718 DOI: 10.1016/j.seizure.2017.02.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 02/05/2023] Open
Abstract
Rolandic epilepsy (RE), or benign epilepsy of childhood with centrotemporal spikes (BECT), is the most frequent idiopathic partial epilepsy syndrome of childhood, where the "idiopathic" implies a genetic predisposition. Although RE has long been presumed to have a genetic component, clinical and genetic studies have shown a complex inheritance pattern. Furthermore, the underlying major genetic influence in RE has been challenged by recent reports of twin studies. Meanwhile, many genes or loci have been shown to be associated the RE/atypical RE (ARE) spectrum, with a higher frequency of causative variants in ARE. However, a full understanding of the genetic basis in the more common forms of the RE spectrum remains elusive.
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Affiliation(s)
- Weixi Xiong
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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Peycheva V, Ivanova N, Kamenarova K, Tsekova I, Aleksandrova I, Bozhinova V, Bozhidarova M, Litvinenko I, Hristova D, Mitev V, Kaneva R, Jordanova A. Impact of KCNQ2 mutations in Bulgarian patients with electroclinical syndromes with onset in the first year of life. BIOTECHNOL BIOTEC EQ 2017. [DOI: 10.1080/13102818.2016.1259017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Valentina Peycheva
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Medical University of Sofia, Sofia, Bulgaria
| | - Neviana Ivanova
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Medical University of Sofia, Sofia, Bulgaria
| | - Kunka Kamenarova
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Medical University of Sofia, Sofia, Bulgaria
| | - Irina Tsekova
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Medical University of Sofia, Sofia, Bulgaria
| | - Iliyana Aleksandrova
- Department of Neurology, Clinic of Child Neurology, University Hospital of Neurology and Psychiatry “St' Naum”, Medical University of Sofia, Sofia, Bulgaria
| | - Veneta Bozhinova
- Department of Neurology, Clinic of Child Neurology, University Hospital of Neurology and Psychiatry “St' Naum”, Medical University of Sofia, Sofia, Bulgaria
| | - Maria Bozhidarova
- Department of Pediatric Neurology, University Pediatrics Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Ivan Litvinenko
- Department of Pediatric Neurology, University Pediatrics Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Dimitrina Hristova
- Children Neurology Unit, Pediatrics Clinic, Tokuda Hospital, Sofia, Bulgaria
| | - Vanyo Mitev
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Medical University of Sofia, Sofia, Bulgaria
| | - Radka Kaneva
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Medical University of Sofia, Sofia, Bulgaria
| | - Albena Jordanova
- Department of Medical Chemistry and Biochemistry, Molecular Medicine Center, Medical University of Sofia, Sofia, Bulgaria
- VIB Department of Molecular Genetics, Molecular Neurogenomics Group, University of Antwerp, Antwerp, Belgium
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Grinton BE, Heron SE, Pelekanos JT, Zuberi SM, Kivity S, Afawi Z, Williams TC, Casalaz DM, Yendle S, Linder I, Lev D, Lerman-Sagie T, Malone S, Bassan H, Goldberg-Stern H, Stanley T, Hayman M, Calvert S, Korczyn AD, Shevell M, Scheffer IE, Mulley JC, Berkovic SF. Familial neonatal seizures in 36 families: Clinical and genetic features correlate with outcome. Epilepsia 2015; 56:1071-80. [PMID: 25982755 DOI: 10.1111/epi.13020] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We evaluated seizure outcome in a large cohort of familial neonatal seizures (FNS), and examined phenotypic overlap with different molecular lesions. METHODS Detailed clinical data were collected from 36 families comprising two or more individuals with neonatal seizures. The seizure course and occurrence of seizures later in life were analyzed. Families were screened for KCNQ2, KCNQ3, SCN2A, and PRRT2 mutations, and linkage studies were performed in mutation-negative families to exclude known loci. RESULTS Thirty-three families fulfilled clinical criteria for benign familial neonatal epilepsy (BFNE); 27 of these families had KCNQ2 mutations, one had a KCNQ3 mutation, and two had SCN2A mutations. Seizures persisting after age 6 months were reported in 31% of individuals with KCNQ2 mutations; later seizures were associated with frequent neonatal seizures. Linkage mapping in two mutation-negative BFNE families excluded linkage to KCNQ2, KCNQ3, and SCN2A, but linkage to KCNQ2 could not be excluded in the third mutation-negative BFNE family. The three remaining families did not fulfill criteria of BFNE due to developmental delay or intellectual disability; a molecular lesion was identified in two; the other family remains unsolved. SIGNIFICANCE Most families in our cohort of familial neonatal seizures fulfill criteria for BFNE; the molecular cause was identified in 91%. Most had KCNQ2 mutations, but two families had SCN2A mutations, which are normally associated with a mixed picture of neonatal and infantile onset seizures. Seizures later in life are more common in BFNE than previously reported and are associated with a greater number of seizures in the neonatal period. Linkage studies in two families excluded known loci, suggesting a further gene is involved in BFNE.
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Affiliation(s)
- Bronwyn E Grinton
- Epilepsy Research Centre, Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Sarah E Heron
- Epilepsy Research Program, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.,Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - James T Pelekanos
- Epilepsy Research Centre, Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia.,Department of Neurology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia.,UQ Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
| | - Sameer M Zuberi
- Paediatric Neurosciences Research Group, Fraser of Allander Neurosciences Unit, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - Sara Kivity
- Epilepsy Unit, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Zaid Afawi
- Tel-Aviv University Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Tristiana C Williams
- Department of Genetic Medicine, SA Pathology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Dan M Casalaz
- Department of Paediatrics, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Simone Yendle
- Epilepsy Research Centre, Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Ilan Linder
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Metabolic-Neurogenetic Clinic, Wolfson Medical Center, Holon, Israel
| | - Dorit Lev
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Metabolic-Neurogenetic Clinic, Wolfson Medical Center, Holon, Israel.,Institute of Medical Genetics, Wolfson Medical Center, Holon, Israel
| | - Tally Lerman-Sagie
- Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Metabolic-Neurogenetic Clinic, Wolfson Medical Center, Holon, Israel
| | - Stephen Malone
- Department of Neurosciences, Royal Children's Hospital, Brisbane, Queensland, Australia
| | - Haim Bassan
- Pediatric Neurology and Development Unit, Tel Aviv Sourasky Medical Center, Dana Children's Hospital, Tel-Aviv, Israel
| | | | - Thorsten Stanley
- Department of Paediatrics, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Michael Hayman
- Department of Neurology, Royal Children's Hospital, Flemington, Victoria, Australia.,Department of Paediatrics, Monash Medical Centre, Clayton, Victoria, Australia
| | - Sophie Calvert
- Department of Neurosciences, Royal Children's Hospital, Brisbane, Queensland, Australia
| | - Amos D Korczyn
- Department of Neurology, Tel-Aviv University, Tel-Aviv, Israel
| | - Michael Shevell
- Department of Pediatrics & Neurology, McGill University, Montreal, Quebec, Canada
| | - Ingrid E Scheffer
- Epilepsy Research Centre, Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia.,Department of Paediatrics, Royal Children's Hospital, The University of Melbourne, Flemington, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - John C Mulley
- Department of Genetic Medicine, SA Pathology, Women's and Children's Hospital, North Adelaide, South Australia, Australia.,School of Molecular and Biomedical Science, The University of Adelaide, Adelaide, South Australia, Australia.,School of Paediatrics and Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Samuel F Berkovic
- Epilepsy Research Centre, Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
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6
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Miceli F, Striano P, Soldovieri MV, Fontana A, Nardello R, Robbiano A, Bellini G, Elia M, Zara F, Taglialatela M, Mangano S. A novel KCNQ3 mutation in familial epilepsy with focal seizures and intellectual disability. Epilepsia 2014; 56:e15-20. [PMID: 25524373 DOI: 10.1111/epi.12887] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2014] [Indexed: 11/29/2022]
Abstract
Mutations in the KCNQ2 gene encoding for voltage-gated potassium channel subunits have been found in patients affected with early onset epilepsies with wide phenotypic heterogeneity, ranging from benign familial neonatal seizures (BFNS) to epileptic encephalopathy with cognitive impairment, drug resistance, and characteristic electroencephalography (EEG) and neuroradiologic features. By contrast, only few KCNQ3 mutations have been rarely described, mostly in patients with typical BFNS. We report clinical, genetic, and functional data from a family in which early onset epilepsy and neurocognitive deficits segregated with a novel mutation in KCNQ3 (c.989G>T; p.R330L). Electrophysiological studies in mammalian cells revealed that incorporation of KCNQ3 R330L mutant subunits impaired channel function, suggesting a pathogenetic role for such mutation. The degree of functional impairment of channels incorporating KCNQ3 R330L subunits was larger than that of channels carrying another KCNQ3 mutation affecting the same codon but leading to a different amino acid substitution (p.R330C), previously identified in two families with typical BFNS. These data suggest that mutations in KCNQ3, similarly to KCNQ2, can be found in patients with more severe phenotypes including intellectual disability, and that the degree of the functional impairment caused by mutations at position 330 in KCNQ3 may contribute to clinical disease severity.
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Affiliation(s)
- Francesco Miceli
- Unit of Pharmacology, Department of Neuroscience, Reproductive Science and Dentistry, University of Naples Federico II, Naples, Italy
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7
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Zara F, Specchio N, Striano P, Robbiano A, Gennaro E, Paravidino R, Vanni N, Beccaria F, Capovilla G, Bianchi A, Caffi L, Cardilli V, Darra F, Bernardina BD, Fusco L, Gaggero R, Giordano L, Guerrini R, Incorpora G, Mastrangelo M, Spaccini L, Laverda AM, Vecchi M, Vanadia F, Veggiotti P, Viri M, Occhi G, Budetta M, Taglialatela M, Coviello DA, Vigevano F, Minetti C. Genetic testing in benign familial epilepsies of the first year of life: Clinical and diagnostic significance. Epilepsia 2013; 54:425-36. [DOI: 10.1111/epi.12089] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Federico Zara
- Laboratory of Neurogenetics; Department of Neuroscience; Istituto ‘G. Gaslini’; Genova; Italy
| | - Nicola Specchio
- Unit of Neurology; Children Hospital “Bambino Gesù”; Roma; Italy
| | | | - Angela Robbiano
- Laboratory of Neurogenetics; Department of Neuroscience; Istituto ‘G. Gaslini’; Genova; Italy
| | - Elena Gennaro
- Laboratory of Genetics; Hospital Galliera; Genova; Italy
| | - Roberta Paravidino
- Laboratory of Neurogenetics; Department of Neuroscience; Istituto ‘G. Gaslini’; Genova; Italy
| | - Nicola Vanni
- Laboratory of Neurogenetics; Department of Neuroscience; Istituto ‘G. Gaslini’; Genova; Italy
| | | | | | - Amedeo Bianchi
- Division of Neurology; Hospital “S. Donato”; Arezzo; Italy
| | - Lorella Caffi
- Unit of Child Neuropsychiatry; Hospital “Ospedali Riuniti”; Bergamo; Italy
| | - Viviana Cardilli
- Unit of Neonatology; University Hospital “Umberto I”; Roma; Italy
| | - Francesca Darra
- Unit of Child Neuropsychiatry; University of Verona; Verona; Italy
| | | | - Lucia Fusco
- Unit of Neurology; Children Hospital “Bambino Gesù”; Roma; Italy
| | | | - Lucio Giordano
- Unit of Child Neuropsychiatry; Hospital “Civile”; Brescia; Italy
| | - Renzo Guerrini
- Pediatric Neurology; Hospital A. Meyer; University of Firenze; Firenze; Italy
| | | | | | | | | | - Marilena Vecchi
- Department of Pediatrics; University Hospital of Padova; Italy
| | - Francesca Vanadia
- Division of Child Neuropsychiatry; Hospital “Civico e Benfratelli”; Palermo; Italy
| | - Pierangelo Veggiotti
- National Neurologic Institute “C. Mondino”; Child Neuropsychiatry Unit; University of Pavia; Pavia; Italy
| | - Maurizio Viri
- Center for Child Epilepsy; Hospital “Fatebenefratelli e Oftalmico”; Milano; Italy
| | - Guya Occhi
- Hospital “Desenzano del Garda”; Desenzano del Garda; Italy
| | - Mauro Budetta
- Unit of Paediatric Neurology; Hospital “S. Maria Incoronata Dell'Olmo”; Cava de' Tirreni; Italy
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8
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Abstract
Epileptic seizures are more frequent in the neonate than at any other time. The incidence of neonatal seizures (NNS) is estimated to be between 1.5 and 5.5/1000 living births, its onset being during the first week in 80% of cases. Mortality rate remains very high (20-45%). Not all paroxysmal manifestations are epileptic, and differential diagnosis remains an important challenge. Neonates may present with different types of seizures: clonic, tonic, myoclonic (axial, focal, erratic), epileptic spasms, and subtle seizures, including autonomic signs or automatisms. The main etiology is hypoxic-ischemic encephalopathy (40-45%) with a very early onset, and variable semiology including all seizure types. An EEG is necessary to recognize the seizures, and interictal tracing may help in assessing prognosis. Ischemic stroke is associated with seizures of early onset, being focal or unilateral. Interictal EEG is asymmetrical, with focal or unilateral patterns. Other etiologies less often linked to epileptic seizures must be looked for such as brain infection, metabolic disorders, chromosomal abnormalities, inborn errors of metabolism, brain malformations, and vitamin B6 dependency. Neonatal epilepsy syndromes may have favorable (benign familial neonatal seizures) or poor (early infantile encephalopathy with epilepsy, early myoclonic encephalopathy, and migrating partial seizures in infancy) prognosis.
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9
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Ishii A, Miyajima T, Kurahashi H, Wang JW, Yasumoto S, Kaneko S, Hirose S. KCNQ2 abnormality in BECTS: benign childhood epilepsy with centrotemporal spikes following benign neonatal seizures resulting from a mutation of KCNQ2. Epilepsy Res 2012; 102:122-5. [PMID: 22884718 DOI: 10.1016/j.eplepsyres.2012.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 07/08/2012] [Indexed: 11/19/2022]
Abstract
The molecular pathogenesis of benign childhood epilepsy with centrotemporal spikes (BECTS) remains unclear whereas mutations of the KCNQ2 and KCNQ3 genes have been identified as causes of benign familial neonatal convulsions. We report here a girl with benign neonatal convulsions followed by BECTS, for whom a mutation of KCNQ2 was identified. This case may provide the clue to the understanding of the molecular pathogenesis of BECTS.
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Affiliation(s)
- Atsushi Ishii
- Department of Pediatrics, Fukuoka University, Fukuoka, Japan
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10
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Yum MS, Ko TS, Yoo HW. The first Korean case of KCNQ2 mutation in a family with benign familial neonatal convulsions. J Korean Med Sci 2010; 25:324-6. [PMID: 20119593 PMCID: PMC2811307 DOI: 10.3346/jkms.2010.25.2.324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 08/23/2008] [Indexed: 12/02/2022] Open
Abstract
Neonatal seizures represent a heterogeneous group of disorders with vastly different etiologies and outcomes. Benign familial neonatal convulsions (BFNC) are a distinctive epileptic syndrome of autosomal dominant inheritance with a favorable prognosis, characterized by the occurrence of unprovoked partial or generalized clonic seizures in the neonatal period or early infancy. Recently, mutations in two potassium channel genes, KCNQ2 and KCNQ3, have been described in this disorder. In this report, we describe a family with BFNC due to a KCNQ2 mutation, the first such family to be described in the Korean population. The diagnosis of BFNC can be made based on clinical suspicion and careful history taking with special emphasis on the familial nature of the disorder. KCNQ2 mutations may be associated with BFNC in a number of different races, as has been reported in other ethnic groups.
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Affiliation(s)
- Mi-Sun Yum
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Sung Ko
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Han-Wook Yoo
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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11
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Panayiotopoulos CP, Michael M, Sanders S, Valeta T, Koutroumanidis M. Benign childhood focal epilepsies: assessment of established and newly recognized syndromes. Brain 2008; 131:2264-86. [DOI: 10.1093/brain/awn162] [Citation(s) in RCA: 277] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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12
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Dulac O, Nabbout R, Plouin P, Chiron C, Scheffer IE. Early seizures: causal events or predisposition to adult epilepsy? Lancet Neurol 2007; 6:643-51. [PMID: 17582364 DOI: 10.1016/s1474-4422(07)70173-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Past studies have been unable to confirm whether early seizures predispose to epilepsy in adults. Seizures in infancy were classically thought to cause brain lesions that led to epilepsy in adulthood. However, these infants were not thought to have epilepsy, but acute events that included seizures. Accumulating evidence suggests that early seizures may be associated with, or cause, brain damage; or alternatively, they may be the first expression of a genetic or lesional predisposition to epilepsy. The course of early seizures ranges from transient to life-long, depending on epilepsy syndrome, causes, and treatment. The main factors that determine late or persisting epilepsy after the occurrence of early seizures are protracted seizures, tonic seizures, and involvement of mesial temporal structures. A developmental approach to seizure disorders will aid understanding of epilepsy in adults and improve the design of antiepileptic agents for children and adults.
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Affiliation(s)
- Olivier Dulac
- Department of Neuropaediatrics, APHP, Centre de Référence Epilepsies Rares, Necker-Enfants Malades Hospital, Paris, France
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Okumura A, Watanabe K, Negoro T. Benign partial epilepsy in infancy long-term outcome and marginal syndromes. Epilepsy Res 2006; 70 Suppl 1:S168-73. [PMID: 16837166 DOI: 10.1016/j.eplepsyres.2005.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Revised: 11/29/2005] [Accepted: 11/29/2005] [Indexed: 11/16/2022]
Abstract
Benign partial epilepsy in infancy (BPEI) is an infantile epilepsy with excellent seizure and developmental outcome proposed by Watanabe et al. Our telephone interview survey revealed that the long-term outcome of patients with BPEI was also excellent over 8 years of age. Six of 39 patients did not fulfill the criteria of BPEI by the last follow-up. Two patients had a recurrence of unprovoked seizure beyond 2 years of age, three had cognitive problems (mild mental retardation in two and Asperger syndrome in one) and the other had both a recurrence of seizure and mild mental retardation. These results indicates that a large majority of patients diagnosed as possible BPEI at 2 years of age did not have a recurrence of unprovoked seizures and mental problems beyond 8 years of age. Our study also suggested a presence of some marginal syndromes of BPEI. An association of paroxysmal kinesigenic choreoathetosis was observed in three patients. Another three patients had experienced seizures with mild gastroenteritis. The seizure outcome of three patients with mild cognitive problems was quite excellent. These patients can be grouped as a marginal syndrome of BPEI.
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Affiliation(s)
- Akihisa Okumura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan.
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de Haan GJ, Pinto D, Carton D, Bader A, Witte J, Peters E, van Erp G, Vandereyken W, Boezeman E, Wapenaar MC, Boon P, Halley D, Koeleman BPC, Lindhout D. A novel splicing mutation in KCNQ2 in a multigenerational family with BFNC followed for 25 years. Epilepsia 2006; 47:851-9. [PMID: 16686649 DOI: 10.1111/j.1528-1167.2006.00552.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE A large multigenerational family with benign familial neonatal convulsions (BFNC) was revisited to identify the disease-causing mutation and to assess long-term outcome. METHODS We supplemented the original data with recent clinical and neurophysiologic data on patients and first-degree relatives, including information on seizure recurrence. We conducted linkage analysis at the EBN1 and EBN2 loci, followed by mutation analysis of KCNQ2. We evaluated the qualitative effect of the KCNQ2 mutation at the messenger RNA (mRNA) level by using reverse-transcribed total RNA isolated from leukocytes. RESULTS Thirteen relatives had a history of neonatal convulsions, 11 of whom showed remission within 2 months. One patient showed an atypical course of neonatal convulsions, developing photosensitive myoclonic epilepsy at age 13 years. We found suggestive linkage of the BFNC phenotype to the 20q13-EBN1 locus (lod score, 2.03) and an intronic mutation IVS14-6 C>A in KCNQ2 segregating with the trait in all affected members, but absent in 100 unrelated control subjects. This mutation creates a new, preferentially used, splice site. Alternative splicing adds 4 nt containing a premature stop codon to the transcript, resulting in a truncated protein after position R588. CONCLUSIONS We detected and characterized a novel splicing mutation in the brain-specific KCNQ2 gene by using easily accessible blood leukocytes. Aberrant splicing cosegregates with BFNC but not with photosensitivity.
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Okumura A, Watanabe K, Negoro T, Hayakawa F, Kato T, Maruyama K, Kubota T, Suzuki M, Kurahashi H, Azuma Y. Long-term Follow-up of Patients with Benign Partial Epilepsy in Infancy. Epilepsia 2006; 47:181-5. [PMID: 16417547 DOI: 10.1111/j.1528-1167.2006.00385.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to investigate the long-term outcome of children with benign partial epilepsy in infancy (BPEI). METHODS A telephone-interview survey using a structured questionnaire was conducted with patients who were diagnosed as having possible BPEI at age 2 years and who were 8 years or older at the time of the survey. The data from 39 of 48 patients were available. The median age at the time of the survey was 11.3 years; 18 boys and 21 girls were included. RESULTS Three patients had a recurrence of unprovoked seizure beyond age 2 years. Four patients had cognitive problems (mild mental retardation in three and Asperger syndrome in one). An association of paroxysmal kinesigenic choreoathetosis was observed in three patients, and another three had experienced seizures associated with mild gastroenteritis. Major behavioral problems were not recognized in any patients. Four patients were excluded from having definite BPEI at age 5 years, and another two were excluded for having definite BPEI at the last follow-up. Eventually, 33 of 39 patients were categorized as having definite BPEI beyond 8 years of age. CONCLUSIONS A large majority of patients diagnosed as possibly having BPEI at age 2 years did not have a recurrence of unprovoked seizures and cognitive problems beyond 8 years of age.
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Affiliation(s)
- Akihisa Okumura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Scheffer IE, Harkin LA, Dibbens LM, Mulley JC, Berkovic SF. Neonatal Epilepsy Syndromes and Generalized Epilepsy with Febrile Seizures Plus (GEFS+). Epilepsia 2005; 46 Suppl 10:41-7. [PMID: 16359471 DOI: 10.1111/j.1528-1167.2005.00358.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
MESH Headings
- Child, Preschool
- Epilepsies, Myoclonic/genetics
- Epilepsy, Benign Neonatal/diagnosis
- Epilepsy, Benign Neonatal/genetics
- Epilepsy, Generalized/diagnosis
- Epilepsy, Generalized/genetics
- Female
- Genetic Heterogeneity
- Humans
- Infant
- KCNQ2 Potassium Channel/genetics
- KCNQ3 Potassium Channel/genetics
- Male
- Mutation
- NAV1.1 Voltage-Gated Sodium Channel
- Nerve Tissue Proteins/genetics
- Phenotype
- Receptors, GABA-A/genetics
- Receptors, GABA-B/genetics
- Seizures, Febrile/diagnosis
- Seizures, Febrile/genetics
- Sodium Channels/genetics
- Voltage-Gated Sodium Channel beta-1 Subunit
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Affiliation(s)
- Ingrid E Scheffer
- Department of Medicine (Neurology), The University of Melbourne, Austin Health, Melbourne, Victoria.
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17
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Schmitt B, Wohlrab G, Sander T, Steinlein OK, Hajnal BL. Neonatal seizures with tonic clonic sequences and poor developmental outcome. Epilepsy Res 2005; 65:161-8. [PMID: 16039833 DOI: 10.1016/j.eplepsyres.2005.05.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Revised: 04/04/2005] [Accepted: 05/29/2005] [Indexed: 11/16/2022]
Abstract
Seizures consisting of a tonic followed by a clonic phase have rarely been described in neonates and are not included in the current classifications of neonatal seizures. Our video archive of 105 neonates with seizures or suspected seizures revealed six neonates with such tonic clonic or tonic myoclonic sequences. Two of those neonates had pyridoxine dependent seizures. The other four neonates had drug refractory seizures and demonstrated similarities in electro-clinical pattern, clinical course and outcome. Their seizures started with tonic posturing and after 10-20s tonic posturing was superimposed by focal or multifocal cloni or myocloni. Ictal EEG started with voltage attenuation followed by bilateral or alternating focal epileptic discharges. The interictal EEG was abnormal. One child died, while the other three children became seizure free but had severe motor delay and mental retardation. In one of those three children, a de novo missense mutation was detected in the voltage gated potassium channel gene KCNQ2, indicating a genetic relationship between drug refractory neonatal seizures of unknown etiology with tonic clonic or myoclonic sequences and the well-known syndrome of benign familial neonatal convulsions (BFNC).
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Affiliation(s)
- Bernhard Schmitt
- University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zürich, Switzerland.
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Komárek V, Stĕrbová K, Faladová L. Evolution of EEG and seizures in childhood. SUPPLEMENTS TO CLINICAL NEUROPHYSIOLOGY 2003; 53:250-8. [PMID: 12741007 DOI: 10.1016/s1567-424x(09)70168-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- V Komárek
- Epilepsy Monitoring Unit, Department of Pediatric Neurology, 2nd Medical School of Charles University, 15018 Prague 5, Czech Republic.
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Doose H, Petersen B, Neubauer BA. Occipital sharp waves in idiopathic partial epilepsies--clinical and genetic aspects. Epilepsy Res 2002; 48:121-30. [PMID: 11823116 DOI: 10.1016/s0920-1211(01)00324-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In order to gain new insight into the pathogenesis and nosography of benign partial epilepsy with occipital paroxysms (BEOP) we retrospectively analysed cases with benign focal sharp waves (SHW) of different localisations, in which analogous EEG changes had been found in at least one first degree relative. Fifty-six families were evaluated. Nineteen cases with occipital SHW (group A) were compared with 37 cases without (group B). There was a broad spectrum of symptomatology with large overlaps between the two groups. However, a number of striking differences, yielding a characteristic picture of early childhood epilepsy with occipital foci were identified: (1) Age of onset under 5 years; (2) a larger proportion of febrile convulsions (FC 47 vs. 19%); (3) a trend towards a higher rate of typical early childhood occipital seizures (26 vs. 5%); (4) a higher rate of frontal and generalizing SHW foci (32 vs. 5%; 37 vs. 11%); (5) a higher rate of generalized spikes and waves (SW) (46 vs. 14%); (6) a trend towards a higher rate of photoparoxysmal response (PPR) (57 vs. 32%). The high prevalence of independent genetic traits favours a multifactorial pathogenesis. The predisposition to FC with characteristic early seizure onset and varying patterns of generalized genetic EEG traits plays a crucial role within the complex pathogenetic network. The early-onset benign childhood occipital seizure susceptibility syndrome of Panayiotopoulos (Benign Childhood Partial Seizures and Related Epileptic Syndromes, John Libbey & Company Ltd., London (1999)) cannot be regarded as the sole representative of occipital spikes in early childhood but as an important even though rare form of occipital epilepsy.
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Abstract
The significant progress made over the past year in understanding the basis for a form of neonatal seizures can be attributed to the successful positional cloning of two new voltage-gated potassium channel genes. Expression studies have increased our understanding of the biology of these channels and their role in epilepsy.
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Affiliation(s)
- M Leppert
- University of Utah, Department of Human Genetics, Salt Lake City, USA.
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