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Ben Said M, Jallouli O, Ben Aissa A, Souissi A, Kamoun F, Fakhfakh F, Masmoudi S, Ben Ayed I, Charfi Triki C. Customized targeted massively parallel sequencing enables the identification of novel pathogenic variants in Tunisian patients with developmental and epileptic encephalopathy. Epilepsia Open 2024; 9:1697-1709. [PMID: 37867425 PMCID: PMC11450609 DOI: 10.1002/epi4.12848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVE To develop a high-throughput sequencing panel for the diagnosis of developmental and epileptic encephalopathy in Tunisia and to clarify the frequency of disease-causing genes in this region. METHODS We developed a custom panel for next-generation sequencing of the coding sequences of 116 genes in individuals with developmental and epileptic encephalopathy from the Tunisian population. Segregation analyses and in silico studies have been conducted to assess the identified variants' pathogenicity. RESULTS We report 12 pathogenic variants in SCN1A, CHD2, CDKL5, SZT2, KCNT1, GNAO1, PCDH19, MECP2, GRIN2A, and SYNGAP1 in patients with developmental and epileptic encephalopathy. Five of these variants are novel: "c.149delA, p.(Asn50MetfsTer26)" in CDKL5; "c.3616C > T, p.(Arg1206Ter)" in SZT2; "c.111_113del, p.(Leu39del)" in GNAO1; "c.1435G>C, p.(Asp479His)" in PCDH19; and "c.2143delC, p.(Arg716GlyfsTer10)" in SYNGAP1. Additionally, for four of our patients, the genetic result facilitated the choice of the appropriate treatment. SIGNIFICANCE This is the first report of a custom gene panel to identify genetic variants implicated in developmental and epileptic encephalopathy in the Tunisian population as well as the North African region (Tunisia, Egypt, Libya, Algeria, Morocco) with a diagnostic rate of 30%. This high-throughput sequencing panel has considerably improved the rate of positive diagnosis of developmental and epileptic encephalopathy in the Tunisian population, which was less than 15% using Sanger sequencing. The benefit of genetic testing in these patients was approved by both physicians and parents.
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Affiliation(s)
- Mariem Ben Said
- Laboratory of Molecular and Cellular Screening Processes, Center of Biotechnology of SfaxUniversity of SfaxSfaxTunisia
| | - Olfa Jallouli
- Department of Child Neurology, Hedi Chaker Hospital, LR19ES15University of SfaxSfaxTunisia
| | - Abir Ben Aissa
- Department of Child Neurology, Hedi Chaker Hospital, LR19ES15University of SfaxSfaxTunisia
| | - Amal Souissi
- Laboratory of Molecular and Cellular Screening Processes, Center of Biotechnology of SfaxUniversity of SfaxSfaxTunisia
| | - Fatma Kamoun
- Department of Child Neurology, Hedi Chaker Hospital, LR19ES15University of SfaxSfaxTunisia
| | - Faiza Fakhfakh
- Molecular Genetics and Functional Laboratory, Faculty of Science of SfaxUniversity of SfaxSfaxTunisia
| | - Saber Masmoudi
- Laboratory of Molecular and Cellular Screening Processes, Center of Biotechnology of SfaxUniversity of SfaxSfaxTunisia
| | - Ikhlas Ben Ayed
- Laboratory of Molecular and Cellular Screening Processes, Center of Biotechnology of SfaxUniversity of SfaxSfaxTunisia
| | - Chahnez Charfi Triki
- Department of Child Neurology, Hedi Chaker Hospital, LR19ES15University of SfaxSfaxTunisia
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Li X, Guo S, Sun Y, Ding J, Chen C, Wu Y, Li P, Sun T, Wang X. GABRG2 mutations in genetic epilepsy with febrile seizures plus: structure, roles, and molecular genetics. J Transl Med 2024; 22:767. [PMID: 39143639 PMCID: PMC11323400 DOI: 10.1186/s12967-024-05387-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/10/2024] [Indexed: 08/16/2024] Open
Abstract
Genetic epilepsy with febrile seizures plus (GEFS+) is a genetic epilepsy syndrome characterized by a marked hereditary tendency inherited as an autosomal dominant trait. Patients with GEFS+ may develop typical febrile seizures (FS), while generalized tonic-clonic seizures (GTCSs) with fever commonly occur between 3 months and 6 years of age, which is generally followed by febrile seizure plus (FS+), with or without absence seizures, focal seizures, or GTCSs. GEFS+ exhibits significant genetic heterogeneity, with polymerase chain reaction, exon sequencing, and single nucleotide polymorphism analyses all showing that the occurrence of GEFS+ is mainly related to mutations in the gamma-aminobutyric acid type A receptor gamma 2 subunit (GABRG2) gene. The most common mutations in GABRG2 are separated in large autosomal dominant families, but their pathogenesis remains unclear. The predominant types of GABRG2 mutations include missense (c.983A → T, c.245G → A, p.Met199Val), nonsense (R136*, Q390*, W429*), frameshift (c.1329delC, p.Val462fs*33, p.Pro59fs*12), point (P83S), and splice site (IVS6+2T → G) mutations. All of these mutations types can reduce the function of ion channels on the cell membrane; however, the degree and mechanism underlying these dysfunctions are different and could be linked to the main mechanism of epilepsy. The γ2 subunit plays a special role in receptor trafficking and is closely related to its structural specificity. This review focused on investigating the relationship between GEFS+ and GABRG2 mutation types in recent years, discussing novel aspects deemed to be great significance for clinically accurate diagnosis, anti-epileptic treatment strategies, and new drug development.
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Affiliation(s)
- Xinxiao Li
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China.
| | - Shengnan Guo
- Department of Rehabilitative Medicine, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China
| | - Yangyang Sun
- Ningxia Key Laboratory of Cerebrocranial Disease, The Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, Ningxia, 750001, People's Republic of China
| | - Jiangwei Ding
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China
| | - Chao Chen
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China
| | - Yuehui Wu
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China
| | - Peidong Li
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China
| | - Tao Sun
- Ningxia Key Laboratory of Cerebrocranial Disease, The Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, Ningxia, 750001, People's Republic of China.
| | - Xinjun Wang
- Department of Neurosurgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China.
- Department of Neurosurgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China.
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Lee S, Kang M, So KH, Jang R, Shin YW, Jang SS, Yoon JG, Kim S, Kim M, Chu K, Lee SK, Kim KJ, Baek ST, Lim BC, Moon J. Broadening the scope of multigene panel analysis for adult epilepsy patients. Epilepsia Open 2024; 9:1538-1549. [PMID: 38946282 PMCID: PMC11296137 DOI: 10.1002/epi4.12993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 05/13/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
OBJECTIVE Epilepsy is a suitable target for gene panel sequencing because a considerable portion of epilepsy is now explained by genetic components, especially in syndromic cases. However, previous gene panel studies on epilepsy have mostly focused on pediatric patients. METHODS We enrolled adult epilepsy patients meeting any of the following criteria: family history of epilepsy, seizure onset age ≤ 19 years, neuronal migration disorder, and seizure freedom not achieved by dual anti-seizure medications. We sequenced the exonic regions of 211 epilepsy genes in these patients. To confirm the pathogenicity of a novel MTOR truncating variant, we electroporated vectors with different MTOR variants into developing mouse brains. RESULTS A total of 92 probands and 4 affected relatives were tested, and the proportion of intellectual disability (ID) and/or developmental disability (DD) was 21.7%. As a result, twelve probands (13.0%) had pathogenic or likely pathogenic variants in the following genes or regions: DEPDC5, 15q12-q13 duplication (n = 2), SLC6A1, SYNGAP1, EEF1A2, LGI1, MTOR, KCNQ2, MEF2C, and TSC1 (n = 1). We confirmed the functional impact of a novel truncating mutation in the MTOR gene (c.7570C > T, p.Gln2524Ter) that disrupted neuronal migration in a mouse model. The diagnostic yield was higher in patients with ID/DD or childhood-onset seizures. We also identified additional candidate variants in 20 patients that could be reassessed by further studies. SIGNIFICANCE Our findings underscore the clinical utility of gene panel sequencing in adult epilepsy patients suspected of having genetic etiology, especially those with ID/DD or early-onset seizures. Gene panel sequencing could not only lead to genetic diagnosis in a substantial portion of adult epilepsy patients but also inform more precise therapeutic decisions based on their genetic background. PLAIN LANGUAGE SUMMARY This study demonstrated the effectiveness of gene panel sequencing in adults with epilepsy, revealing pathogenic or likely pathogenic variants in 13.0% of patients. Higher diagnostic yields were observed in those with neurodevelopmental disorders or childhood-onset seizures. Additionally, we have shown that expanding genetic studies into adult patients would uncover new types of pathogenic variants for epilepsy, contributing to the advancement of precision medicine for individuals with epilepsy. In conclusion, our results highlight the practical value of employing gene panel sequencing in adult epilepsy patients, particularly when genetic etiology is clinically suspected.
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Affiliation(s)
- Seungbok Lee
- Department of Genomic MedicineSeoul National University HospitalSeoulKorea
- Department of PediatricsSeoul National University College of Medicine, Seoul National University Children's HospitalSeoulKorea
| | - Mi‐Kyoung Kang
- Department of NeurologySeoul National University College of Medicine, Seoul National University HospitalSeoulKorea
| | - Ki Hurn So
- Department of Life SciencesPohang University of Science and Technology (POSTECH)PohangKorea
| | - Riyul Jang
- Department of Life SciencesPohang University of Science and Technology (POSTECH)PohangKorea
| | - Yong Woo Shin
- Department of NeurologySeoul National University College of Medicine, Seoul National University HospitalSeoulKorea
| | - Se Song Jang
- Department of PediatricsSeoul National University College of Medicine, Seoul National University Children's HospitalSeoulKorea
| | - Jihoon G. Yoon
- Department of Genomic MedicineSeoul National University HospitalSeoulKorea
| | - Sheehyun Kim
- Department of Genomic MedicineSeoul National University HospitalSeoulKorea
| | - Manjin Kim
- Department of Genomic MedicineSeoul National University HospitalSeoulKorea
- Department of Laboratory MedicineSeoul National University College of Medicine, Seoul National University HospitalSeoulKorea
| | - Kon Chu
- Department of NeurologySeoul National University College of Medicine, Seoul National University HospitalSeoulKorea
| | - Sang Kun Lee
- Department of NeurologySeoul National University College of Medicine, Seoul National University HospitalSeoulKorea
| | - Ki Joong Kim
- Department of PediatricsSeoul National University College of Medicine, Seoul National University Children's HospitalSeoulKorea
| | - Seung Tae Baek
- Department of Life SciencesPohang University of Science and Technology (POSTECH)PohangKorea
| | - Byung Chan Lim
- Department of PediatricsSeoul National University College of Medicine, Seoul National University Children's HospitalSeoulKorea
| | - Jangsup Moon
- Department of Genomic MedicineSeoul National University HospitalSeoulKorea
- Department of NeurologySeoul National University College of Medicine, Seoul National University HospitalSeoulKorea
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Lado FA, Ahrens SM, Riker E, Muh CR, Richardson RM, Gray J, Small B, Lewis SZ, Schofield TJ, Clarke DF, Hopp JL, Lee RR, Salpekar JA, Arnold ST. Guidelines for Specialized Epilepsy Centers: Executive Summary of the Report of the National Association of Epilepsy Centers Guideline Panel. Neurology 2024; 102:e208087. [PMID: 38306606 PMCID: PMC10962912 DOI: 10.1212/wnl.0000000000208087] [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: 09/13/2023] [Accepted: 10/26/2023] [Indexed: 02/04/2024] Open
Abstract
The National Association of Epilepsy Centers first published the guidelines for epilepsy centers in 1990, which were last updated in 2010. Since that update, epilepsy care and the science of guideline development have advanced significantly, including the importance of incorporating a diversity of stakeholder perspectives such as those of patients and their caregivers. Currently, despite extensive published data examining the efficacy of treatments and diagnostic testing for epilepsy, there remain significant gaps in data identifying the essential services needed for a comprehensive epilepsy center and the optimal manner for their delivery. The trustworthy consensus-based statements (TCBS) process produces unbiased, scientifically valid guidelines through a transparent process that incorporates available evidence and expert opinion. A systematic literature search returned 5937 relevant studies from which 197 articles were retained for data extraction. A panel of 41 stakeholders with diverse expertise evaluated this evidence and drafted recommendations following the TCBS process. The panel reached consensus on 52 recommendations covering services provided by specialized epilepsy centers in both the inpatient and outpatient settings in major topic areas including epilepsy monitoring unit care, surgery, neuroimaging, neuropsychology, genetics, and outpatient care. Recommendations were informed by the evidence review and reflect the consensus of a broad panel of expert opinions.
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Affiliation(s)
- Fred A Lado
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Stephanie M Ahrens
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Ellen Riker
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Carrie R Muh
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - R Mark Richardson
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Johanna Gray
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Barbara Small
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Sandra Z Lewis
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Thomas J Schofield
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Dave F Clarke
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Jennifer L Hopp
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Roland R Lee
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Jay A Salpekar
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
| | - Susan T Arnold
- Zucker School of Medicine at Hofstra/Northwell (F.A.L.), Hempstead, NY; The Ohio State University College of Medicine (S.M.A.), Columbus; National Association of Epilepsy Centers (E.R., J.G., B.S.), Washington, DC; New York Medical College (C.R.M.), Valhalla, NY; Harvard Medical School (R.M.R.), Boston, MA; EBQ Consulting (S.Z.L., T.J.S.), Santa Monica, CA; University of Texas at Austin Dell Medical School (D.F.C.); University of Maryland School of Medicine (J.L.H.), Baltimore; University of California San Diego School of Medicine (R.R.L.); Johns Hopkins University Medical School (J.A.S.), Baltimore, MD; Yale School of Medicine (S.T.A.), New Haven, CT
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Hebbar M, Al-Taweel N, Gill I, Boelman C, Dean RA, Goodchild SJ, Mezeyova J, Shuart NG, Johnson JP, Lee J, Michoulas A, Huh LL, Armstrong L, Connolly MB, Demos MK. Expanding the genotype-phenotype spectrum in SCN8A-related disorders. BMC Neurol 2024; 24:31. [PMID: 38233770 PMCID: PMC10792783 DOI: 10.1186/s12883-023-03478-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/27/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND SCN8A-related disorders are a group of variable conditions caused by pathogenic variations in SCN8A. Online Mendelian Inheritance in Man (OMIM) terms them as developmental and epileptic encephalopathy 13, benign familial infantile seizures 5 or cognitive impairment with or without cerebellar ataxia. METHODS In this study, we describe clinical and genetic results on eight individuals from six families with SCN8A pathogenic variants identified via exome sequencing. RESULTS Clinical findings ranged from normal development with well-controlled epilepsy to significant developmental delay with treatment-resistant epilepsy. Three novel and three reported variants were observed in SCN8A. Electrophysiological analysis in transfected cells revealed a loss-of-function variant in Patient 4. CONCLUSIONS This work expands the clinical and genotypic spectrum of SCN8A-related disorders and provides electrophysiological results on a novel loss-of-function SCN8A variant.
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Affiliation(s)
- Malavika Hebbar
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nawaf Al-Taweel
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Inderpal Gill
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Cyrus Boelman
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard A Dean
- Xenon Pharmaceuticals, 200-3650 Gilmore Way, Burnaby, BC, V5G 4W8, Canada
| | - Samuel J Goodchild
- Xenon Pharmaceuticals, 200-3650 Gilmore Way, Burnaby, BC, V5G 4W8, Canada
| | - Janette Mezeyova
- Xenon Pharmaceuticals, 200-3650 Gilmore Way, Burnaby, BC, V5G 4W8, Canada
| | | | - J P Johnson
- Xenon Pharmaceuticals, 200-3650 Gilmore Way, Burnaby, BC, V5G 4W8, Canada
| | - James Lee
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Aspasia Michoulas
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda L Huh
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linlea Armstrong
- Department of Medical Genetics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mary B Connolly
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michelle K Demos
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Arslan A. Pathogenic variants of human GABRA1 gene associated with epilepsy: A computational approach. Heliyon 2023; 9:e20218. [PMID: 37809401 PMCID: PMC10559982 DOI: 10.1016/j.heliyon.2023.e20218] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/17/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023] Open
Abstract
Critical for brain development, neurodevelopmental and network disorders, the GABRA1 gene encodes for the α1 subunit, an abundantly and developmentally expressed subunit of heteropentameric gamma-aminobutyric acid A receptors (GABAARs) mediating primary inhibition in the brain. Mutations of the GABAAR subunit genes including GABRA1 gene are associated with epilepsy, a group of syndromes, characterized by unprovoked seizures and diagnosed by integrative approach, that involves genetic testing. Despite the diagnostic use of genetic testing, a large fraction of the GABAAR subunit gene variants including the variants of GABRA1 gene is not known in terms of their molecular consequence, a challenge for precision and personalized medicine. Addressing this, one hundred thirty-seven GABRA1 gene variants of unknown clinical significance have been extracted from the ClinVar database and computationally analyzed for pathogenicity. Eight variants (L49H, P59L, W97R, D99G, G152S, V270G, T294R, P305L) are predicted as pathogenic and mapped to the α1 subunit's extracellular domain (ECD), transmembrane domains (TMDs) and extracellular linker. This is followed by the integration with relevant data for cellular pathology and severity of the epilepsy syndromes retrieved from the literature. Our results suggest that the pathogenic variants in the ECD of GABRA1 (L49H, P59L, W97R, D99G, G152S) will probably manifest decreased surface expression and reduced current with mild epilepsy phenotypes while V270G, T294R in the TMDs and P305L in the linker between the second and the third TMDs will likely cause reduced cell current with severe epilepsy phenotypes. The results presented in this study provides insights for clinical genetics and wet lab experimentation.
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Affiliation(s)
- Ayla Arslan
- Department of Molecular Biology and Genetics, Faculty of Engineering and Natural Sciences, Üsküdar University, Istanbul, Turkey
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7
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Hebbar M, Al-Taweel N, Gill I, Boelman C, Dean RA, Goodchild SJ, Mezeyova J, Shuart NG, Johnson JP, Lee J, Michoulas A, Huh LL, Armstrong L, Connolly MB, Demos MK. Expanding the genotype-phenotype spectrum in SCN8A-related disorders. RESEARCH SQUARE 2023:rs.3.rs-3221902. [PMID: 37609289 PMCID: PMC10441468 DOI: 10.21203/rs.3.rs-3221902/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Background SCN8A-related disorders are a group of variable conditions caused by pathogenic variations in SCN8A. Online Mendelian Inheritance in Man (OMIM) terms them as developmental and epileptic encephalopathy 13, benign familial infantile seizures 5 or cognitive impairment with or without cerebellar ataxia. Methods In this study, we describe clinical and genetic results on eight individuals from six families with SCN8A pathogenic variants identified via exome sequencing. Results Clinical findings ranged from normal development with well-controlled epilepsy to significant developmental delay with treatment-resistant epilepsy. Three novel and three reported variants were observed in SCN8A. Electrophysiological analysis in transfected cells revealed a loss-of-function variant in Patient 4. Conclusions This work expands the clinical and genotypic spectrum of SCN8A-related disorders and provides electrophysiological results on a novel loss-of-function SCN8A variant.
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Affiliation(s)
- Malavika Hebbar
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver BC
| | - Nawaf Al-Taweel
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver BC
| | - Inderpal Gill
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver BC
| | - Cyrus Boelman
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver BC
| | - Richard A Dean
- Xenon Pharmaceuticals, 200-3650 Gilmore Way, Burnaby, BC V5G 4W8
| | | | - Janette Mezeyova
- Xenon Pharmaceuticals, 200-3650 Gilmore Way, Burnaby, BC V5G 4W8
| | | | - J P Johnson
- Xenon Pharmaceuticals, 200-3650 Gilmore Way, Burnaby, BC V5G 4W8
| | - James Lee
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver BC
| | - Aspasia Michoulas
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver BC
| | - Linda L Huh
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver BC
| | - Linlea Armstrong
- Department of Medical Genetics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver BC
| | - Mary B Connolly
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver BC
| | - Michelle K Demos
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Faculty of Medicine, University of British Columbia, Vancouver BC
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8
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Graifman JL, Lippa NC, Mulhern MS, Bergner AL, Sands TT. Clinical utility of exome sequencing in a pediatric epilepsy cohort. Epilepsia 2023; 64:986-997. [PMID: 36740579 DOI: 10.1111/epi.17534] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Exome sequencing (ES) has played an important role in the identification of causative variants for individuals with epilepsy and has proven to be a valuable diagnostic tool. Less is known about its clinical utility once a diagnosis is received. This study systematically reviewed the impact of ES results on clinical decision-making and patient care in a pediatric epilepsy cohort at a tertiary care medical center. METHODS Pediatric patients with unexplained epilepsy were referred by their neurologist, and informed consent was obtained through an institutional review board-approved research ES protocol. For patients who received a genetic diagnosis, a retrospective chart review was completed of the probands and their relatives' medical records prior to and after genetic diagnosis. The following outcomes were explored: provider management recommendations, changes in care actually implemented, and anticipatory guidance provided regarding the proband's condition. RESULTS Fifty-three probands met the inclusion criteria. Genetic diagnosis led to at least one provider recommendation in 41.5% families (22/53). Recommendations were observed in the following categories: medication, screening for non-neurological comorbidities/referrals to specialists, referrals to clinical research/trials, and cascade testing. Anticipatory guidance including information about molecular diagnosis, prognosis, and relevant foundations/advocacy groups was also observed. SIGNIFICANCE Results demonstrate the clinical utility of ES for individuals with epilepsy across multiple aspects of patient care, including anti-seizure medication (ASM) selection; screening for non-neurological comorbidities and referrals to appropriate medical specialists; referral to reproductive genetic counseling; and access to research, information, and support resources. To our knowledge, this is the first study to evaluate the clinical utility of ES for a pediatric epilepsy cohort with broad epilepsy phenotypes. This work supports the implementation of ES as part of clinical care in this population.
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Affiliation(s)
- Jordana L Graifman
- Genetic Counseling Graduate Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Natalie C Lippa
- Genetic Counseling Graduate Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, New York, USA.,Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Maureen S Mulhern
- Genetic Counseling Graduate Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Amanda L Bergner
- Genetic Counseling Graduate Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Genetics and Development, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Tristan T Sands
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, New York, USA.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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9
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Esterhuizen AI, Tiffin N, Riordan G, Wessels M, Burman RJ, Aziz MC, Calhoun JD, Gunti J, Amiri EE, Ramamurthy A, Bamshad MJ, Mefford HC, Ramesar R, Wilmshurst JM, Carvill GL, Leal SM, Nickerson DA, Anderson P, Bacus TJ, Blue EE, Brower K, Buckingham KJ, Chong JX, Cornejo Sánchez D, Davis CP, Davis CJ, Frazar CD, Gomeztagle-Burgess K, Gordon WW, Horike-Pyne M, Hurless JR, Jarvik GP, Johanson E, Thomas Kolar J, Marvin CT, McGee S, McGoldrick DJ, Mekonnen B, Nielsen PM, Patterson K, Radhakrishnan A, Richardson MA, Roote GT, Ryke EL, Schrauwen I, Shively KM, Smith JD, Tackett M, Wang G, Weiss JM, Wheeler MM, Yi Q, Zhang X. Precision medicine for developmental and epileptic encephalopathies in Africa-strategies for a resource-limited setting. Genet Med 2023; 25:100333. [PMID: 36480001 DOI: 10.1016/j.gim.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Sub-Saharan Africa bears the highest burden of epilepsy worldwide. A presumed proportion is genetic, but this etiology is buried under the burden of infections and perinatal insults in a setting of limited awareness and few options for testing. Children with developmental and epileptic encephalopathies (DEEs) are most severely affected by this diagnostic gap in Africa, because the rate of actionable findings is highest in DEE-associated genes. METHODS We tested 234 genetically naive South African children diagnosed with/possible DEE using gene panels, exome sequencing, and chromosomal microarray. Statistical comparison of electroclinical features in children with and children without candidate variants was performed to identify characteristics most likely predictive of a positive genetic finding. RESULTS Of the 41 (of 234) children with likely/pathogenic variants, 26 had variants supporting precision therapy. Multivariate regression modeling highlighted neonatal or infantile-onset seizures and movement abnormalities as predictive of a positive genetic finding. We used this, coupled with an emphasis on precision medicine outcomes, to propose the pragmatic "Think-Genetics" strategy for early recognition of a possible genetic etiology. CONCLUSION Our findings emphasize the importance of an early genetic diagnosis in DEE. We designed the Think-Genetics strategy for early recognition, appropriate interim management, and genetic testing for DEE in resource-constrained settings.
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Affiliation(s)
- Alina I Esterhuizen
- The South African MRC/UCT Genomic and Precision Medicine Research Unit, Division of Human Genetics, Institute of Infectious Diseases and Molecular Medicine, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Nicki Tiffin
- South African National Bioinformatics Institute, University of the Western Cape, Bellville, Western Cape, South Africa
| | - Gillian Riordan
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Marie Wessels
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Richard J Burman
- Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Miriam C Aziz
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jeffrey D Calhoun
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jonathan Gunti
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Ezra E Amiri
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Aishwarya Ramamurthy
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael J Bamshad
- Department of Pediatrics, University of Washington, Seattle, WA; Department of Genome Sciences, University of Washington, Seattle, WA; Brotman Baty Institute, Seattle, WA
| | | | - Heather C Mefford
- Centre for Pediatric Neurological Disease Research, St. Jude Children's Research Hospital, Memphis, TN
| | - Raj Ramesar
- The South African MRC/UCT Genomic and Precision Medicine Research Unit, Division of Human Genetics, Institute of Infectious Diseases and Molecular Medicine, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Jo M Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
| | - Gemma L Carvill
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pharmacology, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL.
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10
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Boonsimma P, Ittiwut C, Kamolvisit W, Ittiwut R, Chetruengchai W, Phokaew C, Srichonthong C, Poonmaksatit S, Desudchit T, Suphapeetiporn K, Shotelersuk V. Exome sequencing as first-tier genetic testing in infantile-onset pharmacoresistant epilepsy: diagnostic yield and treatment impact. Eur J Hum Genet 2023; 31:179-187. [PMID: 36198807 PMCID: PMC9905506 DOI: 10.1038/s41431-022-01202-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/06/2022] [Accepted: 09/20/2022] [Indexed: 11/09/2022] Open
Abstract
Pharmacoresistant epilepsy presenting during infancy poses both diagnostic and therapeutic challenges. We aim to identify diagnostic yield and treatment implications of exome sequencing (ES) as first-tier genetic testing for infantile-onset pharmacoresistant epilepsy. From June 2016 to December 2020, we enrolled patients with infantile-onset (age ≤ 12 months) pharmacoresistant epilepsy. 103 unrelated patients underwent ES. Clinical characteristics and changes in management due to the molecular diagnosis were studied. 42% (43/103) had epilepsy onset within the first month of life. After ES as first-tier genetic testing, 62% (64/103) of the cases were solved. Two partially solved cases (2%; 2/103) with heterozygous variants identified in ALDH7A1 known to cause autosomal recessive pyridoxine dependent epilepsy underwent genome sequencing (GS). Two novel large deletions in ALDH7A1 were detected in both cases. ES identified 66 pathogenic and likely pathogenic single nucleotide variants (SNVs) in 27 genes. 19 variants have not been previously reported. GS identified two additional copy number variations (CNVs). The most common disease-causing genes are SCN1A (13%; 13/103) and KCNQ2 (8%; 8/103). Eight percent (8/103) of the patients had treatable disorders and specific treatments were provided resulting in seizure freedom. Pyridoxine dependent epilepsy was the most common treatable epilepsy (6%; 6/103). Furthermore, 35% (36/103) had genetic defects which guided gene-specific treatments. Altogether, the diagnostic yield is 64%. Molecular diagnoses change management in 43% of the cases. This study substantiates the use of next generation sequencing (NGS) as the first-tier genetic investigation in infantile-onset pharmacoresistant epilepsy.
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Affiliation(s)
- Ponghatai Boonsimma
- Center of Excellence for Medical Genomics, Medical Genomics Cluster, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Chupong Ittiwut
- Center of Excellence for Medical Genomics, Medical Genomics Cluster, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Wuttichart Kamolvisit
- Center of Excellence for Medical Genomics, Medical Genomics Cluster, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Rungnapa Ittiwut
- Center of Excellence for Medical Genomics, Medical Genomics Cluster, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Wanna Chetruengchai
- Center of Excellence for Medical Genomics, Medical Genomics Cluster, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Chureerat Phokaew
- Center of Excellence for Medical Genomics, Medical Genomics Cluster, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Chalurmpon Srichonthong
- Center of Excellence for Medical Genomics, Medical Genomics Cluster, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Sathida Poonmaksatit
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Tayard Desudchit
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Kanya Suphapeetiporn
- Center of Excellence for Medical Genomics, Medical Genomics Cluster, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
- Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, 10330, Thailand.
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genomics, Medical Genomics Cluster, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, 10330, Thailand
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11
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McKnight D, Morales A, Hatchell KE, Bristow SL, Bonkowsky JL, Perry MS, Berg AT, Borlot F, Esplin ED, Moretz C, Angione K, Ríos-Pohl L, Nussbaum RL, Aradhya S, Levy RJ, Parachuri VG, Lay-Son G, de Montellano DJDO, Ramirez-Garcia MA, Benítez Alonso EO, Ziobro J, Chirita-Emandi A, Felix TM, Kulasa-Luke D, Megarbane A, Karkare S, Chagnon SL, Humberson JB, Assaf MJ, Silva S, Zarroli K, Boyarchuk O, Nelson GR, Palmquist R, Hammond KC, Hwang ST, Boutlier SB, Nolan M, Batley KY, Chavda D, Reyes-Silva CA, Miroshnikov O, Zuccarelli B, Amlie-Wolf L, Wheless JW, Seinfeld S, Kanhangad M, Freeman JL, Monroy-Santoyo S, Rodriguez-Vazquez N, Ryan MM, Machie M, Guerra P, Hassan MJ, Candee MS, Bupp CP, Park KL, Muller E, Lupo P, Pedersen RC, Arain AM, Murphy A, Schatz K, Mu W, Kalika PM, Plaza L, Kellogg MA, Lora EG, Carson RP, Svystilnyk V, Venegas V, Luke RR, Jiang H, Stetsenko T, Dueñas-Roque MM, Trasmonte J, Burke RJ, Hurst AC, Smith DM, Massingham LJ, Pisani L, Costin CE, Ostrander B, Filloux FM, Ananth AL, Mohamed IS, Nechai A, Dao JM, Fahey MC, Aliu E, Falchek S, Press CA, Treat L, Eschbach K, Starks A, Kammeyer R, Bear JJ, Jacobson M, Chernuha V, Meibos B, Wong K, Sweney MT, Espinoza AC, Van Orman CB, Weinstock A, Kumar A, Soler-Alfonso C, Nolan DA, Raza M, Rojas Carrion MD, Chari G, Marsh ED, Shiloh-Malawsky Y, Parikh S, Gonzalez-Giraldo E, Fulton S, Sogawa Y, Burns K, Malets M, Montiel Blanco JD, Habela CW, Wilson CA, Guzmán GG, Pavliuk M. Genetic Testing to Inform Epilepsy Treatment Management From an International Study of Clinical Practice. JAMA Neurol 2022; 79:1267-1276. [PMID: 36315135 PMCID: PMC9623482 DOI: 10.1001/jamaneurol.2022.3651] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Importance It is currently unknown how often and in which ways a genetic diagnosis given to a patient with epilepsy is associated with clinical management and outcomes. Objective To evaluate how genetic diagnoses in patients with epilepsy are associated with clinical management and outcomes. Design, Setting, and Participants This was a retrospective cross-sectional study of patients referred for multigene panel testing between March 18, 2016, and August 3, 2020, with outcomes reported between May and November 2020. The study setting included a commercial genetic testing laboratory and multicenter clinical practices. Patients with epilepsy, regardless of sociodemographic features, who received a pathogenic/likely pathogenic (P/LP) variant were included in the study. Case report forms were completed by all health care professionals. Exposures Genetic test results. Main Outcomes and Measures Clinical management changes after a genetic diagnosis (ie, 1 P/LP variant in autosomal dominant and X-linked diseases; 2 P/LP variants in autosomal recessive diseases) and subsequent patient outcomes as reported by health care professionals on case report forms. Results Among 418 patients, median (IQR) age at the time of testing was 4 (1-10) years, with an age range of 0 to 52 years, and 53.8% (n = 225) were female individuals. The mean (SD) time from a genetic test order to case report form completion was 595 (368) days (range, 27-1673 days). A genetic diagnosis was associated with changes in clinical management for 208 patients (49.8%) and usually (81.7% of the time) within 3 months of receiving the result. The most common clinical management changes were the addition of a new medication (78 [21.7%]), the initiation of medication (51 [14.2%]), the referral of a patient to a specialist (48 [13.4%]), vigilance for subclinical or extraneurological disease features (46 [12.8%]), and the cessation of a medication (42 [11.7%]). Among 167 patients with follow-up clinical information available (mean [SD] time, 584 [365] days), 125 (74.9%) reported positive outcomes, 108 (64.7%) reported reduction or elimination of seizures, 37 (22.2%) had decreases in the severity of other clinical signs, and 11 (6.6%) had reduced medication adverse effects. A few patients reported worsening of outcomes, including a decline in their condition (20 [12.0%]), increased seizure frequency (6 [3.6%]), and adverse medication effects (3 [1.8%]). No clinical management changes were reported for 178 patients (42.6%). Conclusions and Relevance Results of this cross-sectional study suggest that genetic testing of individuals with epilepsy may be materially associated with clinical decision-making and improved patient outcomes.
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Affiliation(s)
| | | | | | | | - Joshua L. Bonkowsky
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City,Center for Personalized Medicine, Primary Children’s Hospital, Salt Lake City, Utah
| | - Michael Scott Perry
- Jane and John Justin Neuroscience Center, Cook Children’s Medical Center, Fort Worth, Texas
| | - Anne T. Berg
- Department of Neurology, Northwestern University—Feinberg School of Medicine, Chicago, Illinois,COMBINEDBrain, Brentwood, Tennessee
| | - Felippe Borlot
- Section of Neurology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Katie Angione
- Children’s Hospital Colorado, Aurora,Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Loreto Ríos-Pohl
- Clinical Integral de Epilepsia, Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
| | | | | | | | - Rebecca J. Levy
- Division of Medical Genetics, Lucile Packard Children’s Hospital at Stanford University, Stanford, California
- Division of Child Neurology, Lucile Packard Children’s Hospital at Stanford University, Stanford, California
| | | | - Guillermo Lay-Son
- Genetic Unit, Pediatrics Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Miguel Angel Ramirez-Garcia
- Genetics Department, National Institute of Neurology and Neurosurgery, “Manuel Velasco Suárez,” Mexico City, Mexico
| | - Edmar O. Benítez Alonso
- Genetics Department, National Institute of Neurology and Neurosurgery, “Manuel Velasco Suárez,” Mexico City, Mexico
| | - Julie Ziobro
- Department of Pediatrics, University of Michigan, Ann Arbor
| | - Adela Chirita-Emandi
- Genetic Discipline, Center of Genomic Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, Timis, Romania
- Regional Center of Medical Genetics Timis, Clinical Emergency Hospital for Children “Louis Turcanu” Timisoara, Timis, Romania
| | - Temis M. Felix
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Dianne Kulasa-Luke
- NeuroDevelopmental Science Center, Akron Children’s Hospital, Akron, Ohio
| | - Andre Megarbane
- Department of Human Genetics, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Institut Jerome Lejeune, Paris, France
| | | | | | | | | | - Sebastian Silva
- Child Neurology Service, Hospital de Puerto Montt, Puerto Montt, Chile
| | | | - Oksana Boyarchuk
- I.Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Gary R. Nelson
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Rachel Palmquist
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Katherine C. Hammond
- Department of Pediatric Neurology, University of Alabama at Birmingham, Birmingham
| | - Sean T. Hwang
- Zucker School of Medicine, Hofstra Northwell, Hempstead, New York
| | - Susan B. Boutlier
- ECU Physician Internal Medicine Pediatric Neurology, Greenville, North Carolina
| | | | - Kaitlin Y. Batley
- Department of Pediatrics and Neurology, UT Southwestern, Dallas, Texas
| | - Devraj Chavda
- SUNY Downstate Health Sciences University, Brooklyn, New York
| | | | | | | | | | - James W. Wheless
- Pediatric Neurology, University of Tennessee Health Science Center, Memphis
- Le Bonheur Comprehensive Epilepsy Program & Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, Tennessee
| | | | - Manoj Kanhangad
- Department of Paediatrics, Monash University, Clayton, Australia
| | | | | | | | - Monique M. Ryan
- The Royal Children’s Hospital Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Michelle Machie
- Department of Pediatrics and Neurology, UT Southwestern, Dallas, Texas
| | - Patricio Guerra
- Universidad San Sebastián, Department of Pediatrics, Medicine School, Patagonia Campus, Puerto Montt, Chile
| | - Muhammad Jawad Hassan
- Department of Biological Sciences, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Meghan S. Candee
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Caleb P. Bupp
- Spectrum Health, West Michigan Helen DeVos Children’s Hospital, Grand Rapids, Michigan
| | - Kristen L. Park
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Eric Muller
- Clinical Genetics, Stanford Children’s Health Specialty Services, San Francisco, California
| | - Pamela Lupo
- Division of Neurology, Department of Pediatrics, University of Texas Medical Branch, League City
| | | | - Amir M. Arain
- Division of Epilepsy, Department of Neurology, University of Utah School of Medicine, Salt Lake City
| | - Andrea Murphy
- Mary Bird Perkins Cancer Center, Baton Rouge, Louisiana
| | | | - Weiyi Mu
- Johns Hopkins University, Baltimore, Maryland
| | | | - Lautaro Plaza
- Hospital Materno Perinatal “Mónica Pretelini Sáenz,” Toluca, México
| | | | - Evelyn G. Lora
- Dominican Neurological and Neurosurgical Society, Santo Domingo, Dominican Republic
| | | | | | - Viviana Venegas
- Clínica Alemana de Santiago, Universidad del Desarrollo, Pediatric Neurology Unit, Santiago, Chile
| | - Rebecca R. Luke
- Jane and John Justin Neuroscience Center, Cook Children’s Medical Center, Fort Worth, Texas
| | | | | | | | | | - Rebecca J. Burke
- Division of Medical Genetics, Department of Pediatrics, West Virginia University School of Medicine, Morgantown
- Division of Neonatology, Department of Pediatrics, West Virginia University School of Medicine, Morgantown
| | - Anna C.E. Hurst
- Department of Genetics, University of Alabama at Birmingham, Birmingham
| | | | - Lauren J. Massingham
- Hasbro Children’s Hospital, Providence, Rhode Island
- Alpert Medical School, Brown University, Providence, Rhode Island
| | - Laura Pisani
- Zucker School of Medicine, Hofstra Northwell, Hempstead, New York
- Northwell Health, Medical Genetics, Great Neck, New York
| | | | - Betsy Ostrander
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Francis M. Filloux
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Amitha L. Ananth
- Department of Pediatric Neurology, University of Alabama at Birmingham, Birmingham
| | - Ismail S. Mohamed
- Department of Pediatric Neurology, University of Alabama at Birmingham, Birmingham
| | - Alla Nechai
- Neurology Department, Kiev City Children Clinical Hospital No. 1, Kyiv City, Ukraine
| | - Jasmin M. Dao
- Adult and Child Neurology Medical Associates, Long Beach, California
- Miller Children’s Hospital, Long Beach, California
| | - Michael C. Fahey
- Department of Paediatrics, Monash University, Clayton, Australia
| | - Ermal Aliu
- Department of Genetics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Stephen Falchek
- Nemours Children’s Hospital, Wilmington, Delaware
- Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Craig A. Press
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Lauren Treat
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Krista Eschbach
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Angela Starks
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Ryan Kammeyer
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Joshua J. Bear
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Mona Jacobson
- Children’s Hospital Colorado, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Veronika Chernuha
- Pediatric Neurology Institute, “Dana-Dwek” Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Kristen Wong
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Matthew T. Sweney
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - A. Chris Espinoza
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Colin B. Van Orman
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Arie Weinstock
- Division of Child Neurology, Department of Neurology, University at Buffalo, Buffalo, New York
- Oishei Children’s Hospital, Buffalo, New York
| | - Ashutosh Kumar
- Department of Pediatrics and Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Claudia Soler-Alfonso
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | | | - Muhammad Raza
- Nishtar Medical University, Multan, Punjab, Pakistan
| | | | - Geetha Chari
- SUNY Downstate Health Sciences University, Brooklyn, New York
- Kings County Hospital Center, Brooklyn, New York
| | - Eric D. Marsh
- Division of Child Neurology, Departments of Neurology and Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Sumit Parikh
- Neurogenetics, Cleveland Clinic, Cleveland, Ohio
| | | | - Stephen Fulton
- Pediatric Neurology, University of Tennessee Health Science Center, Memphis
- Le Bonheur Comprehensive Epilepsy Program & Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, Tennessee
| | - Yoshimi Sogawa
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | - Carey A. Wilson
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Guillermo G. Guzmán
- Servicio Neuropsiquiatria Infantil, Hospital San Borja Arriarán, Santiago, Chile
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12
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Alam A, Parfyonov M, Huang CY, Gill I, Connolly MB, Illes J. Targeted Whole Exome Sequencing in Children With Early-Onset Epilepsy: Parent Experiences. J Child Neurol 2022; 37:840-850. [PMID: 35921196 PMCID: PMC9554160 DOI: 10.1177/08830738221113901] [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] [Indexed: 11/21/2022]
Abstract
This study investigated the experiences of 25 caregivers of children with early-onset, treatment-resistant epilepsy who pursued whole exome sequencing to determine the impact of the test results on their child's treatment. Caregivers who consented to be recontacted were recruited from a previous study investigating the diagnostic yield of whole exome sequencing. A semistructured interview addressed questions based on one of 2 study phases. The first phase discussed the decision-making process for genetic testing (15 interviews), which revealed 4 major themes: (1) prognosis, (2) engagement, (3) concerns, and (4) autonomy. The second phase discussed the impact of genetic testing on treatment (10 interviews), which revealed 3 major themes: (1) testing features, (2) emotional impact, and (3) treatment outcomes. Overall, parents pursued genetic testing to obtain a clear prognosis, inform treatment decisions, engage with other families, and exercise autonomy. Caregivers felt that early testing is warranted to inform their child's diagnostic odyssey.
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Affiliation(s)
- Armaghan Alam
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maksim Parfyonov
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Department of Pediatrics, Division of Neurology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Camille Y. Huang
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Inderpal Gill
- Department of Pediatrics, Division of Neurology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Mary B. Connolly
- Department of Pediatrics, Division of Neurology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Judy Illes, CM, PhD, Professor of Neurology, Department of Medicine, University of British Columbia, 2211 Wesbrook Mall, Koerner S124, Vancouver, BC V6T 2B5 Canada.
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13
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Krey I, Johannesen KM, Kohnen O, Lemke JR. Genetic testing in adults with developmental and epileptic encephalopathy - what do we know? MED GENET-BERLIN 2022; 34:207-213. [PMID: 38835877 PMCID: PMC11006368 DOI: 10.1515/medgen-2022-2144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Knowledge of underlying genetic causes of developmental and epileptic encephalopathies (DEE) in adults is still limited when compared to the routine diagnostic approach in similarly affected children. A well-documented longitudinal study of adults with DEE is of utmost importance to understand the natural history of the respective entity. This information is of great value especially for genetic counselling of newly diagnosed children with identical genetic diagnoses and may impact treatment and management of affected individuals. In our meta-analysis we provide an overview of the most recurrent genetic findings across an adult DEE cohort (n = 1 , 020 ). The gene mostly associated with a pathogenic or likely pathogenic variant in adult DEE is SCN1A, followed by MECP2 and CHD2. Studies employing exome sequencing and calling of both single nucleotide variants and copy number variants are associated with diagnostic yields of almost 50 %. Finally, we highlight three remarkable cases, each representing the oldest individual ever published with their genetic diagnosis, i. e., Angelman syndrome, Miller-Dieker syndrome, and CAMK2A-related disorder, and describe lessons learned from each of these adults.
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Affiliation(s)
- Ilona Krey
- Institute of Human Genetics, University of Leipzig Medical Center, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| | - Kathrine M Johannesen
- Department of Epilepsy Genetics and Personalized Medicine, The Danish Epilepsy Centre, Dianalund, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Oona Kohnen
- Swiss Epilepsy Center, Klinik Lengg, Zurich, Switzerland
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Medical Center, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
- Center for Rare Diseases, University of Leipzig Medical Center, Leipzig, Germany
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14
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Brodie KD, Liao EN, Florentine MM, Chan DK. Impact of Genetic Testing on Hearing Interventions. Laryngoscope 2022. [PMID: 36165585 DOI: 10.1002/lary.30409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Clinical guidelines recommend genetic testing when evaluating congenital and late-onset sensorineural hearing loss (SNHL). Genetic diagnoses can provide parents additional information regarding anticipated hearing loss progression, comorbid conditions, and family planning. Additionally, obtaining a genetic diagnosis may increase parental acceptance of hearing loss and subsequent pursuit of intervention. This study evaluates the association between genetic diagnoses and hearing loss intervention. METHODS We included children ages 0-18 years with SNHL who were hearing aid or cochlear implant candidates but non-users and underwent hearing-loss gene panel testing prior to initiating intervention. Univariate analyses were performed to identify predictors of hearing aid fitting or cochlear implantation. Multivariate logistic regression evaluated the impact of demographic and clinical factors on subsequent intervention. RESULTS Of the 385 children with SNHL who underwent hearing loss gene panel testing, 111 were included. Median age was 7.5 years. 56% were underrepresented minorities, 71% were non-White, and 71% were publicly insured. Those found to have a genetic diagnosis were 4.6 times as likely to subsequently undergo intervention (p = 0.035). Additionally, bilateral hearing loss and earlier age of genetic testing were associated with increased likelihood of intervention. CONCLUSION Up to half of children with SNHL are suspected to have an underlying genetic etiology. Children diagnosed with a genetic diagnosis are significantly more likely to subsequently utilize hearing aids or cochlear implantation. This provides additional support for clinical guidelines recommending genetic testing not only due to the impact of prognostication but also on treatment decision-making. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Kara D Brodie
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Elizabeth N Liao
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Michelle M Florentine
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Dylan K Chan
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
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15
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Blazekovic A, Gotovac Jercic K, Meglaj S, Duranovic V, Prpic I, Lozic B, Malenica M, Markovic S, Lujic L, Petelin Gadze Z, Juraski RG, Barišic N, Baric I, Borovecki F. Genetics of Pediatric Epilepsy: Next-Generation Sequencing in Clinical Practice. Genes (Basel) 2022; 13:genes13081466. [PMID: 36011376 PMCID: PMC9407986 DOI: 10.3390/genes13081466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Epilepsy is one of the most common neurological disorders with diverse phenotypic characteristics and high genetic heterogeneity. Epilepsy often occurs in childhood, so timely diagnosis and adequate therapy are crucial for preserving quality of life and unhindered development of a child. Next-generation-sequencing (NGS)-based tools have shown potential in increasing diagnostic yield. The primary objective of this study was to evaluate the impact of genetic testing and to investigate the diagnostic utility of targeted gene panel sequencing. This retrospective cohort study included 277 patients aged 6 months to 17 years undergoing NGS with an epilepsy panel covering 142 genes. Of 118 variants detected, 38 (32.2%) were not described in the literature. We identified 64 pathogenic or likely pathogenic variants with an overall diagnostic yield of 23.1%. We showed a significantly higher diagnostic yield in patients with developmental delay (28.9%). Furthermore, we showed that patients with variants reported as pathogenic presented with seizures at a younger age, which led to the conclusion that such children should be included in genomic diagnostic procedures as soon as possible to achieve a correct diagnosis in a timely manner, potentially leading to better treatment and avoidance of unnecessary procedures. Describing and discovering the genetic background of the disease not only leads to a better understanding of the mechanisms of the disorder but also opens the possibility of more precise and individualized treatment based on stratified medicine.
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Affiliation(s)
- Antonela Blazekovic
- Department for Functional Genomics, Center for Translational and Clinical Research, University Hospital Center Zagreb, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
- Department for Anatomy and Clinical Anatomy, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
- Correspondence:
| | - Kristina Gotovac Jercic
- Department for Functional Genomics, Center for Translational and Clinical Research, University Hospital Center Zagreb, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
- Department of Neurology, University Hospital Center Zagreb, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Sarah Meglaj
- Department for Functional Genomics, Center for Translational and Clinical Research, University Hospital Center Zagreb, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Vlasta Duranovic
- Department of Neuropediatrics, Children’s Hospital Zagreb, 10000 Zagreb, Croatia
- Department of Pediatrics, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Igor Prpic
- Department of Pediatrics, Clinical Hospital Center Rijeka, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Bernarda Lozic
- Department of Pediatrics, University Hospital of Split, University of Split School of Medicine, 21000 Split, Croatia
| | - Masa Malenica
- Department of Pediatrics, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Silvana Markovic
- Dr. Tomislav Bardek General Hospital Koprivnica, 48000 Koprivnica, Croatia
| | - Lucija Lujic
- Department of Neuropediatrics, Children’s Hospital Zagreb, 10000 Zagreb, Croatia
| | - Zeljka Petelin Gadze
- Department of Neurology, University Hospital Center Zagreb, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
- Referral Centre of the Ministry of Health of the Republic of Croatia for Epilepsy, Affiliated to ERN EpiCARE, 10000 Zagreb, Croatia
| | | | - Nina Barišic
- Department of Pediatrics, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Ivo Baric
- Department of Pediatrics, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Fran Borovecki
- Department for Functional Genomics, Center for Translational and Clinical Research, University Hospital Center Zagreb, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
- Department of Neurology, University Hospital Center Zagreb, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
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16
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Bayat A, Fenger CD, Techlo TR, Højte AF, Nørgaard I, Hansen TF, Rubboli G, Møller RS, Group DCCRS. Impact of Genetic Testing on Therapeutic Decision-Making in Childhood-Onset Epilepsies-a Study in a Tertiary Epilepsy Center. Neurotherapeutics 2022; 19:1353-1367. [PMID: 35723786 PMCID: PMC9587146 DOI: 10.1007/s13311-022-01264-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 12/13/2022] Open
Abstract
We assessed the frequency of pediatric monogenic epilepsies and precision therapies at a tertiary epilepsy center. We analyzed medical records of children, born in 2006-2011 and followed at the Danish Epilepsy Center from January to December 2015; 357 patients were identified, of whom 27 without epilepsy and 35 with acquired brain damage were excluded. Of the remaining 295 children, 188 were consented for study inclusion and genetic testing. At inclusion, 86/188 had a preexisting genetic diagnosis and did not undergo further genetic testing. The 102 genetically unsolved patients underwent WES, which identified a (likely) pathogenic variant in eight patients and a highly relevant variant of unknown significance (VUS) in seven additional patients. Single nucleotide polymorphism array was performed in the remaining 87 patients and revealed no (likely) pathogenic copy number variants (CNVs). Patients with a genetic diagnosis had a significantly lower median age at seizure onset and more often had febrile seizures, status epilepticus, or neurodevelopmental impairment compared to those who remained genetically unsolved. Most common epilepsies were focal or multifocal epilepsies and developmental and epileptic encephalopathies (DDEs). Fifty-three patients, with a putative genetic diagnosis, were potentially eligible for precision therapy approaches. Indeed, genetic diagnosis enabled treatment adjustment in 32/53 (60%); 30/32 (93%) patients experienced at least a 50% reduction in seizure burden while only 4/32 (12.5%) became seizure-free. In summary, a genetic diagnosis was achieved in approximately 50% of patients with non-acquired epilepsy enabling precision therapy approaches in half of the patients, a strategy that results in > 50% reduction in seizure burden, in the majority of the treated patients.
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Affiliation(s)
- Allan Bayat
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Filadelfia, Dianalund, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Christina D Fenger
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Filadelfia, Dianalund, Denmark
- Amplexa Genetics A/S, Odense, Denmark
| | - Tanya R Techlo
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Anne F Højte
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Filadelfia, Dianalund, Denmark
| | | | - Thomas F Hansen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Glostrup, Denmark
- Novo Nordic Foundation Center for Protein Research, Copenhagen University, Copenhagen, Denmark
| | - Guido Rubboli
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Filadelfia, Dianalund, Denmark
- Copenhagen University, Copenhagen, Denmark
| | - Rikke S Møller
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Filadelfia, Dianalund, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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17
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Tumienė B, del Toro Riera M, Grikiniene J, Samaitiene-Aleknienė R, Praninskienė R, Monavari AA, Sykut-Cegielska J. Multidisciplinary Care of Patients with Inherited Metabolic Diseases and Epilepsy: Current Perspectives. J Multidiscip Healthc 2022; 15:553-566. [PMID: 35387391 PMCID: PMC8977775 DOI: 10.2147/jmdh.s251863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022] Open
Abstract
More than 650 inherited metabolic diseases may present with epilepsy or seizures. These diseases are often multisystem, life-long and induce complex needs of patients and families. Multidisciplinary care involves all stages of disease management: diagnostics, specific or symptomatic, acute and chronic treatments, and integrated care that takes into account not only medical, but also manifold psychosocial, educational, vocational and other needs of patients and their caregivers. Care coordination is indispensable to ensure smooth transitions of care across life and disease stages, including management of emergencies, transition from pediatric to adult services and palliative care. Care pathways are highly diverse and have to find the right balance between highly specialized and locally provided services. While multidisciplinary teams consist of many professionals, a named supervising physician in a highly specialized healthcare setting and a care coordinator are highly important. As the greatest burden of care always falls onto the shoulders of patients and/or families, patient empowerment should be a part of every care pathway and include provision of required information, involvement into common decision-making, patient’s and family’s education, support for self-management, liaison with peer support groups and emotional/ psychological support. Due to the rarity and complexity of these diseases, sufficient expertise may not be available in a national healthcare system and cross-border services (virtual or physical) in the recently developed European Reference Networks should be ensured through the proper organization of referral systems in each EU and EEA country. Finally, digital technologies are particularly important in the provision of services for patients with rare diseases and can significantly increase the availability of highly specialized services and expertise.
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Affiliation(s)
- Birutė Tumienė
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
- Correspondence: Birutė Tumienė, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Santariskiu str. 2, Vilnius, LT-06681, Lithuania, Tel +370 614 45026, Email
| | - Mireia del Toro Riera
- Pediatric Neurology Department, Unit of Hereditary Metabolic Disorders, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Jurgita Grikiniene
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rūta Samaitiene-Aleknienė
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rūta Praninskienė
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ahmad Ardeshir Monavari
- National Centre for Inherited Metabolic Disorders, Children’s Health Ireland at Temple Street Dublin, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Jolanta Sykut-Cegielska
- Department of Inborn Errors of Metabolism and Paediatrics, the Institute of Mother and Child, Warsaw, Poland
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18
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Callahan KP, Flibotte J, Skraban C, Wild KT, Joffe S, Munson D, Feudtner C. Influence of Genetic Information on Neonatologists' Decisions: A Psychological Experiment. Pediatrics 2022; 149:184790. [PMID: 35169841 PMCID: PMC8892772 DOI: 10.1542/peds.2021-052130] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Genetic testing is expanding among ill neonates, yet the influence of genetic results on medical decision-making is not clear. With this study, we sought to determine how different types of genetic information with uncertain implications for prognosis influence clinicians' decisions to recommend intensive versus palliative care. METHODS We conducted a national study of neonatologists using a split sample experimental design. The questionnaire contained 4 clinical vignettes. Participants were randomly assigned to see one of 2 versions that varied only regarding whether they included the following genetic findings: (1) a variant of uncertain significance; (2) a genetic diagnosis that affects neurodevelopment but not acute survival; (3) a genetic versus nongenetic etiology of equally severe pathology; (4) a pending genetic testing result. Physicians answered questions about recommendations they would make for the patient described in each vignette. RESULTS Vignette versions that included a variant of uncertain significance, a diagnosis foreshadowing neurodevelopmental impairment, or a genetic etiology of disease were all associated with an increased likelihood of recommending palliative rather than intensive care. A pending genetic test result did not have a significant effect on care recommendations. CONCLUSIONS Findings from this study of hypothetical cases suggest neonatologists apply uncertain genetic findings or those that herald neurodevelopmental disability in problematic ways. As genetic testing expands, understanding how it is used in decision-making and educating clinicians regarding appropriate use are paramount.
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Affiliation(s)
- Katharine Press Callahan
- Children's Hospital of Philadelphia, Philadelphia,
Pennsylvania,Department of Medical Ethics and Health Policy, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania,Address correspondence to Katharine Press Callahan, MD,
Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia,
PA 19104. E-mail:
| | - John Flibotte
- Children's Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | - Cara Skraban
- Children's Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | | | - Steven Joffe
- Children's Hospital of Philadelphia, Philadelphia,
Pennsylvania,Department of Medical Ethics and Health Policy, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Munson
- Children's Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | - Chris Feudtner
- Children's Hospital of Philadelphia, Philadelphia,
Pennsylvania,Department of Medical Ethics and Health Policy, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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19
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McKnight D, Bristow SL, Truty RM, Morales A, Stetler M, Westbrook MJ, Robinson K, Riethmaier D, Borlot F, Kellogg M, Hwang ST, Berg A, Aradhya S. Multigene Panel Testing in a Large Cohort of Adults With Epilepsy: Diagnostic Yield and Clinically Actionable Genetic Findings. Neurol Genet 2022; 8:e650. [PMID: 34926809 PMCID: PMC8678910 DOI: 10.1212/nxg.0000000000000650] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/04/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Although genetic testing among children with epilepsy has demonstrated clinical utility and become a part of routine testing, studies in adults are limited. This study reports the diagnostic yield of genetic testing in adults with epilepsy. METHODS Unrelated individuals aged 18 years and older who underwent diagnostic genetic testing for epilepsy using a comprehensive, next-generation sequencing-based, targeted gene panel (range 89-189 genes) were included in this cross-sectional study. Clinical information, provided at the discretion of the ordering clinician, was reviewed and analyzed. Diagnostic yield was calculated for all individuals including by age at seizure onset and comorbidities based on clinician-reported information. The proportion of individuals with clinically actionable genetic findings, including instances when a specific treatment would be indicated or contraindicated due to a diagnostic finding, was calculated. RESULTS Among 2,008 individuals, a diagnostic finding was returned for 218 adults (10.9%), with clinically actionable findings in 55.5% of diagnoses. The highest diagnostic yield was in adults with seizure onset during infancy (29.6%, 0-1 year), followed by in early childhood (13.6%, 2-4 years), late childhood (7.0%, 5-10 years), adolescence (2.4%, 11-17 years), and adulthood (3.7%, ≥18 years). Comorbid intellectual disability (ID) or developmental delay resulted in a high diagnostic yield (16.0%), most notably for females (19.6% in females vs 12.3% in males). Among individuals with pharmacoresistant epilepsy, 13.5% had a diagnostic finding, and of these, 57.4% were clinically actionable genetic findings. DISCUSSION These data reinforce the utility of genetic testing for adults with epilepsy, particularly for those with childhood-onset seizures, ID, and pharmacoresistance. This is an important consideration due to longer survival and the complexity of the transition from pediatric to adult care. In addition, more than half of diagnostic findings in this study were considered clinically actionable, suggesting that genetic testing could have a direct impact on clinical management and outcomes.
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Affiliation(s)
- Dianalee McKnight
- From the Invitae (D.M., S.L.B., R.M.T., A.M., M.S., M.J.W., K.R., D.R., S.A.), San Francisco, CA; Alberta Children's Hospital Research Institute, Cumming School of Medicine, (F.B.) University of Calgary, Canada; Oregon Health & Science University Comprehensive Epilepsy Center (M.K.); Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (S.T.H); Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago (A.B.); and Department of Neurology, Northwestern University-Feinberg School of Medicine (A.B.), Chicago, IL
| | - Sara L. Bristow
- From the Invitae (D.M., S.L.B., R.M.T., A.M., M.S., M.J.W., K.R., D.R., S.A.), San Francisco, CA; Alberta Children's Hospital Research Institute, Cumming School of Medicine, (F.B.) University of Calgary, Canada; Oregon Health & Science University Comprehensive Epilepsy Center (M.K.); Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (S.T.H); Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago (A.B.); and Department of Neurology, Northwestern University-Feinberg School of Medicine (A.B.), Chicago, IL
| | - Rebecca M. Truty
- From the Invitae (D.M., S.L.B., R.M.T., A.M., M.S., M.J.W., K.R., D.R., S.A.), San Francisco, CA; Alberta Children's Hospital Research Institute, Cumming School of Medicine, (F.B.) University of Calgary, Canada; Oregon Health & Science University Comprehensive Epilepsy Center (M.K.); Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (S.T.H); Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago (A.B.); and Department of Neurology, Northwestern University-Feinberg School of Medicine (A.B.), Chicago, IL
| | - Ana Morales
- From the Invitae (D.M., S.L.B., R.M.T., A.M., M.S., M.J.W., K.R., D.R., S.A.), San Francisco, CA; Alberta Children's Hospital Research Institute, Cumming School of Medicine, (F.B.) University of Calgary, Canada; Oregon Health & Science University Comprehensive Epilepsy Center (M.K.); Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (S.T.H); Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago (A.B.); and Department of Neurology, Northwestern University-Feinberg School of Medicine (A.B.), Chicago, IL
| | - Molly Stetler
- From the Invitae (D.M., S.L.B., R.M.T., A.M., M.S., M.J.W., K.R., D.R., S.A.), San Francisco, CA; Alberta Children's Hospital Research Institute, Cumming School of Medicine, (F.B.) University of Calgary, Canada; Oregon Health & Science University Comprehensive Epilepsy Center (M.K.); Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (S.T.H); Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago (A.B.); and Department of Neurology, Northwestern University-Feinberg School of Medicine (A.B.), Chicago, IL
| | - M. Jody Westbrook
- From the Invitae (D.M., S.L.B., R.M.T., A.M., M.S., M.J.W., K.R., D.R., S.A.), San Francisco, CA; Alberta Children's Hospital Research Institute, Cumming School of Medicine, (F.B.) University of Calgary, Canada; Oregon Health & Science University Comprehensive Epilepsy Center (M.K.); Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (S.T.H); Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago (A.B.); and Department of Neurology, Northwestern University-Feinberg School of Medicine (A.B.), Chicago, IL
| | - Kristina Robinson
- From the Invitae (D.M., S.L.B., R.M.T., A.M., M.S., M.J.W., K.R., D.R., S.A.), San Francisco, CA; Alberta Children's Hospital Research Institute, Cumming School of Medicine, (F.B.) University of Calgary, Canada; Oregon Health & Science University Comprehensive Epilepsy Center (M.K.); Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (S.T.H); Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago (A.B.); and Department of Neurology, Northwestern University-Feinberg School of Medicine (A.B.), Chicago, IL
| | - Darlene Riethmaier
- From the Invitae (D.M., S.L.B., R.M.T., A.M., M.S., M.J.W., K.R., D.R., S.A.), San Francisco, CA; Alberta Children's Hospital Research Institute, Cumming School of Medicine, (F.B.) University of Calgary, Canada; Oregon Health & Science University Comprehensive Epilepsy Center (M.K.); Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (S.T.H); Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago (A.B.); and Department of Neurology, Northwestern University-Feinberg School of Medicine (A.B.), Chicago, IL
| | - Felippe Borlot
- From the Invitae (D.M., S.L.B., R.M.T., A.M., M.S., M.J.W., K.R., D.R., S.A.), San Francisco, CA; Alberta Children's Hospital Research Institute, Cumming School of Medicine, (F.B.) University of Calgary, Canada; Oregon Health & Science University Comprehensive Epilepsy Center (M.K.); Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (S.T.H); Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago (A.B.); and Department of Neurology, Northwestern University-Feinberg School of Medicine (A.B.), Chicago, IL
| | - Marissa Kellogg
- From the Invitae (D.M., S.L.B., R.M.T., A.M., M.S., M.J.W., K.R., D.R., S.A.), San Francisco, CA; Alberta Children's Hospital Research Institute, Cumming School of Medicine, (F.B.) University of Calgary, Canada; Oregon Health & Science University Comprehensive Epilepsy Center (M.K.); Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (S.T.H); Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago (A.B.); and Department of Neurology, Northwestern University-Feinberg School of Medicine (A.B.), Chicago, IL
| | - Sean T. Hwang
- From the Invitae (D.M., S.L.B., R.M.T., A.M., M.S., M.J.W., K.R., D.R., S.A.), San Francisco, CA; Alberta Children's Hospital Research Institute, Cumming School of Medicine, (F.B.) University of Calgary, Canada; Oregon Health & Science University Comprehensive Epilepsy Center (M.K.); Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (S.T.H); Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago (A.B.); and Department of Neurology, Northwestern University-Feinberg School of Medicine (A.B.), Chicago, IL
| | - Anne Berg
- From the Invitae (D.M., S.L.B., R.M.T., A.M., M.S., M.J.W., K.R., D.R., S.A.), San Francisco, CA; Alberta Children's Hospital Research Institute, Cumming School of Medicine, (F.B.) University of Calgary, Canada; Oregon Health & Science University Comprehensive Epilepsy Center (M.K.); Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (S.T.H); Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago (A.B.); and Department of Neurology, Northwestern University-Feinberg School of Medicine (A.B.), Chicago, IL
| | - Swaroop Aradhya
- From the Invitae (D.M., S.L.B., R.M.T., A.M., M.S., M.J.W., K.R., D.R., S.A.), San Francisco, CA; Alberta Children's Hospital Research Institute, Cumming School of Medicine, (F.B.) University of Calgary, Canada; Oregon Health & Science University Comprehensive Epilepsy Center (M.K.); Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (S.T.H); Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago (A.B.); and Department of Neurology, Northwestern University-Feinberg School of Medicine (A.B.), Chicago, IL
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20
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Sheidley BR, Malinowski J, Bergner AL, Bier L, Gloss DS, Mu W, Mulhern MM, Partack EJ, Poduri A. Genetic testing for the epilepsies: A systematic review. Epilepsia 2021; 63:375-387. [PMID: 34893972 DOI: 10.1111/epi.17141] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Numerous genetic testing options for individuals with epilepsy have emerged over the past decade without clear guidelines regarding optimal testing strategies. We performed a systematic evidence review (SER) and conducted meta-analyses of the diagnostic yield of genetic tests commonly utilized for patients with epilepsy. We also assessed nonyield outcomes (NYOs) such as changes in treatment and/or management, prognostic information, recurrence risk determination, and genetic counseling. METHODS We performed an SER, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), using PubMed, Embase, CINAHL, and Cochrane Central through December of 2020. We included studies that utilized genome sequencing (GS), exome sequencing (ES), multigene panel (MGP), and/or genome-wide comparative genomic hybridization/chromosomal microarray (CGH/CMA) in cohorts (n ≥ 10) ascertained for epilepsy. Quality assessment was undertaken using ROBINS-I (Risk of Bias in Non-Randomized Studies of Interventions). We estimated diagnostic yields and 95% confidence intervals with random effects meta-analyses and narratively synthesized NYOs. RESULTS From 5985 nonduplicated articles published through 2020, 154 met inclusion criteria and were included in meta-analyses of diagnostic yield; 43 of those were included in the NYO synthesis. The overall diagnostic yield across all test modalities was 17%, with the highest yield for GS (48%), followed by ES (24%), MGP (19%), and CGH/CMA (9%). The only phenotypic factors that were significantly associated with increased yield were (1) the presence of developmental and epileptic encephalopathy and/or (2) the presence of neurodevelopmental comorbidities. Studies reporting NYOs addressed clinical and personal utility of testing. SIGNIFICANCE This comprehensive SER, focused specifically on the literature regarding patients with epilepsy, provides a comparative assessment of the yield of clinically available tests, which will help shape clinician decision-making and policy regarding insurance coverage for genetic testing. We highlight the need for prospective assessment of the clinical and personal utility of genetic testing for patients with epilepsy and for standardization in reporting patient characteristics.
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Affiliation(s)
- Beth R Sheidley
- Epilepsy Genetics Program, Division of Epilepsy and Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Amanda L Bergner
- Department of Genetics and Development, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Louise Bier
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - David S Gloss
- Department of Neurology, Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Weiyi Mu
- Department of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maureen M Mulhern
- Department of Pathology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Emily J Partack
- Genomics Services, Quest Diagnostics, Marlborough, Massachusetts, USA
| | - Annapurna Poduri
- Epilepsy Genetics Program, Division of Epilepsy and Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
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21
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Abstract
BACKGROUND A large number of patients have epilepsy that is intractable and adversely affects a child's lifelong experience with addition societal burden that is disabling and expensive. The last two decades have seen a major explosion of new antiseizure medication options. Despite these advances, children with epilepsy continue to have intractable seizures. An option that has been long available but little used is epilepsy surgery to control intractable epilepsy. METHODS This article is a review of the literature as well as published opinions. RESULTS Epilepsy surgery in pediatrics is an underused modality to effectively treat children with epilepsy. Adverse effects of medication should be weighed against risks of surgery as well as risks of nonefficacy. CONCLUSIONS We discuss an approach to selecting the appropriate pediatric patient for consideration, a detailed evaluation including necessary evaluation, and the creation of an algorithm to approach patients with both generalized and focal epilepsy. We then discuss surgical options available including outcome data. New modalities are also addressed including high-frequency ultrasound and co-registration techniques including magnetic resonance imaging-guided laser therapy.
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22
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Abstract
The presence of unprovoked, recurrent seizures, particularly when drug resistant and associated with cognitive and behavioral deficits, warrants investigation for an underlying genetic cause. This article provides an overview of the major classes of genes associated with epilepsy phenotypes divided into functional categories along with the recommended work-up and therapeutic considerations. Gene discovery in epilepsy supports counseling and anticipatory guidance but also opens the door for precision medicine guiding therapy with a focus on those with disease-modifying effects.
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Affiliation(s)
- Luis A Martinez
- Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, 1250 Moursund Drive, Houston, TX 77030, USA
| | - Yi-Chen Lai
- Department of Pediatrics, Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, 1250 Moursund Drive, Houston, TX 77030, USA
| | - J Lloyd Holder
- Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, 1250 Moursund Drive, Houston, TX 77030, USA
| | - Anne E Anderson
- Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, 1250 Moursund Drive, Houston, TX 77030, USA.
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23
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Willimsky EK, Munzig A, Mayer K, Biskup S, Abicht A, Hoertnagel K, Voss HV, Klein HG, Rost I, Larsen LHG, Dahl HA, Hoelz H, Stuelpnagel CV, Borggraefe I. Next Generation Sequencing in Pediatric Epilepsy Using Customized Panels: Size Matters. Neuropediatrics 2021; 52:92-97. [PMID: 33086385 DOI: 10.1055/s-0040-1712488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Next generation sequencing (NGS) with customized gene panels is a helpful tool to identify monogenic epilepsy syndromes. The number of genes tested within a customized panel may vary greatly. The aim of the present study was to compare the diagnostic yield of small (<25 kb) and large (>25 kb) customized epilepsy panels. METHODS This retrospective cohort study investigated data of 190 patients of 18 years or younger, with the diagnosis of an epilepsy of unknown etiology who underwent NGS using customized gene panels. Small (<25 kb) and large (>25 kb) panels were compared regarding the distribution of benign/likely benign and pathogenic/likely pathogenic variants and variants of unclear significance. In addition, differences of the diagnostic yield with respect to epilepsy severity, i.e., developmental and epileptic encephalopathy [DEE] vs. non-DEE, were analyzed. RESULTS The diagnostic yield defined as pathogenic or likely pathogenic variants in large panels was significantly increased (29% [n = 14/48] vs. 13% [n = 18/142], p = 0.0198) compared with smaller panels. In non-DEE patients the increase of the diagnostic yield in large panels was significant(35% n = 6/17 vs. 13% n = 12/94, p = 0.0378), which was not true for DEE patients. DISCUSSION This study indicates that large panels are superior for pediatric patients with epilepsy forms without encephalopathy (non-DEE). For patients suffering from DEE small panels of a maximum of 10 genes seem to be sufficient. The proportion of unclear findings increases with rising panel sizes. CONCLUSION Customized epilepsy panels of >25 kb compared with smaller panels show a significant higher diagnostic yield in patients with epilepsy especially in non-DEE patients.
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Affiliation(s)
- Eva-Katharina Willimsky
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics Department of Pediatrics, Ludwig-Maximilians University of Munich, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Anna Munzig
- Center of Human Genetics and Laboratory Diagnostics, Martinsried, Germany
| | - Karin Mayer
- Center of Human Genetics and Laboratory Diagnostics, Martinsried, Germany
| | | | | | | | - Hubertus von Voss
- Center of Human Genetics and Laboratory Diagnostics, Martinsried, Germany
| | - Hanns-Georg Klein
- Center of Human Genetics and Laboratory Diagnostics, Martinsried, Germany
| | - Imma Rost
- Center of Human Genetics and Laboratory Diagnostics, Martinsried, Germany
| | | | | | - Hannes Hoelz
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics Department of Pediatrics, Ludwig-Maximilians University of Munich, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Celina von Stuelpnagel
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics Department of Pediatrics, Ludwig-Maximilians University of Munich, Dr. von Hauner Children's Hospital, Munich, Germany.,Paracelsus Medical University, Salzburg, Austria
| | - Ingo Borggraefe
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics Department of Pediatrics, Ludwig-Maximilians University of Munich, Dr. von Hauner Children's Hospital, Munich, Germany.,Comprehensive Epilepsy Center (Pediatric section), Ludwig-Maximilians University of Munich, Munich, Germany
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24
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Atli EI, Atli E, Yalcintepe S, Demir S, Kalkan R, Eker D, Gurkan H. Customized Targeted Massively Parallel Sequencing Enables More Precisely Diagnosis of Patients with Epilepsy. Intern Med J 2021; 52:1174-1184. [PMID: 33528079 DOI: 10.1111/imj.15219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/18/2021] [Accepted: 01/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Advancement in genetic technology has led to the identification of an increasing number of genes in epilepsy. This will provide a huge information in clinical practice and improve diagnosis and treatment of epilepsy. METHODS this was a single-center retrospective cohort study of 80 patients who underwent NGS testing with customize epilepsy panel. RESULTS In total 54 out of 80 patients (67, 5%), pathogenic / likely pathogenic and variants of uncertain significance variants were identified according to ACMG criteria. Pathogenic or likely pathogenic variants (n=35) were identified in 29 out of 80 individuals (36.25%). Variants of uncertain significance (VOUS) (n=34) have identified in 28 out of 80 patients (35%). Pathogenic, likely pathogenic, and variants of uncertain significance (VOUS) were most frequently identified in TSC2 (n = 11), SCN1A (n = 6) and TSC1 (n = 5) genes. Other common genes were KCNQ2 (n = 3), AMT (n = 3), CACNA1H (n = 3), CLCN2 (n = 3), MECP2 (n = 2), ASAH1 (n = 2) and SLC2A1 (n = 2). CONCLUSIONS NGS based testing panels contributes the diagnosis of epilepsy and may change the clinical management by preventing unnecessary and potentially harmful diagnostic procedures and management in patients. Thus, our results highlighted the benefit of genetic testing in children suffered with epilepsy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Emine Ikbal Atli
- Faculty of Medicine, Department of Medical Genetics, Edirne, Trakya University, Edirne, Turkey
| | - Engin Atli
- Faculty of Medicine, Department of Medical Genetics, Edirne, Trakya University, Edirne, Turkey
| | - Sinem Yalcintepe
- Faculty of Medicine, Department of Medical Genetics, Edirne, Trakya University, Edirne, Turkey
| | - Selma Demir
- Faculty of Medicine, Department of Medical Genetics, Edirne, Trakya University, Edirne, Turkey
| | - Rasime Kalkan
- Faculty of Medicine, Department of Medical Genetics, Near East University, Nicosia, Cyprus
| | - Damla Eker
- Faculty of Medicine, Department of Medical Genetics, Edirne, Trakya University, Edirne, Turkey
| | - Hakan Gurkan
- Faculty of Medicine, Department of Medical Genetics, Edirne, Trakya University, Edirne, Turkey
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25
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von Stülpnagel C, van Baalen A, Borggraefe I, Eschermann K, Hartlieb T, Kiwull L, Pringsheim M, Wolff M, Kudernatsch M, Wiegand G, Striano P, Kluger G. Network for Therapy in Rare Epilepsies (NETRE): Lessons From the Past 15 Years. Front Neurol 2021; 11:622510. [PMID: 33519703 PMCID: PMC7840830 DOI: 10.3389/fneur.2020.622510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/14/2020] [Indexed: 01/14/2023] Open
Abstract
Background: In 2005, Network for Therapy in Rare Epilepsies (NETRE)-was initiated in order to share treatment experiences among clinicians in patients with rare epilepsies. Here we describe the structure of the rapidly growing NETRE and summarize some of the findings of the last 15 years. Methodology/Structure of NETRE: NETRE is organized in distinct groups (currently >270). Starting point is always a patient with a rare epilepsy/ epileptic disorder. This creates a new group, and next, a medical coordinator is appointed. The exchange of experiences is established using a data entry form, which the coordinator sends to colleagues. The primary aim is to exchange experiences (retrospectively, anonymously, MRI results also non-anonymously) of the epilepsy treatment as well as on clinical presentation and comorbidities NETRE is neither financed nor sponsored. Results: Some of the relevant results: (1) first description of FIRES as a new epilepsy syndrome and its further investigation, (2) in SCN2A, the assignment to gain- vs. loss-of-function mutations has a major impact on clinical decisions to use or avoid treatment with sodium channel blockers, (3) the important aspect of avoiding overtreatment in CDKL5 patients, due to loss of effects of anticonvulsants after 12 months, (4) pathognomonic MRI findings in FOXG1 patients, (5) the first description of pathognomonic chewing-induced seizures in SYNGAP1 patients, and the therapeutic effect of statins as anticonvulsant in these patients, (6) the phenomenon of another reflex epilepsy-bathing epilepsy associated with a SYN1 mutation. Of special interest is also a NETRE group following twins with genetic and/or structural epilepsies [including vanishing-twin-syndrome and twin-twin-transfusion syndrome) [= "Early Neuroimpaired Twin Entity" (ENITE)]. Discussion and Perspective: NETRE enables clinicians to quickly exchange information on therapeutic experiences in rare diseases with colleagues at an international level. For both parents and clinicians/scientist this international exchange is both reassuring and helpful. In collaboration with other groups, personalized therapeutic approaches are sought, but the present limitations of currently available therapies are also highlighted. Presently, the PATRE Project (PATient based phenotyping and evaluation of therapy for Rare Epilepsies) is commencing, in which information on therapies will be obtained directly from patients and their caregivers.
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Affiliation(s)
- Celina von Stülpnagel
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics and Epilepsy Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University, Salzburg, Austria
| | - Andreas van Baalen
- Clinic for Child and Adolescent Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ingo Borggraefe
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics and Epilepsy Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Kirsten Eschermann
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University, Salzburg, Austria
| | - Till Hartlieb
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University, Salzburg, Austria
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Klinik Vogtareuth, Vogtareuth, Germany
| | - Lorenz Kiwull
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics and Epilepsy Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University, Salzburg, Austria
- Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilian-University, Munich, Germany
| | - Milka Pringsheim
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University, Salzburg, Austria
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Klinik Vogtareuth, Vogtareuth, Germany
| | - Markus Wolff
- Department of Pediatric Neurology, Vivantes Hospital Neukölln, Berlin, Germany
| | - Manfred Kudernatsch
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University, Salzburg, Austria
- Clinic for Neurosurgery, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Gert Wiegand
- Clinic for Child and Adolescent Medicine II, University Hospital Schleswig-Holstein, Kiel, Germany
- Neuropediatrics Section of the Department of Pediatrics, Asklepios Clinic Hamburg Nord-Heidberg, Hamburg, Germany
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Istituto die Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Gerhard Kluger
- Institute for Transition, Rehabilitation and Palliation, Paracelsus Medical University, Salzburg, Austria
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Klinik Vogtareuth, Vogtareuth, Germany
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