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Lin ZJ, He JW, Zhu SY, Xue LH, Zheng JF, Zheng LQ, Huang BX, Chen GZ, Lin PX. Gene-gene interaction network analysis indicates CNTN2 is a candidate gene for idiopathic generalized epilepsy. Neurogenetics 2024; 25:131-139. [PMID: 38460076 DOI: 10.1007/s10048-024-00748-w] [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: 11/16/2023] [Accepted: 01/19/2024] [Indexed: 03/11/2024]
Abstract
Twin and family studies have established the genetic contribution to idiopathic generalized epilepsy (IGE). The genetic architecture of IGE is generally complex and heterogeneous, and the majority of the genetic burden in IGE remains unsolved. We hypothesize that gene-gene interactions contribute to the complex inheritance of IGE. CNTN2 (OMIM* 615,400) variants have been identified in cases with familial adult myoclonic epilepsy and other epilepsies. To explore the gene-gene interaction network in IGE, we took the CNTN2 gene as an example and investigated its co-occurrent genetic variants in IGE cases. We performed whole-exome sequencing in 114 unrelated IGE cases and 296 healthy controls. Variants were qualified with sequencing quality, minor allele frequency, in silico prediction, genetic phenotype, and recurrent case numbers. The STRING_TOP25 gene interaction network analysis was introduced with the bait gene CNTN2 (denoted as A). The gene-gene interaction pair mode was presumed to be A + c, A + d, A + e, with a leading gene A, or A + B + f, A + B + g, A + B + h, with a double-gene A + B, or other combinations. We compared the number of gene interaction pairs between the case and control groups. We identified three pairs in the case group, CNTN2 + PTPN18, CNTN2 + CNTN1 + ANK2 + ANK3 + SNTG2, and CNTN2 + PTPRZ1, while we did not discover any pairs in the control group. The number of gene interaction pairs in the case group was much more than in the control group (p = 0.021). Taking together the genetic bioinformatics, reported epilepsy cases, and statistical evidence in the study, we supposed CNTN2 as a candidate pathogenic gene for IGE. The gene interaction network analysis might help screen candidate genes for IGE or other complex genetic disorders.
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Affiliation(s)
- Zhi-Jian Lin
- Department of Neurology, School of Clinical Medicine, the Affiliated Hospital of Putian UniversityFujian Medical UniversityBrain Science Institute of Putian University, 999 Dongzhen East Road, Licheng District, Putian, 351100, China
| | - Jun-Wei He
- Department of Neurology, School of Clinical Medicine, the Affiliated Hospital of Putian UniversityFujian Medical UniversityBrain Science Institute of Putian University, 999 Dongzhen East Road, Licheng District, Putian, 351100, China
| | - Sheng-Yin Zhu
- Department of Neurology, School of Clinical Medicine, the Affiliated Hospital of Putian UniversityFujian Medical UniversityBrain Science Institute of Putian University, 999 Dongzhen East Road, Licheng District, Putian, 351100, China
| | - Li-Hong Xue
- Department of Neurology, School of Clinical Medicine, the Affiliated Hospital of Putian UniversityFujian Medical UniversityBrain Science Institute of Putian University, 999 Dongzhen East Road, Licheng District, Putian, 351100, China
| | - Jian-Feng Zheng
- Department of Neurology, School of Clinical Medicine, the Affiliated Hospital of Putian UniversityFujian Medical UniversityBrain Science Institute of Putian University, 999 Dongzhen East Road, Licheng District, Putian, 351100, China
| | - Li-Qin Zheng
- Department of Neurology, School of Clinical Medicine, the Affiliated Hospital of Putian UniversityFujian Medical UniversityBrain Science Institute of Putian University, 999 Dongzhen East Road, Licheng District, Putian, 351100, China
| | - Bi-Xia Huang
- Department of Neurology, School of Clinical Medicine, the Affiliated Hospital of Putian UniversityFujian Medical UniversityBrain Science Institute of Putian University, 999 Dongzhen East Road, Licheng District, Putian, 351100, China
| | - Guo-Zhang Chen
- Department of Neurology, School of Clinical Medicine, the Affiliated Hospital of Putian UniversityFujian Medical UniversityBrain Science Institute of Putian University, 999 Dongzhen East Road, Licheng District, Putian, 351100, China
| | - Peng-Xing Lin
- Department of Neurology, School of Clinical Medicine, the Affiliated Hospital of Putian UniversityFujian Medical UniversityBrain Science Institute of Putian University, 999 Dongzhen East Road, Licheng District, Putian, 351100, China.
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Lin ZJ, Li B, Lin PX, Song W, Yan LM, Meng H, He N. Clinical application of trio-based whole-exome sequencing in idiopathic generalized epilepsy. Seizure 2024; 116:24-29. [PMID: 36842888 DOI: 10.1016/j.seizure.2023.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 02/13/2023] Open
Abstract
PURPOSE Idiopathic generalized epilepsies (IGEs) are a common group of genetic generalized epilepsies with high genetic heterogeneity and complex inheritance. However, the genetic basis is still largely unknown. This study aimed to explore the genetic etiologies in IGEs. METHODS Trio-based whole-exome sequencing was performed in 60 cases with IGEs. The pathogenicity of candidate genetic variants was evaluated by the criteria of the American College of Medical Genetics and Genomics (ACMG), and the clinical causality was assessed by concordance between the observed phenotype and the reported phenotype. RESULTS Seven candidate variants were detected in seven unrelated cases with IGE (11.7%, 7/60). According to ACMG, a de novo SLC2A1 (c.376C>T/p.Arg126Cys) variant identified in childhood absence epilepsy was evaluated as pathogenic with clinical concordance. Six variants were assessed to be uncertain significance by ACMG, but then considered causative after evaluation of clinical concordance. These variants included CLCN4 hemizygous variant (c.2044G>A/p.Glu682Lys) and IQSEC2 heterozygous variant (c.4315C>T/p.Pro1439Ser) in juvenile absence epilepsy, EFHC1 variant (c.1504C>T/p.Arg502Trp) and CACNA1H (c.589G>T/p.Ala197Ser) both with incomplete penetrance in juvenile myoclonic epilepsy, and GRIN2A variant (c.2011C>G/p.Gln671Glu) and GABRB1 variant (c.1075G>A/p.Val359Ile) both co-segregated with juvenile myoclonic epilepsy. Among them, GABRB1 was for the first time identified as potential novel causative gene for IGE. SIGNIFICANCE Considering the genetic heterogeneity and complex inheritance of IGEs, a comprehensive evaluation combined the ACMG scoring and assessment of clinical concordance is suggested for the pathogenicity analysis of variants identified in clinical screening. GABRB1 is probably a novel causative gene for IGE, which warrants further studies.
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Affiliation(s)
- Zhi-Jian Lin
- Department of Neurology, the Affiliated Hospital of Putian University, Putian 351100, Fujian Province, China; Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Bin Li
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Peng-Xing Lin
- Department of Neurology, the Affiliated Hospital of Putian University, Putian 351100, Fujian Province, China
| | - Wang Song
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Li-Min Yan
- Department of Neurology, The Second Affiliated Hospital of Hainan Medical University, 570311 Haikou, Hainan, China
| | - Heng Meng
- Department of Neurology, the First Affiliated Hospital of Jinan University, Guangzhou 510632, China.
| | - Na He
- Department of Neurology, Institute of Neuroscience, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
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Devinsky O, Elder C, Sivathamboo S, Scheffer IE, Koepp MJ. Idiopathic Generalized Epilepsy: Misunderstandings, Challenges, and Opportunities. Neurology 2024; 102:e208076. [PMID: 38165295 PMCID: PMC11097769 DOI: 10.1212/wnl.0000000000208076] [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: 06/12/2023] [Accepted: 10/19/2023] [Indexed: 01/03/2024] Open
Abstract
The idiopathic generalized epilepsies (IGE) make up a fifth of all epilepsies, but <1% of epilepsy research. This skew reflects misperceptions: diagnosis is straightforward, pathophysiology is understood, seizures are easily controlled, epilepsy is outgrown, morbidity and mortality are low, and surgical interventions are impossible. Emerging evidence reveals that patients with IGE may go undiagnosed or misdiagnosed with focal epilepsy if EEG or semiology have asymmetric or focal features. Genetic, electrophysiologic, and neuroimaging studies provide insights into pathophysiology, including overlaps and differences from focal epilepsies. IGE can begin in adulthood and patients have chronic and drug-resistant seizures. Neuromodulatory interventions for drug-resistant IGE are emerging. Rates of psychiatric and other comorbidities, including sudden unexpected death in epilepsy, parallel those in focal epilepsy. IGE is an understudied spectrum for which our diagnostic sensitivity and specificity, scientific understanding, and therapies remain inadequate.
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Affiliation(s)
- Orrin Devinsky
- From the Comprehensive Epilepsy Center (O.D., C.E.), New York University School of Medicine, New York, Department of Neuroscience (S.S.), Central Clinical School, Monash University, Melbourne, Department of Neurology (S.S.), Alfred Health, Melbourne; Departments of Medicine and Neurology, The Royal Melbourne Hospital (S.S.), Epilepsy Research Centre, Department of Medicine, Austin Health (I.E.S.), Murdoch Children's Research Institute (I.E.S.), and Department of Pediatrics (I.E.S.), Royal Children's Hospital, The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Victoria, Australia; and Department of Clinical and Experimental Epilepsy (M.J.K.), University College London Institute of Neurology, United Kingdom
| | - Christopher Elder
- From the Comprehensive Epilepsy Center (O.D., C.E.), New York University School of Medicine, New York, Department of Neuroscience (S.S.), Central Clinical School, Monash University, Melbourne, Department of Neurology (S.S.), Alfred Health, Melbourne; Departments of Medicine and Neurology, The Royal Melbourne Hospital (S.S.), Epilepsy Research Centre, Department of Medicine, Austin Health (I.E.S.), Murdoch Children's Research Institute (I.E.S.), and Department of Pediatrics (I.E.S.), Royal Children's Hospital, The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Victoria, Australia; and Department of Clinical and Experimental Epilepsy (M.J.K.), University College London Institute of Neurology, United Kingdom
| | - Shobi Sivathamboo
- From the Comprehensive Epilepsy Center (O.D., C.E.), New York University School of Medicine, New York, Department of Neuroscience (S.S.), Central Clinical School, Monash University, Melbourne, Department of Neurology (S.S.), Alfred Health, Melbourne; Departments of Medicine and Neurology, The Royal Melbourne Hospital (S.S.), Epilepsy Research Centre, Department of Medicine, Austin Health (I.E.S.), Murdoch Children's Research Institute (I.E.S.), and Department of Pediatrics (I.E.S.), Royal Children's Hospital, The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Victoria, Australia; and Department of Clinical and Experimental Epilepsy (M.J.K.), University College London Institute of Neurology, United Kingdom
| | - Ingrid E Scheffer
- From the Comprehensive Epilepsy Center (O.D., C.E.), New York University School of Medicine, New York, Department of Neuroscience (S.S.), Central Clinical School, Monash University, Melbourne, Department of Neurology (S.S.), Alfred Health, Melbourne; Departments of Medicine and Neurology, The Royal Melbourne Hospital (S.S.), Epilepsy Research Centre, Department of Medicine, Austin Health (I.E.S.), Murdoch Children's Research Institute (I.E.S.), and Department of Pediatrics (I.E.S.), Royal Children's Hospital, The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Victoria, Australia; and Department of Clinical and Experimental Epilepsy (M.J.K.), University College London Institute of Neurology, United Kingdom
| | - Matthias J Koepp
- From the Comprehensive Epilepsy Center (O.D., C.E.), New York University School of Medicine, New York, Department of Neuroscience (S.S.), Central Clinical School, Monash University, Melbourne, Department of Neurology (S.S.), Alfred Health, Melbourne; Departments of Medicine and Neurology, The Royal Melbourne Hospital (S.S.), Epilepsy Research Centre, Department of Medicine, Austin Health (I.E.S.), Murdoch Children's Research Institute (I.E.S.), and Department of Pediatrics (I.E.S.), Royal Children's Hospital, The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (I.E.S.), Melbourne, Victoria, Australia; and Department of Clinical and Experimental Epilepsy (M.J.K.), University College London Institute of Neurology, United Kingdom
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Lin ZJ, Huang BX, Su LF, Zhu SY, He JW, Chen GZ, Lin PX. Sub-region analysis of DMD gene in cases with idiopathic generalized epilepsy. Neurogenetics 2023; 24:161-169. [PMID: 37022522 DOI: 10.1007/s10048-023-00715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/24/2023] [Indexed: 04/07/2023]
Abstract
Gene sub-region encoded protein domain is the basic unit for protein structure and function. The DMD gene is the largest coding gene in humans, with its phenotype relevant to idiopathic generalized epilepsy. We hypothesized variants clustered in sub-regions of idiopathic generalized epilepsy genes and investigated the relationship between the DMD gene and idiopathic generalized epilepsy. Whole exome sequencing was performed in 106 idiopathic generalized epilepsy individuals. DMD variants were filtered with variant type, allele frequency, in silico prediction, hemizygous or homozygous status in the population, inheritance mode, and domain location. Variants located at the sub-regions were selected by the subRVIS software. The pathogenicity of variants was evaluated by the American College of Medical Genetics and Genomics criteria. Articles on functional studies related to epilepsy for variants clustered protein domains were reviewed. In sub-regions of the DMD gene, two variants were identified in two unrelated cases with juvenile absence epilepsy or juvenile myoclonic epilepsy. The pathogenicity of both variants was uncertain significance. Allele frequency of both variants in probands with idiopathic generalized epilepsy reached statistical significance compared with the population (Fisher's test, p = 2.02 × 10-6, adjusted α = 4.52 × 10-6). The variants clustered in the spectrin domain of dystrophin, which binds to glycoprotein complexes and indirectly affects ion channels contributing to epileptogenesis. Gene sub-region analysis suggests a weak association between the DMD gene and idiopathic generalized epilepsy. Functional analysis of gene sub-region helps infer the pathogenesis of idiopathic generalized epilepsy.
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Affiliation(s)
- Zhi-Jian Lin
- Department of Neurology, The Affiliated Hospital of Putian University, Brain Science Institute of Putian University, 999 Dongzhen East Road, Licheng District, Putian, 351100, China
| | - Bi-Xia Huang
- Department of Neurology, The Affiliated Hospital of Putian University, Brain Science Institute of Putian University, 999 Dongzhen East Road, Licheng District, Putian, 351100, China
| | - Li-Fang Su
- Department of Neurology, The Affiliated Hospital of Putian University, Brain Science Institute of Putian University, 999 Dongzhen East Road, Licheng District, Putian, 351100, China
| | - Sheng-Yin Zhu
- Department of Neurology, The Affiliated Hospital of Putian University, Brain Science Institute of Putian University, 999 Dongzhen East Road, Licheng District, Putian, 351100, China
| | - Jun-Wei He
- Department of Neurology, The Affiliated Hospital of Putian University, Brain Science Institute of Putian University, 999 Dongzhen East Road, Licheng District, Putian, 351100, China
| | - Guo-Zhang Chen
- Department of Neurology, The Affiliated Hospital of Putian University, Brain Science Institute of Putian University, 999 Dongzhen East Road, Licheng District, Putian, 351100, China
| | - Peng-Xing Lin
- Department of Neurology, The Affiliated Hospital of Putian University, Brain Science Institute of Putian University, 999 Dongzhen East Road, Licheng District, Putian, 351100, China.
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Pickrell WO, Fry AE. Epilepsy genetics: a practical guide for adult neurologists. Pract Neurol 2023; 23:111-119. [PMID: 36639246 DOI: 10.1136/pn-2022-003623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 01/15/2023]
Abstract
An understanding of epilepsy genetics is important for adult neurologists, as making a genetic diagnosis gives clinical benefit. In this review, we describe the key features of different groups of genetic epilepsies. We describe the common available genetic tests for epilepsy, and how to interpret them.
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Affiliation(s)
- William Owen Pickrell
- Department of Neurology, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Andrew E Fry
- All Wales Medical Genomics Service, University Hospital of Wales, Cardiff, UK
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
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Wang X, Rao X, Zhang J, Gan J. Genetic mechanisms in generalized epilepsies. ACTA EPILEPTOLOGICA 2023. [DOI: 10.1186/s42494-023-00118-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
AbstractThe genetic generalized epilepsies (GGEs) have been proved to generate from genetic impact by twin studies and family studies. The genetic mechanisms of generalized epilepsies are always updating over time. Although the genetics of GGE is complex, there are always new susceptibility genes coming up as well as copy number variations which can lead to important breakthroughs in exploring the problem. At the same time, the development of ClinGen fades out some of the candidate genes. This means we have to figure out what accounts for a reliable gene for GGE, in another word, which gene has sufficient evidence for GGE. This will improve our understanding of the genetic mechanisms of GGE. In this review, important up-to-date genetic mechanisms of GGE were discussed.
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Sun S, Wang H. Clocking Epilepsies: A Chronomodulated Strategy-Based Therapy for Rhythmic Seizures. Int J Mol Sci 2023; 24:4223. [PMID: 36835631 PMCID: PMC9962262 DOI: 10.3390/ijms24044223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
Epilepsy is a neurological disorder characterized by hypersynchronous recurrent neuronal activities and seizures, as well as loss of muscular control and sometimes awareness. Clinically, seizures have been reported to display daily variations. Conversely, circadian misalignment and circadian clock gene variants contribute to epileptic pathogenesis. Elucidation of the genetic bases of epilepsy is of great importance because the genetic variability of the patients affects the efficacies of antiepileptic drugs (AEDs). For this narrative review, we compiled 661 epilepsy-related genes from the PHGKB and OMIM databases and classified them into 3 groups: driver genes, passenger genes, and undetermined genes. We discuss the potential roles of some epilepsy driver genes based on GO and KEGG analyses, the circadian rhythmicity of human and animal epilepsies, and the mutual effects between epilepsy and sleep. We review the advantages and challenges of rodents and zebrafish as animal models for epileptic studies. Finally, we posit chronomodulated strategy-based chronotherapy for rhythmic epilepsies, integrating several lines of investigation for unraveling circadian mechanisms underpinning epileptogenesis, chronopharmacokinetic and chronopharmacodynamic examinations of AEDs, as well as mathematical/computational modeling to help develop time-of-day-specific AED dosing schedules for rhythmic epilepsy patients.
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Affiliation(s)
- Sha Sun
- Center for Circadian Clocks, Soochow University, Suzhou 215123, China
- School of Biology and Basic Medical Sciences, Suzhou Medical College, Soochow University, Suzhou 215123, China
| | - Han Wang
- Center for Circadian Clocks, Soochow University, Suzhou 215123, China
- School of Biology and Basic Medical Sciences, Suzhou Medical College, Soochow University, Suzhou 215123, China
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A Multi-Disciplinary Team Approach to Genomic Testing for Drug-Resistant Epilepsy Patients—The GENIE Study. J Clin Med 2022; 11:jcm11144238. [PMID: 35888005 PMCID: PMC9319736 DOI: 10.3390/jcm11144238] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 12/10/2022] Open
Abstract
Background. The genomic era has led to enormous progress in clinical care and a multi-disciplinary team (MDT) approach is imperative for integration of genomics into epilepsy patient care. Methods. The MDT approach involved patient selection, genomic testing choice, variant discussions and return of results. Genomics analysis included cytogenomic testing and whole exome sequencing (WES). Neurologist surveys were undertaken at baseline and after genomic testing to determine if genomic diagnoses would alter their management, and if there was a change in confidence in genomic testing and neurologist perceptions of the MDT approach. Results. The total diagnostic yield from all genomic testing was 17% (11/66), with four diagnoses from cytogenomic analyses. All chromosomal microarray (CMA) diagnoses were in patients seen by adult neurologists. Diagnostic yield for WES was 11% (7/62). The most common gene with pathogenic variants was DCX, reported in three patients, of which two were mosaic. The genomic diagnosis impacted management in 82% (9/11). There was increased confidence with integrating genomics into clinical care (Pearson chi square = 83, p = 0.004) and qualitative comments were highly supportive of the MDT approach. Conclusions. We demonstrated diagnostic yield from genomic testing, and the impact on management in a cohort with drug-resistant epilepsy. The MDT approach increased confidence in genomic testing and neurologists valued the input from this approach. The utility of CMA was demonstrated in epilepsy patients seen by adult neurologists as was the importance of considering mosaicism for previously undiagnosed patients.
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Hirsch E, French J, Scheffer IE, Bogacz A, Alsaadi T, Sperling MR, Abdulla F, Zuberi SM, Trinka E, Specchio N, Somerville E, Samia P, Riney K, Nabbout R, Jain S, Wilmshurst JM, Auvin S, Wiebe S, Perucca E, Moshé SL, Tinuper P, Wirrell EC. ILAE definition of the Idiopathic Generalized Epilepsy Syndromes: Position statement by the ILAE Task Force on Nosology and Definitions. Epilepsia 2022; 63:1475-1499. [PMID: 35503716 DOI: 10.1111/epi.17236] [Citation(s) in RCA: 149] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 12/13/2022]
Abstract
In 2017, the International League Against Epilepsy (ILAE) Classification of Epilepsies described the "genetic generalized epilepsies" (GGEs), which contained the "idiopathic generalized epilepsies" (IGEs). The goal of this paper is to delineate the four syndromes comprising the IGEs, namely childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy, and epilepsy with generalized tonic-clonic seizures alone. We provide updated diagnostic criteria for these IGE syndromes determined by the expert consensus opinion of the ILAE's Task Force on Nosology and Definitions (2017-2021) and international external experts outside our Task Force. We incorporate current knowledge from recent advances in genetic, imaging, and electroencephalographic studies, together with current terminology and classification of seizures and epilepsies. Patients that do not fulfill criteria for one of these syndromes, but that have one, or a combination, of the following generalized seizure types: absence, myoclonic, tonic-clonic and myoclonic-tonic-clonic seizures, with 2.5-5.5 Hz generalized spike-wave should be classified as having GGE. Recognizing these four IGE syndromes as a special grouping among the GGEs is helpful, as they carry prognostic and therapeutic implications.
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Affiliation(s)
- Edouard Hirsch
- Francis Rohmer Neurology Epilepsy Units, National Institute of Health and Medical Research 1258, Federation of Translational Medicine of Strasbourg, Strasbourg University, Strasbourg, France
| | - Jacqueline French
- New York University Grossman School of Medicine and NYU Langone Health, New York, New York, USA
| | - Ingrid E Scheffer
- Austin Health and Royal Children's Hospital, Florey Institute, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Alicia Bogacz
- Institute of Neurology, Clinical Hospital, Faculty of Medicine, University of the Republic, Montevideo, Uruguay
| | - Taoufik Alsaadi
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, United Arab Emirates
| | - Michael R Sperling
- Department of Neurology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Fatema Abdulla
- Salmaniya Medical Complex-Government Hospital, Manama, Bahrain
| | - Sameer M Zuberi
- Paediatric Neurosciences Research Group, Royal Hospital for Children and Institute of Health & Wellbeing, University of Glasgow, member of EpiCARE, Glasgow, UK
| | - Eugen Trinka
- Department of Neurology and Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University, Center for Cognitive Neuroscience, member of EpiCARE, Salzburg, Austria.,Department of Public Health, Health Services Research, and Health Technology Assessment, University for Health Sciences, Medical Informatics, and Technology, Hall in Tirol, Austria
| | - Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, Scientific Institute for Research and Health Care, member of EpiCARE, Rome, Italy
| | - Ernest Somerville
- Prince of Wales Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Pauline Samia
- Department of Pediatrics and Child Health, Aga Khan University, East Africa, Nairobi, Kenya
| | - Kate Riney
- Neurosciences Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Rima Nabbout
- Reference Center for Rare Epilepsies, Department of Pediatric Neurology, Necker-Enfants Malades Hospital, Public Hospital Network of Paris, member of EpiCARE, Imagine Institute, National Institute of Health and Medical Research, Mixed Unit of Research 1163, University of Paris, Paris, France
| | | | - Jo M Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Stephane Auvin
- Pediatric Neurology, Public Hospital Network of Paris, Robert Debré Hospital, NeuroDiderot, National Institute of Health and Medical Research, Department Medico-Universitaire, Innovation Robert-Debré, University of Paris, Paris, France.,University Institute of France, Paris, France
| | - Samuel Wiebe
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Emilio Perucca
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Solomon L Moshé
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology, and Departments of Neuroscience and Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Institute of Neurological Sciences, Scientific Institute for Research and Health Care, member of EpiCARE, Bologna, Italy
| | - Elaine C Wirrell
- Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
PURPOSE OF REVIEW This article reviews the clinical features, typical EEG findings, treatment, prognosis, and underlying molecular etiologies of the more common genetic epilepsy syndromes. Genetic generalized epilepsy, self-limited focal epilepsy of childhood, self-limited neonatal and infantile epilepsy, select developmental and epileptic encephalopathies, progressive myoclonus epilepsies, sleep-related hypermotor epilepsy, photosensitive occipital lobe epilepsy, and focal epilepsy with auditory features are discussed. Also reviewed are two familial epilepsy syndromes: genetic epilepsy with febrile seizures plus and familial focal epilepsy with variable foci. RECENT FINDINGS Recent years have seen considerable advances in our understanding of the genetic factors underlying genetic epilepsy syndromes. New therapies are emerging for some of these conditions; in some cases, these precision medicine approaches may dramatically improve the prognosis. SUMMARY Many recognizable genetic epilepsy syndromes exist, the identification of which is a crucial skill for neurologists, particularly those who work with children. Proper diagnosis of the electroclinical syndrome allows for appropriate treatment choices and counseling regarding prognosis and possible comorbidities.
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11
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Altmann A, Ryten M, Di Nunzio M, Ravizza T, Tolomeo D, Reynolds RH, Somani A, Bacigaluppi M, Iori V, Micotti E, Di Sapia R, Cerovic M, Palma E, Ruffolo G, Botía JA, Absil J, Alhusaini S, Alvim MKM, Auvinen P, Bargallo N, Bartolini E, Bender B, Bergo FPG, Bernardes T, Bernasconi A, Bernasconi N, Bernhardt BC, Blackmon K, Braga B, Caligiuri ME, Calvo A, Carlson C, Carr SJ, Cavalleri GL, Cendes F, Chen J, Chen S, Cherubini A, Concha L, David P, Delanty N, Depondt C, Devinsky O, Doherty CP, Domin M, Focke NK, Foley S, Franca W, Gambardella A, Guerrini R, Hamandi K, Hibar DP, Isaev D, Jackson GD, Jahanshad N, Kalviainen R, Keller SS, Kochunov P, Kotikalapudi R, Kowalczyk MA, Kuzniecky R, Kwan P, Labate A, Langner S, Lenge M, Liu M, Martin P, Mascalchi M, Meletti S, Morita-Sherman ME, O’Brien TJ, Pariente JC, Richardson MP, Rodriguez-Cruces R, Rummel C, Saavalainen T, Semmelroch MK, Severino M, Striano P, Thesen T, Thomas RH, Tondelli M, Tortora D, Vaudano AE, Vivash L, von Podewils F, Wagner J, Weber B, Wiest R, Yasuda CL, Zhang G, Zhang J, Leu C, Avbersek A, Thom M, Whelan CD, Thompson P, McDonald CR, Vezzani A, Sisodiya SM. A systems-level analysis highlights microglial activation as a modifying factor in common epilepsies. Neuropathol Appl Neurobiol 2022; 48:e12758. [PMID: 34388852 PMCID: PMC8983060 DOI: 10.1111/nan.12758] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/15/2021] [Indexed: 02/03/2023]
Abstract
AIMS The causes of distinct patterns of reduced cortical thickness in the common human epilepsies, detectable on neuroimaging and with important clinical consequences, are unknown. We investigated the underlying mechanisms of cortical thinning using a systems-level analysis. METHODS Imaging-based cortical structural maps from a large-scale epilepsy neuroimaging study were overlaid with highly spatially resolved human brain gene expression data from the Allen Human Brain Atlas. Cell-type deconvolution, differential expression analysis and cell-type enrichment analyses were used to identify differences in cell-type distribution. These differences were followed up in post-mortem brain tissue from humans with epilepsy using Iba1 immunolabelling. Furthermore, to investigate a causal effect in cortical thinning, cell-type-specific depletion was used in a murine model of acquired epilepsy. RESULTS We identified elevated fractions of microglia and endothelial cells in regions of reduced cortical thickness. Differentially expressed genes showed enrichment for microglial markers and, in particular, activated microglial states. Analysis of post-mortem brain tissue from humans with epilepsy confirmed excess activated microglia. In the murine model, transient depletion of activated microglia during the early phase of the disease development prevented cortical thinning and neuronal cell loss in the temporal cortex. Although the development of chronic seizures was unaffected, the epileptic mice with early depletion of activated microglia did not develop deficits in a non-spatial memory test seen in epileptic mice not depleted of microglia. CONCLUSIONS These convergent data strongly implicate activated microglia in cortical thinning, representing a new dimension for concern and disease modification in the epilepsies, potentially distinct from seizure control.
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Affiliation(s)
- Andre Altmann
- Centre for Medical Image Computing, University College London, London, UK
| | - Mina Ryten
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Martina Di Nunzio
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Teresa Ravizza
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Daniele Tolomeo
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Regina H Reynolds
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Alyma Somani
- Division of Neuropathology, UCL Queen Square Institute of Neurology, London, UK
| | - Marco Bacigaluppi
- Department of Neurology, San Raffaele Scientific Institute and Vita Salute San Raffaele University, Milan, Italy
| | - Valentina Iori
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Edoardo Micotti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Rossella Di Sapia
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Milica Cerovic
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Eleonora Palma
- Department of Physiology and Pharmacology, University of Rome, Sapienza
| | - Gabriele Ruffolo
- Department of Physiology and Pharmacology, University of Rome, Sapienza
| | - Juan A. Botía
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK.,Departamento de Ingeniería de la Información y las Comunicaciones. Universidad de Murcia, Murcia, Spain
| | - Julie Absil
- Department of Radiology, Hôpital Erasme, Universite Libre de Bruxelles, Brussels 1070, Belgium
| | - Saud Alhusaini
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | | | - Pia Auvinen
- Epilepsy Center, Department of Neurology, Kuopio University, Kuopio, Finland.,Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Nuria Bargallo
- Magnetic Resonance Image Core Facility, IDIBAPS, Barcelona, Spain.,Centre de Diagnostic Per la Imatge (CDIC), Hospital Clinic, Barcelona, Spain
| | - Emanuele Bartolini
- Pediatric Neurology Unit, Children’s Hospital A. Meyer-University of Florence, Italy.,IRCCS Stella Maris Foundation, Pisa, Italy
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
| | | | - Tauana Bernardes
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Boris C. Bernhardt
- Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.,Multimodal Imaging and Connectome Analysis Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Karen Blackmon
- Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, New York, USA.,Department of Physiology, Neuroscience and Behavioral Science, St. George’s University, Grenada, West Indies
| | - Barbara Braga
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Maria Eugenia Caligiuri
- Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Catanzaro, Italy
| | - Anna Calvo
- Magnetic Resonance Image Core Facility, IDIBAPS, Barcelona, Spain
| | - Chad Carlson
- Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, New York, USA.,Medical College of Wisconsin, Department of Neurology, Milwaukee, WI, USA
| | - Sarah J. Carr
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - Gianpiero L. Cavalleri
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland.,FutureNeuro Research Centre, RCSI, Dublin, Ireland
| | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Jian Chen
- Department of Computer Science and Engineering, The Ohio State University, USA
| | - Shuai Chen
- Cognitive Science Department, Xiamen University, Xiamen, China.,Fujian Key Laboratory of the Brain-like Intelligent Systems, China
| | - Andrea Cherubini
- Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Catanzaro, Italy
| | - Luis Concha
- Instituto de Neurobiología, Universidad Nacional Autónoma de México. Querétaro, Querétaro, México
| | - Philippe David
- Department of Radiology, Hôpital Erasme, Universite Libre de Bruxelles, Brussels 1070, Belgium
| | - Norman Delanty
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland.,FutureNeuro Research Centre, RCSI, Dublin, Ireland.,Division of Neurology, Beaumont Hospital, Dublin 9, Ireland
| | - Chantal Depondt
- Department of Neurology, Hôpital Erasme, Universite Libre de Bruxelles, Brussels 1070, Belgium
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, New York, USA
| | - Colin P. Doherty
- FutureNeuro Research Centre, RCSI, Dublin, Ireland.,Neurology Department, St. James’s Hospital, Dublin 8, Ireland
| | - Martin Domin
- Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Niels K. Focke
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Department of Clinical Neurophysiology, University Medicine Göttingen, Göttingen, Germany
| | - Sonya Foley
- Cardiff University Brain Research Imaging Centre, School of Psychology, Wales, UK
| | - Wendy Franca
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Antonio Gambardella
- Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Catanzaro, Italy.,Institute of Neurology, University ‚ “Magna Græcia”, Catanzaro, Italy
| | - Renzo Guerrini
- Pediatric Neurology Unit, Children’s Hospital A. Meyer-University of Florence, Italy.,IRCCS Stella Maris Foundation, Pisa, Italy
| | - Khalid Hamandi
- Institute of Psychological Medicine and Clinical Neurosciences, Hadyn Ellis Building, Maindy Road, Cardiff, UK.,Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Derrek P. Hibar
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California, USA
| | - Dmitry Isaev
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California, USA
| | - Graeme D. Jackson
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne, VIC, Australia.,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California, USA
| | - Reetta Kalviainen
- Epilepsy Center, Department of Neurology, Kuopio University, Kuopio, Finland.,Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Simon S. Keller
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, UK
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Maryland, USA
| | - Raviteja Kotikalapudi
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany.,Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Magdalena A. Kowalczyk
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne, VIC, Australia
| | - Ruben Kuzniecky
- Department of Neurology, Zucker Hofstra School of Medicine, New York, NY 10075, USA
| | - Patrick Kwan
- Department of Neurology, Royal Melbourne Hospital, Parkville, 3050, Australia
| | - Angelo Labate
- Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Catanzaro, Italy.,Institute of Neurology, University ‚ “Magna Græcia”, Catanzaro, Italy
| | - Soenke Langner
- Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Matteo Lenge
- Pediatric Neurology Unit, Children’s Hospital A. Meyer-University of Florence, Italy
| | - Min Liu
- Neuroimaging of Epilepsy Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Pascal Martin
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Mario Mascalchi
- Neuroradiology Unit, Children’s Hospital A. Meyer, Florence, Italy.,“Mario Serio” Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, NOCSE Hospital, Modena, Italy
| | | | - Terence J. O’Brien
- Department of Neurology, Royal Melbourne Hospital, Parkville, 3050, Australia.,Department of Medicine, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Jose C. Pariente
- Magnetic Resonance Image Core Facility, IDIBAPS, Barcelona, Spain
| | - Mark P. Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK.,Department of Neurology, King’s College Hospital, London, UK
| | - Raul Rodriguez-Cruces
- Instituto de Neurobiología, Universidad Nacional Autónoma de México. Querétaro, Querétaro, México
| | - Christian Rummel
- Support Center for Advanced Neuroimaging (SCAN), University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Taavi Saavalainen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Central Finland Central Hospital, Medical Imaging Unit, Jyväskylä, Finland
| | - Mira K. Semmelroch
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne, VIC, Australia
| | - Mariasavina Severino
- Neuroradiology Unit, Department of Head and Neck and Neurosciences, Istituto Giannina Gaslini, Genova, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Thomas Thesen
- Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, New York, USA.,Department of Physiology, Neuroscience and Behavioral Science, St. George’s University, Grenada, West Indies
| | - Rhys H. Thomas
- Institute of Psychological Medicine and Clinical Neurosciences, Hadyn Ellis Building, Maindy Road, Cardiff, UK.,Department of Neurology, University Hospital of Wales, Cardiff, UK
| | - Manuela Tondelli
- Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, NOCSE Hospital, Modena, Italy
| | - Domenico Tortora
- Neuroradiology Unit, Department of Head and Neck and Neurosciences, Istituto Giannina Gaslini, Genova, Italy
| | - Anna Elisabetta Vaudano
- Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, NOCSE Hospital, Modena, Italy
| | - Lucy Vivash
- Department of Neurology, Royal Melbourne Hospital, Parkville, 3050, Australia.,Melbourne Brain Centre, Department of Medicine, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Felix von Podewils
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Jan Wagner
- Department of Neurology, University of Ulm and Universitäts- and Rehabilitationskliniken Ulm, Germany
| | - Bernd Weber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.,Department of Neurocognition / Imaging, Life & Brain Research Centre, Bonn, Germany
| | - Roland Wiest
- Support Center for Advanced Neuroimaging (SCAN), University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | | | - Guohao Zhang
- Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County, USA
| | - Junsong Zhang
- Cognitive Science Department, Xiamen University, Xiamen, China.,Fujian Key Laboratory of the Brain-like Intelligent Systems, China
| | | | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Andreja Avbersek
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | | | - Maria Thom
- Division of Neuropathology, UCL Queen Square Institute of Neurology, London, UK.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Christopher D Whelan
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland.,Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California, USA
| | - Paul Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California, USA
| | - Carrie R McDonald
- Multimodal Imaging Laboratory, University of California San Diego, San Diego, California, USA.,Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Annamaria Vezzani
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.,To whom correspondence may be addressed
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Bucks, UK.,To whom correspondence may be addressed
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12
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Sarecka-Hujar B. Is There a Relation between 677C>T Polymorphism in the MTHFR Gene and the Susceptibility to Epilepsy in Young Patients? A Meta-Analysis. Brain Sci 2021; 11:brainsci11101327. [PMID: 34679392 PMCID: PMC8533948 DOI: 10.3390/brainsci11101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Numerous data show a role for genetic polymorphisms in the development of epilepsy. Previously, the TT genotype of the MTHFR 677C>T polymorphism was found to be associated with a decreased leucocyte DNA methylation status. Polymorphisms in the MTHFR gene could modify the pharmacodynamics of many drugs. This meta-analysis aimed to assess the relationship between MTHFR 677C>T polymorphism and susceptibility to epilepsy in young patients. Methods: Available databases (PubMed, Embase, Google Scholar, SciELO, and Medline) were searched using specific keywords. Eight studies, published between 1999 and 2019, with 1678 young patients with epilepsy and 1784 controls, met the inclusion criteria. Apart from the total groups, additional analyses in age subgroups (i.e., young adults and children) were conducted. Statistical analyses were conducted using the RevMan 5.4 and MedCalc software. The pooled odds ratio (OR) was estimated with a random- or fixed-effects model depending on the heterogeneity. Analyses were performed for five genetic models, i.e., dominant (CT + TT vs. CC), recessive (TT vs. CC + CT), additive (TT vs. CC), heterozygous (CT vs. CC), and allelic (T vs. C). The publication bias was assessed with the use of Egger's and Begg's tests. Results: Both the MTHFR TT genotype (in the additive model) and the T allele (in the allelic model) significantly increased the risk of epilepsy when the total groups were compared (OR = 1.44, p = 0.002, and OR = 1.183, p = 0.001, respectively). The sensitivity analysis for these models indicated the stability of the results. Similarly, significant results were obtained among young adults for all the genetic models (dominant model: OR = 1.28, p = 0.002; recessive model: OR = 1.48, p = 0.003; additive model: OR = 1.63, p < 0.001; heterozygous model: OR = 1.21, p = 0.028; and allelic model: OR = 1.256, p < 0.001). Those results were also stable and reliable. In the group of children, no relation between 677C>T polymorphism and epilepsy was observed; however, the analysis was based only on three studies, and one study also comprised young adults. No publication bias was demonstrated. Conclusions: The meta-analysis revealed that the carrier state for the T allele as well as the TT genotype of the MTHFR 677C>T polymorphism increases the risk of epilepsy in young adults but not in children.
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Affiliation(s)
- Beata Sarecka-Hujar
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, 41-200 Sosnowiec, Poland
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13
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New avenues in molecular genetics for the diagnosis and application of therapeutics to the epilepsies. Epilepsy Behav 2021; 121:106428. [PMID: 31400936 DOI: 10.1016/j.yebeh.2019.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/14/2019] [Accepted: 07/06/2019] [Indexed: 11/22/2022]
Abstract
Genetic epidemiology studies have shown that most epilepsies involve some genetic cause. In addition, twin studies have helped strengthen the hypothesis that in most patients with epilepsy, a complex inheritance is involved. More recently, with the development of high-density single-nucleotide polymorphism (SNP) microarrays and next-generation sequencing (NGS) technologies, the discovery of genes related to the epilepsies has accelerated tremendously. Especially, the use of whole exome sequencing (WES) has had a considerable impact on the identification of rare genetic variants with large effect sizes, including inherited or de novo mutations in severe forms of childhood epilepsies. The identification of pathogenic variants in patients with these childhood epilepsies provides many benefits for patients and families, such as the confirmation of the genetic nature of the diseases. This process will allow for better genetic counseling, more accurate therapy decisions, and a significant positive emotional impact. However, to study the genetic component of the more common forms of epilepsy, the use of high-density SNP arrays in genome-wide association studies (GWAS) seems to be the strategy of choice. As such, researchers can identify loci containing genetic variants associated with the common forms of epilepsy. The knowledge generated over the past two decades about the effects of the mutations that cause the monogenic epilepsy is tremendous; however, the scientific community is just starting to apply this information in order to generate better target treatments.
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14
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Ahmad MA, Pottoo FH, Akbar M. Gene Therapy Repairs for the Epileptic Brain: Potential for Treatment and Future Directions. Curr Gene Ther 2021; 19:367-375. [PMID: 32003688 DOI: 10.2174/1566523220666200131142423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 01/01/2020] [Accepted: 01/15/2020] [Indexed: 01/19/2023]
Abstract
Epilepsy is a syndrome specified by frequent seizures and is one of the most prevalent neurological conditions, and that one-third of people of epilepsy are resistant to available drugs. Surgery is supposed to be the main treatment for the remedy of multiple drug-resistant epilepsy, but it is a drastic procedure. Advancement in genomic technologies indicates that gene therapy can make such surgery unnecessary. The considerable number of new studies show the significance of mutation in mammalian target of rapamycin pathway, NMDA receptors, GABA receptors, potassium channels and G-protein coupled receptors. Illustration of the meticulous drug in epilepsy targeting new expression of mutations in SCN8A, GRIN2A, GRIN2D and KCNT1 are conferred. Various methods are utilized to express a gene in a precise area of the brain; Transplantation of cells in an ex vivo approach (fetal cells, fibroblasts, immortalized cells), nonviral vector delivery and viral vector delivery like retrovirus, herpes simplex virus adenovirus and adeno-related virus. Gene therapy has thus been explored to generate anti-epileptogenic, anti-seizure and disease-modifying effects. Specific targeting of the epileptogenic region is facilitated by gene therapy, hence sparing the adjacent healthy tissue and decreasing the adverse effects that frequently go hand in hand with antiepileptic medication.
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Affiliation(s)
- Md A Ahmad
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow, India
| | - Faheem H Pottoo
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdul Rahman Bin Faisal University, P.O. Box 1982, Dammam, 31441, Saudi Arabia
| | - Md Akbar
- Department of Pharmacology, School of Pharmaceutical, Education and Research, Jamia Hamdard, New Delhi- 110062, India
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15
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Suzuki T, Koike Y, Ashikawa K, Otomo N, Takahashi A, Aoi T, Kamatani N, Nakamura Y, Kubo M, Kamatani Y, Momozawa Y, Terao C, Yamakawa K. Genome-wide association study of epilepsy in a Japanese population identified an associated region at chromosome 12q24. Epilepsia 2021; 62:1391-1400. [PMID: 33913524 DOI: 10.1111/epi.16911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Although a number of genes responsible for epilepsy have been identified through Mendelian genetic approaches, and genome-wide association studies (GWASs) have implicated several susceptibility loci, the role of ethnic-specific markers remains to be fully explored. We aimed to identify novel genetic associations with epilepsy in a Japanese population. METHODS We conducted a GWAS on 1825 patients with a variety of epilepsies and 7975 control individuals. Expression quantitative trait locus (eQTL) analysis of epilepsy-associated single nucleotide polymorphisms (SNPs) was performed using Japanese eQTL data. RESULTS We identified a novel region, which is ~2 Mb (lead SNP rs149212747, p = 8.57 × 10-10 ), at chromosome 12q24 as a risk for epilepsy. Most of these loci were polymorphic in East Asian populations including Japanese, but monomorphic in the European population. This region harbors 24 transcripts including genes expressed in the brain such as CUX2, ATXN2, BRAP, ALDH2, ERP29, TRAFD1, HECTD4, RPL6, PTPN11, and RPH3A. The eQTL analysis revealed that the associated SNPs are also correlated to differential expression of genes at 12q24. SIGNIFICANCE These findings suggest that a gene or genes in the CUX2-RPH3A ~2-Mb region contribute to the pathology of epilepsy in the Japanese population.
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Affiliation(s)
- Toshimitsu Suzuki
- Department of Neurodevelopmental Disorder Genetics, Institute of Brain Science, Nagoya City University Graduate School of Medical Science, Aichi, Japan.,Laboratory for Neurogenetics, Institute of Physical and Chemical Research (RIKEN) Center for Brain Science, Saitama, Japan
| | - Yoshinao Koike
- Laboratory for Statistical and Translational Genetics, Institute of Physical and Chemical Research (RIKEN) Center for Integrative Medical Sciences, Yokohama, Japan.,Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kyota Ashikawa
- Laboratory for Genotyping Development, Institute of Physical and Chemical Research (RIKEN) Center for Integrative Medical Sciences, Yokohama, Japan
| | - Nao Otomo
- Laboratory for Statistical and Translational Genetics, Institute of Physical and Chemical Research (RIKEN) Center for Integrative Medical Sciences, Yokohama, Japan.,Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Atsushi Takahashi
- Laboratory for Statistical Analysis, Institute of Physical and Chemical Research (RIKEN) Center for Integrative Medical Sciences, Yokohama, Japan.,Department of Genomic Medicine, National Cerebral and Cardiovascular Center, Research Institute, Osaka, Japan
| | - Tomomi Aoi
- Laboratory for Genotyping Development, Institute of Physical and Chemical Research (RIKEN) Center for Integrative Medical Sciences, Yokohama, Japan
| | - Naoyuki Kamatani
- Center for Genomic Medicine, Institute of Physical and Chemical Research (RIKEN), Yokohama, Japan
| | - Yusuke Nakamura
- Laboratory of Molecular Medicine, Human Genome Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan.,Cancer Precision Medicine Research Center, The Japanese Foundation for Cancer Research (JFCR), Tokyo, Japan
| | - Michiaki Kubo
- Laboratory for Genotyping Development, Institute of Physical and Chemical Research (RIKEN) Center for Integrative Medical Sciences, Yokohama, Japan
| | - Yoichiro Kamatani
- Laboratory for Statistical Analysis, Institute of Physical and Chemical Research (RIKEN) Center for Integrative Medical Sciences, Yokohama, Japan.,Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Laboratory of Complex Trait Genomics, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, University of Tokyo, Tokyo, Japan
| | - Yukihide Momozawa
- Laboratory for Genotyping Development, Institute of Physical and Chemical Research (RIKEN) Center for Integrative Medical Sciences, Yokohama, Japan
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, Institute of Physical and Chemical Research (RIKEN) Center for Integrative Medical Sciences, Yokohama, Japan
| | - Kazuhiro Yamakawa
- Department of Neurodevelopmental Disorder Genetics, Institute of Brain Science, Nagoya City University Graduate School of Medical Science, Aichi, Japan.,Laboratory for Neurogenetics, Institute of Physical and Chemical Research (RIKEN) Center for Brain Science, Saitama, Japan
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16
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Ellis CA, Ottman R, Epstein MP, Berkovic SF. Generalized, focal, and combined epilepsies in families: New evidence for distinct genetic factors. Epilepsia 2020; 61:2667-2674. [PMID: 33098311 DOI: 10.1111/epi.16732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the roles of shared and distinct genetic influences on generalized and focal epilepsy operating in individuals who manifest features of both types (combined epilepsies), and in families manifesting both generalized and focal epilepsies in separate individuals (mixed families). METHODS We analyzed the deeply phenotyped Epi4K cohort of multiplex families (≥3 affected individuals per family) using methods that quantify the aggregation of phenotypes within families and the relatedness of individuals with different phenotypes within family pedigrees. RESULTS The cohort included 281 families containing 1021 individuals with generalized (n = 484), focal (304), combined (51), or unclassified (182) epilepsies. The odds of combined epilepsy was higher in relatives of participants with combined epilepsy than in relatives of those with other epilepsy types (odds ratio [OR] 5.2, 95% confidence interval [CI] 1.7-16.1, P = .004). Individuals with combined epilepsy co-occurred in families more often than expected by chance (P = .03). Within mixed families, individuals with each type of epilepsy were more closely related to relatives with the same type than to relatives with other types (P < .001). SIGNIFICANCE These findings suggest that distinct genetic influences underlie the recently recognized entity of combined epilepsies, just as generalized epilepsies and focal epilepsies each have distinct genetic influences. Mixed families may in part reflect chance co-occurrence of these distinct genetic influences. These conclusions have important implications for molecular genetic studies aimed at identifying genetic determinants of the epilepsies.
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Affiliation(s)
- Colin A Ellis
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ruth Ottman
- Departments of Epidemiology and Neurology, and the G. H. Sergievsky Center, Columbia University, New York, NY, USA.,Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY, USA
| | - Michael P Epstein
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Samuel F Berkovic
- Epilepsy Research Centre, Department of Medicine, University of Melbourne (Austin Health), Heidelberg, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
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17
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Chaves J, Martins-Ferreira R, Carvalho C, Bettencourt A, Brás S, Chorão R, Freitas J, Samões R, Lopes J, Ramalheira J, Silva BM, Pinho e Costa P, da Silva AM, Leal B. Apolipoprotein E isoforms and susceptibility to genetic generalized epilepsies. Int J Neurosci 2020; 130:892-897. [DOI: 10.1080/00207454.2019.1709840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- João Chaves
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (UMIB/ICBAS-UP), Porto, Portugal
- Serviço de Neurologia, Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal
| | - Ricardo Martins-Ferreira
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (UMIB/ICBAS-UP), Porto, Portugal
- Laboratório Imunogenética - Departamento de Patologia e Imunologia Molecular, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (ICBAS/UP), Porto, Portugal
| | - Cláudia Carvalho
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (UMIB/ICBAS-UP), Porto, Portugal
- Laboratório Imunogenética - Departamento de Patologia e Imunologia Molecular, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (ICBAS/UP), Porto, Portugal
| | - Andreia Bettencourt
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (UMIB/ICBAS-UP), Porto, Portugal
- Laboratório Imunogenética - Departamento de Patologia e Imunologia Molecular, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (ICBAS/UP), Porto, Portugal
| | - Sandra Brás
- Laboratório Imunogenética - Departamento de Patologia e Imunologia Molecular, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (ICBAS/UP), Porto, Portugal
| | - Rui Chorão
- Serviço de Neurologia, Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal
| | - Joel Freitas
- Serviço de Neurologia, Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal
| | - Raquel Samões
- Serviço de Neurologia, Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal
| | - João Lopes
- Serviço de Neurofisiologia, Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal
| | - João Ramalheira
- Serviço de Neurofisiologia, Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal
| | - Berta M. Silva
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (UMIB/ICBAS-UP), Porto, Portugal
- Laboratório Imunogenética - Departamento de Patologia e Imunologia Molecular, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (ICBAS/UP), Porto, Portugal
| | - Paulo Pinho e Costa
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (UMIB/ICBAS-UP), Porto, Portugal
- Departamento de Genética, Instituto Nacional de Saúde Dr. Ricardo Jorge, Porto, Portugal
| | - António Martins da Silva
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (UMIB/ICBAS-UP), Porto, Portugal
- Serviço de Neurofisiologia, Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal
| | - Bárbara Leal
- Unidade Multidisciplinar de Investigação Biomédica, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (UMIB/ICBAS-UP), Porto, Portugal
- Laboratório Imunogenética - Departamento de Patologia e Imunologia Molecular, Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto (ICBAS/UP), Porto, Portugal
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18
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Lalwani AM, Yilmaz A, Bisgin H, Ugur Z, Akyol S, Graham SF. The Biochemical Profile of Post-Mortem Brain from People Who Suffered from Epilepsy Reveals Novel Insights into the Etiopathogenesis of the Disease. Metabolites 2020; 10:metabo10060261. [PMID: 32585915 PMCID: PMC7345034 DOI: 10.3390/metabo10060261] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 01/08/2023] Open
Abstract
Epilepsy not-otherwise-specified (ENOS) is one of the most common causes of chronic disorders impacting human health, with complex multifactorial etiology and clinical presentation. Understanding the metabolic processes associated with the disorder may aid in the discovery of preventive and therapeutic measures. Post-mortem brain samples were harvested from the frontal cortex (BA8/46) of people diagnosed with ENOS cases (n = 15) and age- and sex-matched control subjects (n = 15). We employed a targeted metabolomics approach using a combination of proton nuclear magnetic resonance (1H-NMR) and direct injection/liquid chromatography tandem mass spectrometry (DI/LC-MS/MS). We accurately identified and quantified 72 metabolites using 1H-NMR and 159 using DI/LC-MS/MS. Among the 212 detected metabolites, 14 showed significant concentration changes between ENOS cases and controls (p < 0.05; q < 0.05). Of these, adenosine monophosphate and O-acetylcholine were the most commonly selected metabolites used to develop predictive models capable of discriminating between ENOS and unaffected controls. Metabolomic set enrichment analysis identified ethanol degradation, butyrate metabolism and the mitochondrial beta-oxidation of fatty acids as the top three significantly perturbed metabolic pathways. We report, for the first time, the metabolomic profiling of postmortem brain tissue form patients who died from epilepsy. These findings can potentially expand upon the complex etiopathogenesis and help identify key predictive biomarkers of ENOS.
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Affiliation(s)
- Ashna M. Lalwani
- Department of Biochemistry and Molecular Biology, Hamilton College, 198 College Hill Rd, Clinton, NY 13323, USA;
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ali Yilmaz
- Department of Obstetrics and Gynecology, Beaumont Health System, 3601 W. 13 Mile Road, Royal Oak, MI 48073, USA; (A.Y.); (Z.U.)
- Oakland University-William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI 48309, USA
- Beaumont Research Institute, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA;
| | - Halil Bisgin
- Department of Computer Science, Engineering, and Physics, University of Michigan-Flint, 303 E. Kearsley St, Flint, MI 48502, USA;
| | - Zafer Ugur
- Department of Obstetrics and Gynecology, Beaumont Health System, 3601 W. 13 Mile Road, Royal Oak, MI 48073, USA; (A.Y.); (Z.U.)
- Beaumont Research Institute, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA;
| | - Sumeyya Akyol
- Beaumont Research Institute, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA;
| | - Stewart Francis Graham
- Department of Obstetrics and Gynecology, Beaumont Health System, 3601 W. 13 Mile Road, Royal Oak, MI 48073, USA; (A.Y.); (Z.U.)
- Oakland University-William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI 48309, USA
- Beaumont Research Institute, Beaumont Health, 3811 W. 13 Mile Road, Royal Oak, MI 48073, USA;
- Correspondence: ; Tel.: +1-248-551-2038
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19
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Abstract
Epilepsy encompasses a group of heterogeneous brain diseases that affect more than 50 million people worldwide. Epilepsy may have discernible structural, infectious, metabolic, and immune etiologies; however, in most people with epilepsy, no obvious cause is identifiable. Based initially on family studies and later on advances in gene sequencing technologies and computational approaches, as well as the establishment of large collaborative initiatives, we now know that genetics plays a much greater role in epilepsy than was previously appreciated. Here, we review the progress in the field of epilepsy genetics and highlight molecular discoveries in the most important epilepsy groups, including those that have been long considered to have a nongenetic cause. We discuss where the field of epilepsy genetics is moving as it enters a new era in which the genetic architecture of common epilepsies is starting to be unraveled.
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Affiliation(s)
- Piero Perucca
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria 3000, Australia.,Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria 3050, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria 3000, Australia
| | - Melanie Bahlo
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria 3052, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Samuel F Berkovic
- Epilepsy Research Centre, Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Victoria 3084, Australia;
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20
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Ostrowski LM, Song DY, Thorn EL, Ross EE, Stoyell SM, Chinappen DM, Eden UT, Kramer MA, Emerton BC, Morgan AK, Stufflebeam SM, Chu CJ. Dysmature superficial white matter microstructure in developmental focal epilepsy. Brain Commun 2019; 1:fcz002. [PMID: 31608323 PMCID: PMC6777514 DOI: 10.1093/braincomms/fcz002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 01/09/2023] Open
Abstract
Benign epilepsy with centrotemporal spikes is a common childhood epilepsy syndrome that predominantly affects boys, characterized by self-limited focal seizures arising from the perirolandic cortex and fine motor abnormalities. Concurrent with the age-specific presentation of this syndrome, the brain undergoes a developmentally choreographed sequence of white matter microstructural changes, including maturation of association u-fibres abutting the cortex. These short fibres mediate local cortico-cortical communication and provide an age-sensitive structural substrate that could support a focal disease process. To test this hypothesis, we evaluated the microstructural properties of superficial white matter in regions corresponding to u-fibres underlying the perirolandic seizure onset zone in children with this epilepsy syndrome compared with healthy controls. To verify the spatial specificity of these features, we characterized global superficial and deep white matter properties. We further evaluated the characteristics of the perirolandic white matter in relation to performance on a fine motor task, gender and abnormalities observed on EEG. Children with benign epilepsy with centrotemporal spikes (n = 20) and healthy controls (n = 14) underwent multimodal testing with high-resolution MRI including diffusion tensor imaging sequences, sleep EEG recordings and fine motor assessment. We compared white matter microstructural characteristics (axial, radial and mean diffusivity, and fractional anisotropy) between groups in each region. We found distinct abnormalities corresponding to the perirolandic u-fibre region, with increased axial, radial and mean diffusivity and fractional anisotropy values in children with epilepsy (P = 0.039, P = 0.035, P = 0.042 and P = 0.017, respectively). Increased fractional anisotropy in this region, consistent with decreased integrity of crossing sensorimotor u-fibres, correlated with inferior fine motor performance (P = 0.029). There were gender-specific differences in white matter microstructure in the perirolandic region; males and females with epilepsy and healthy males had higher diffusion and fractional anisotropy values than healthy females (P ≤ 0.035 for all measures), suggesting that typical patterns of white matter development disproportionately predispose boys to this developmental epilepsy syndrome. Perirolandic white matter microstructure showed no relationship to epilepsy duration, duration seizure free, or epileptiform burden. There were no group differences in diffusivity or fractional anisotropy in superficial white matter outside of the perirolandic region. Children with epilepsy had increased radial diffusivity (P = 0.022) and decreased fractional anisotropy (P = 0.027) in deep white matter, consistent with a global delay in white matter maturation. These data provide evidence that atypical maturation of white matter microstructure is a basic feature in benign epilepsy with centrotemporal spikes and may contribute to the epilepsy, male predisposition and clinical comorbidities observed in this disorder.
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Affiliation(s)
- Lauren M Ostrowski
- Department of Neuroscience, Brown University, Providence, RI 02912, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Daniel Y Song
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Emily L Thorn
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Erin E Ross
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sally M Stoyell
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Uri T Eden
- Department of Mathematics and Statistics, Boston University, Boston, MA 02215, USA
| | - Mark A Kramer
- Department of Mathematics and Statistics, Boston University, Boston, MA 02215, USA
| | - Britt C Emerton
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Amy K Morgan
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Steven M Stufflebeam
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Catherine J Chu
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
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21
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Mohandas N, Loke YJ, Hopkins S, Mackenzie L, Bennett C, Berkovic SF, Vadlamudi L, Craig JM. Evidence for type-specific DNA methylation patterns in epilepsy: a discordant monozygotic twin approach. Epigenomics 2019; 11:951-968. [DOI: 10.2217/epi-2018-0136] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aim: Epilepsy is a common neurological disorder characterized by recurrent seizures. We performed epigenetic analyses between and within 15 monozygotic (MZ) twin pairs discordant for focal or generalized epilepsy. Methods: DNA methylation analysis was performed using Illumina Infinium MethylationEPIC arrays, in blood and buccal samples. Results: Differentially methylated regions between epilepsy types associated with PM20D1 and GFPT2 genes in both tissues. Within MZ discordant twin pairs, differentially methylated regions associated with OTX1 and ARID5B genes for generalized epilepsy and TTC39C and DLX5 genes for focal epilepsy. Conclusion: This is the first epigenome-wide association study, utilizing the discordant MZ co-twin model, to deepen our understanding of the neurobiology of epilepsy.
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Affiliation(s)
- Namitha Mohandas
- Environmental & Genetic Epidemiology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, Victoria, Australia
| | - Yuk Jing Loke
- Environmental & Genetic Epidemiology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia
| | - Stephanie Hopkins
- Environmental & Genetic Epidemiology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia
- School of Medicine & Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Lisa Mackenzie
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Carmen Bennett
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Samuel F Berkovic
- Epilepsy Research Centre, University of Melbourne, Austin Health, Victoria, Australia
| | - Lata Vadlamudi
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Queensland, Australia
- Royal Brisbane & Women's Hospital, Queensland, Australia
| | - Jeffrey M Craig
- Environmental & Genetic Epidemiology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, Victoria, Australia
- Centre for Molecular & Medical Research, School of Medicine, Deakin University, Geelong, Victoria 3220, Australia
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22
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Ellis CA, Churilov L, Epstein MP, Xie SX, Bellows ST, Ottman R, Berkovic SF. Epilepsy in families: Age at onset is a familial trait, independent of syndrome. Ann Neurol 2019; 86:91-98. [PMID: 31050039 DOI: 10.1002/ana.25499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 04/04/2019] [Accepted: 04/28/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We tested 2 hypotheses regarding age at onset within familial epilepsies: (1) family members with epilepsy tend to have similar ages at onset, independent of epilepsy syndrome; and (2) age at onset is younger in successive generations after controlling for sampling bias. METHODS We analyzed clinical data collected by the Epi4K Consortium (303 multiplex families, 1,120 individuals). To test hypothesis 1, we used both linear mixed models commonly used for heritability analysis and Cox regression models with frailty terms to assess clustering of onset within families after controlling for other predictors. To test hypothesis 2, we used mixed effects models, pairwise analyses, and survival analysis to address sampling-related bias that may mimic anticipation. RESULTS Regarding hypothesis 1, age at seizure onset was significantly heritable (intraclass correlation coefficient = 0.17, p < 0.001) after adjusting for epilepsy type, sex, site, history of febrile seizure, and age at last observation. This finding remained significant after adjusting for epilepsy syndromes, and was robust across statistical methods in all families and in generalized families. Regarding hypothesis 2, the mean age at onset decreased in successive generations (p < 0.001). After adjusting for age at last observation, this effect was not significant in mixed effects models (p = 0.14), but remained significant in pairwise (p = 0.0003) and survival analyses (p = 0.02). INTERPRETATION Age at seizure onset is an independent familial trait, and may have genetic determinants distinct from the determinants of particular epilepsy syndromes. Younger onsets in successive generations can be explained in part by sampling bias, but the presence of genetic anticipation cannot be excluded. ANN NEUROL 2019.
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Affiliation(s)
- Colin A Ellis
- Epilepsy Research Centre, Department of Medicine, University of Melbourne (Austin Health), Heidelberg, Victoria, Australia.,Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Leonid Churilov
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | | | - Sharon X Xie
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Susannah T Bellows
- Epilepsy Research Centre, Department of Medicine, University of Melbourne (Austin Health), Heidelberg, Victoria, Australia
| | - Ruth Ottman
- Departments of Epidemiology and Neurology, and the G. H. Sergievsky Center, Columbia University; and Division of Translational Epidemiology, New York State Psychiatric Institute, New York, NY
| | - Samuel F Berkovic
- Epilepsy Research Centre, Department of Medicine, University of Melbourne (Austin Health), Heidelberg, Victoria, Australia
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23
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Genome-wide mega-analysis identifies 16 loci and highlights diverse biological mechanisms in the common epilepsies. Nat Commun 2018; 9:5269. [PMID: 30531953 PMCID: PMC6288131 DOI: 10.1038/s41467-018-07524-z] [Citation(s) in RCA: 238] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/30/2018] [Indexed: 12/16/2022] Open
Abstract
The epilepsies affect around 65 million people worldwide and have a substantial missing heritability component. We report a genome-wide mega-analysis involving 15,212 individuals with epilepsy and 29,677 controls, which reveals 16 genome-wide significant loci, of which 11 are novel. Using various prioritization criteria, we pinpoint the 21 most likely epilepsy genes at these loci, with the majority in genetic generalized epilepsies. These genes have diverse biological functions, including coding for ion-channel subunits, transcription factors and a vitamin-B6 metabolism enzyme. Converging evidence shows that the common variants associated with epilepsy play a role in epigenetic regulation of gene expression in the brain. The results show an enrichment for monogenic epilepsy genes as well as known targets of antiepileptic drugs. Using SNP-based heritability analyses we disentangle both the unique and overlapping genetic basis to seven different epilepsy subtypes. Together, these findings provide leads for epilepsy therapies based on underlying pathophysiology. Epilepsies are common brain disorders and are classified based on clinical phenotyping, imaging and genetics. Here, the authors perform genome-wide association studies for 3 broad and 7 subtypes of epilepsy and identify 16 loci - 11 novel - that are further annotated by eQTL and partitioned heritability analyses.
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24
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Abstract
This article is based on a lecture delivered at the 2017 American Epilepsy Society Annual Meeting and provides an overview of the growing evidence supporting the strong genetic contribution to focal epilepsies. This also discusses how advances in the molecular genetics of focal epilepsies are rapidly translating to routine clinical care.
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25
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Myers KA, Johnstone DL, Dyment DA. Epilepsy genetics: Current knowledge, applications, and future directions. Clin Genet 2018; 95:95-111. [PMID: 29992546 DOI: 10.1111/cge.13414] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/03/2018] [Accepted: 07/06/2018] [Indexed: 12/12/2022]
Abstract
The rapid pace of disease gene discovery has resulted in tremendous advances in the field of epilepsy genetics. Clinical testing with comprehensive gene panels, exomes, and genomes are now available and have led to higher diagnostic rates and insights into the underlying disease processes. As such, the contribution to the care of patients by medical geneticists, neurogeneticists and genetic counselors are significant; the dysmorphic examination, the necessary pre- and post-test counseling, the selection of the appropriate next-generation sequencing-based test(s), and the interpretation of sequencing results require a care provider to have a comprehensive working knowledge of the strengths and limitations of the available testing technologies. As the underlying mechanisms of the encephalopathies and epilepsies are better understood, there may be opportunities for the development of novel therapies based on an individual's own specific genotype. Drug screening with in vitro and in vivo models of epilepsy can potentially facilitate new treatment strategies. The future of epilepsy genetics will also probably include other-omic approaches such as transcriptomes, metabolomes, and the expanded use of whole genome sequencing to further improve our understanding of epilepsy and provide better care for those with the disease.
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Affiliation(s)
- K A Myers
- Department of Pediatrics, University of McGill, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada
| | - D L Johnstone
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - D A Dyment
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada.,Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Canada
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26
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Clinical and genetic study of Tunisian families with genetic generalized epilepsy: contribution of CACNA1H and MAST4 genes. Neurogenetics 2018; 19:165-178. [PMID: 29948376 DOI: 10.1007/s10048-018-0550-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/01/2018] [Accepted: 06/03/2018] [Indexed: 12/11/2022]
Abstract
Genetic generalized epilepsies (GGE) (childhood absence epilepsy (CAE), juvenile myoclonic epilepsy (JME) and epilepsy with generalized tonic-clonic seizures (GTCS)) are mainly determined by genetic factors. Since few mutations were identified in rare families with autosomal dominant GGE, a polygenic inheritance was suspected in most patients. Recent studies on large American or European cohorts of sporadic cases showed that susceptibility genes were numerous although their variants were rare, making their identification difficult. Here, we reported clinical and genetic characteristics of 30 Tunisian GGE families, including 71 GGE patients. The phenotype was close to that in sporadic cases. Nineteen pedigrees had a homogeneous type of GGE (JME-CAE-CGTS), and 11 combined these epileptic syndromes. Rare non-synonymous variants were selected in probands using a targeted panel of 30 candidate genes and their segregation was determined in families. Molecular studies incriminated different genes, mainly CACNA1H and MAST4. The segregation of at least two variants in different genes in some pedigrees was compatible with the hypothesis of an oligogenic inheritance, which was in accordance with the relatively low frequency of consanguineous probands. Since at least 2 susceptibility genes were likely shared by different populations, genetic factors involved in the majority of Tunisian GGE families remain to be discovered. Their identification should be easier in families with a homogeneous type of GGE, in which an intra-familial genetic homogeneity could be suspected.
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27
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Liu XW, Li W, Han T, Wei K, Qiao S, Su L, Chi Z. The finding of a new heterozygous mutation site of the SCN2A gene in a monozygotic twin family carrying and exhibiting genetic epilepsy with febrile seizures plus (GEFS+) using targeted next-generation sequencing. Clin Neurol Neurosurg 2018; 169:86-91. [DOI: 10.1016/j.clineuro.2017.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 10/13/2017] [Accepted: 10/21/2017] [Indexed: 12/30/2022]
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28
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Fuller TD, Westfall TA, Das T, Dawson DV, Slusarski DC. High-throughput behavioral assay to investigate seizure sensitivity in zebrafish implicates ZFHX3 in epilepsy. J Neurogenet 2018; 32:92-105. [PMID: 29718741 DOI: 10.1080/01677063.2018.1445247] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Epilepsy, which affects ∼1% of the population, is caused by abnormal synchronous neural activity in the central nervous system (CNS). While there is a significant genetic contribution to epilepsy, the underlying causes for the majority of genetic cases remain unknown. The NIH Undiagnosed Diseases Project (UDP) utilized exome sequencing to identify genetic variants in patients affected by various conditions with undefined etiology, including epilepsy. Confirming the functional relevance of the candidate genes identified by exome sequencing in a timely manner is crucial to translating exome data into clinically useful information. To this end, we developed a high throughput version of a seizure-sensitivity assay in zebrafish (Danio rerio) to rapidly evaluate candidate genes found by exome sequencing. We developed open access software, Studying Epilepsy In Zebrafish using R (SEIZR), to efficiently analyze the data. SEIZR was validated by disrupting function of a known epilepsy gene, prickle 1. Next, using SEIZR, we analyzed a candidate gene from the UDP screen (Zinc Finger Homeobox 3, ZFHX3), and showed that reduced ZFHX3 function in zebrafish results in a significant hyperactive response to the convulsant drug pentylenetetrazol (PTZ). We find that ZFHX3 shows strong expression in the CNS during neurogenesis including in the pallium, thalamus, tegmentum, reticular formation, and medulla oblongata - all regions which have roles in motor control and coordination. Our findings in the zebrafish confirm human ZFHX3 is a strong candidate for further neurological studies. We offer SEIZR to other researchers as a tool to rapidly and efficiently analyze large behavioral data sets.
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Affiliation(s)
- Tyson D Fuller
- a Department of Biology , University of Iowa , Iowa City , IA , USA.,b Interdisciplinary Graduate Program in Genetics , University of Iowa , Iowa City , IA , USA
| | - Trudi A Westfall
- a Department of Biology , University of Iowa , Iowa City , IA , USA
| | - Tirthasree Das
- a Department of Biology , University of Iowa , Iowa City , IA , USA
| | - Deborah V Dawson
- b Interdisciplinary Graduate Program in Genetics , University of Iowa , Iowa City , IA , USA.,c Iowa Institute for Oral Health Research , University of Iowa , Iowa City , IA , USA.,d Department of Biostatistics , University of Iowa , Iowa City , IA , USA
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Lesca G. Aspetti genetici delle epilessie. Neurologia 2018. [DOI: 10.1016/s1634-7072(18)41286-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Churbanov A, Abrahamyan L. Preventing Common Hereditary Disorders through Time-Separated Twinning. BIONANOSCIENCE 2018. [DOI: 10.1007/s12668-017-0488-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Koeleman BP. What do genetic studies tell us about the heritable basis of common epilepsy? Polygenic or complex epilepsy? Neurosci Lett 2018; 667:10-16. [DOI: 10.1016/j.neulet.2017.03.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 12/23/2022]
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Abstract
A proposal for an Australian Brain Initiative (ABI) is under development by members of the Australian Brain Alliance. Here we discuss the goals of the ABI, its areas of research focus, its context in the Australian research setting, and its necessity for ensuring continued success for Australian brain research.
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Torres CM, Siebert M, Bock H, Mota SM, Krammer BR, Duarte JÁ, Bragatti JA, Castan JU, de Castro LA, Saraiva-Pereira ML, Bianchin MM. NTRK2 (TrkB gene) variants and temporal lobe epilepsy: A genetic association study. Epilepsy Res 2017; 137:1-8. [PMID: 28863320 DOI: 10.1016/j.eplepsyres.2017.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/14/2017] [Accepted: 08/19/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The NTRK2 gene encodes a member of the neurotrophic tyrosine kinase receptor family known as TrkB. It is a membrane-associated receptor with signaling and cellular differentiation properties that has been involved in neuropsychiatric disorders, including epilepsy. We report here the frequencies of NTRK2 allele variants in patients with temporal lobe epilepsy (TLE) compared to controls without epilepsy and explore the impact of these polymorphisms on major clinical variables in TLE. METHODS A case-control study comparing the frequencies of the NTRK2 gene polymorphisms beween 198 TLE Caucasian patients and 200 matching controls without epilepsy. In a second step, the impact of allelic variation on major clinical and electroencephalographic epilepsy variables was evaluated in the group of TLE patients. The following polymorphisms were determined by testing different regions of the NTRK2 gene: rs1867283, rs10868235, rs1147198, rs11140800, rs1187286, rs2289656, rs1624327, rs1443445, rs3780645, and rs2378672. To correct for multiple correlations the level of significance was set at p<0.01. RESULTS Patients with TLE showed a statistical trend for increase of the T/T genotype in rs10868235 compared to control (O.R.=1.90; 95%CI=1.17-3.09; p=0.01). Homozygous patients for the A allele in rs1443445 had earlier mean age at onset of seizures, p=0.009 (mean age of 16.6 versus 22.4years). We also observed that the T allele in rs3780645 was more frequent in patients who needed polytheraphy for seizure control than in patients on monotherapy, (O.R.=4.13; 95%CI=1.68-10.29; p=0.001). This finding may reflect an increased difficulty to obtain seizure control in this group of patients. No additional differences were observed in this study. CONCLUSIONS Patients with epilepsy showed a trend for a difference in rs10868235 allelic distribution compared to controls without epilepsy. NTRK2 variability influenced age at seizure onset and the pharmacological response to seizure control. As far as we know, this is the first study showing an association between NTKR2 allelic variants in human epilepsy. We believe that further studies in this venue will shade some light on the molecular mechanisms involved in epileptogenesis and in the clinical characteristics of epilepsy.
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Affiliation(s)
- Carolina Machado Torres
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Brazil; Basic Research and Advanced Investigations in Neurology (BRAIN), Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; Centro de Tratamento de Epilepsia Refratária (CETER), Hospital de Clínicas de Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Brazil
| | - Marina Siebert
- Laboratory of Genetic Identification, Experimental Research Centre, Hospital de Clinicas de Porto Alegre, Brazil
| | - Hugo Bock
- Laboratory of Genetic Identification, Experimental Research Centre, Hospital de Clinicas de Porto Alegre, Brazil
| | - Suelen Mandelli Mota
- Basic Research and Advanced Investigations in Neurology (BRAIN), Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Bárbara Reis Krammer
- Basic Research and Advanced Investigations in Neurology (BRAIN), Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Juliana Ávila Duarte
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Brazil; Centro de Tratamento de Epilepsia Refratária (CETER), Hospital de Clínicas de Porto Alegre, Brazil
| | - José Augusto Bragatti
- Centro de Tratamento de Epilepsia Refratária (CETER), Hospital de Clínicas de Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Brazil
| | - Juliana Unis Castan
- Centro de Tratamento de Epilepsia Refratária (CETER), Hospital de Clínicas de Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Brazil
| | - Luiza Amaral de Castro
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Brazil; Basic Research and Advanced Investigations in Neurology (BRAIN), Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Maria Luiza Saraiva-Pereira
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Brazil; Basic Research and Advanced Investigations in Neurology (BRAIN), Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; Laboratory of Genetic Identification, Experimental Research Centre, Hospital de Clinicas de Porto Alegre, Brazil
| | - Marino Muxfeldt Bianchin
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Brazil; Basic Research and Advanced Investigations in Neurology (BRAIN), Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; Centro de Tratamento de Epilepsia Refratária (CETER), Hospital de Clínicas de Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Brazil.
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Phenotypic analysis of 303 multiplex families with common epilepsies. Brain 2017; 140:2144-2156. [PMID: 28899008 PMCID: PMC6059182 DOI: 10.1093/brain/awx129] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/07/2017] [Accepted: 04/24/2017] [Indexed: 12/24/2022] Open
Abstract
Gene identification in epilepsy has mainly been limited to large families segregating genes of major effect and de novo mutations in epileptic encephalopathies. Many families that present with common non-acquired focal epilepsies and genetic generalized epilepsies remain unexplained. We assembled a cohort of 'genetically enriched' common epilepsies by collecting and phenotyping families containing multiple individuals with unprovoked seizures. We aimed to determine if specific clinical epilepsy features aggregate within families, and whether this segregation of phenotypes may constitute distinct 'familial syndromes' that could inform genomic analyses. Families with three or more individuals with unprovoked seizures were studied across multiple international centres. Affected individuals were phenotyped and classified according to specific electroclinical syndromes. Families were categorized based on syndromic groupings of affected family members, examined for pedigree structure and phenotypic patterns and, where possible, assigned specific familial epilepsy syndromes. A total of 303 families were assembled and analysed, comprising 1120 affected phenotyped individuals. Of the 303 families, 117 exclusively segregated generalized epilepsy, 62 focal epilepsy, and 22 were classified as genetic epilepsy with febrile seizures plus. Over one-third (102 families) were observed to have mixed epilepsy phenotypes: 78 had both generalized and focal epilepsy features within the same individual (n = 39), or within first or second degree relatives (n = 39). Among the genetic generalized epilepsy families, absence epilepsies were found to cluster within families independently of juvenile myoclonic epilepsy, and significantly more females were affected than males. Of the 62 familial focal epilepsy families, two previously undescribed familial focal syndrome patterns were evident: 15 families had posterior quadrant epilepsies, including seven with occipito-temporal localization and seven with temporo-parietal foci, and four families displayed familial focal epilepsy of childhood with multiple affected siblings that was suggestive of recessive inheritance. The findings suggest (i) specific patterns of syndromic familial aggregation occur, including newly recognized forms of familial focal epilepsy; (ii) although syndrome-specificity usually occurs in multiplex families, the one-third of families with features of both focal and generalized epilepsy is suggestive of shared genetic determinants; and (iii) patterns of features observed across families including pedigree structure, sex, and age of onset may hold clues for future gene identification. Such detailed phenotypic information will be invaluable in the conditioning and interpretation of forthcoming sequencing data to understand the genetic architecture and inter-relationships of the common epilepsy syndromes.
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Affiliation(s)
- The Epi4K Consortium
- Correspondence to: Samuel Berkovic, Epilepsy Research Centre, L2 Melbourne Brain Centre, 245 Burgundy Street, Austin Health, Heidelberg Victoria Australia 3084 E-mail:
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Pérez-Palma E, Helbig I, Klein KM, Anttila V, Horn H, Reinthaler EM, Gormley P, Ganna A, Byrnes A, Pernhorst K, Toliat MR, Saarentaus E, Howrigan DP, Hoffman P, Miquel JF, De Ferrari GV, Nürnberg P, Lerche H, Zimprich F, Neubauer BA, Becker AJ, Rosenow F, Perucca E, Zara F, Weber YG, Lal D. Heterogeneous contribution of microdeletions in the development of common generalised and focal epilepsies. J Med Genet 2017; 54:598-606. [PMID: 28756411 PMCID: PMC5574393 DOI: 10.1136/jmedgenet-2016-104495] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/21/2017] [Accepted: 06/26/2017] [Indexed: 11/27/2022]
Abstract
Background Microdeletions are known to confer risk to epilepsy, particularly at genomic rearrangement ‘hotspot’ loci. However, microdeletion burden not overlapping these regions or within different epilepsy subtypes has not been ascertained. Objective To decipher the role of microdeletions outside hotspots loci and risk assessment by epilepsy subtype. Methods We assessed the burden, frequency and genomic content of rare, large microdeletions found in a previously published cohort of 1366 patients with genetic generalised epilepsy (GGE) in addition to two sets of additional unpublished genome-wide microdeletions found in 281 patients with rolandic epilepsy (RE) and 807 patients with adult focal epilepsy (AFE), totalling 2454 cases. Microdeletions were assessed in a combined and subtype-specific approaches against 6746 controls. Results When hotspots are considered, we detected an enrichment of microdeletions in the combined epilepsy analysis (adjusted p=1.06×10−6,OR 1.89, 95% CI 1.51 to 2.35). Epilepsy subtype-specific analyses showed that hotspot microdeletions in the GGE subgroup contribute most of the overall signal (adjusted p=9.79×10−12, OR 7.45, 95% CI 4.20–13.5). Outside hotspots , microdeletions were enriched in the GGE cohort for neurodevelopmental genes (adjusted p=9.13×10−3,OR 2.85, 95% CI 1.62–4.94). No additional signal was observed for RE and AFE. Still, gene-content analysis identified known (NRXN1, RBFOX1 and PCDH7) and novel (LOC102723362) candidate genes across epilepsy subtypes that were not deleted in controls. Conclusions Our results show a heterogeneous effect of recurrent and non-recurrent microdeletions as part of the genetic architecture of GGE and a minor contribution in the aetiology of RE and AFE.
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Affiliation(s)
- Eduardo Pérez-Palma
- Faculty of Biological Sciences and Medicine, Center for Biomedical Research, Universidad Andres Bello, Santiago, Chile.,Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Ingo Helbig
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany.,Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Karl Martin Klein
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital, Goethe-University Frankfurt, Frankfurt, Germany.,Department of Neurology, Epilepsy Center Hessen, University Hospitals Giessen & Marburg, and University of Marburg, Marburg, Germany
| | - Verneri Anttila
- Stanley Center for Psychiatric Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.,Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Heiko Horn
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Padhraig Gormley
- Stanley Center for Psychiatric Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.,Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea Ganna
- Stanley Center for Psychiatric Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Andrea Byrnes
- Stanley Center for Psychiatric Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | | | - Mohammad R Toliat
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Elmo Saarentaus
- Stanley Center for Psychiatric Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.,Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel P Howrigan
- Stanley Center for Psychiatric Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.,Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Per Hoffman
- Division of Medical Genetics Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Juan Francisco Miquel
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Giancarlo V De Ferrari
- Faculty of Biological Sciences and Medicine, Center for Biomedical Research, Universidad Andres Bello, Santiago, Chile
| | - Peter Nürnberg
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research,University of Tübingen, Tübingen, Germany
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Bern A Neubauer
- Department of Neuropediatrics, University Medical Center Giessen and Marburg, Giessen, Germany
| | - Albert J Becker
- Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, University Hospital, Goethe-University Frankfurt, Frankfurt, Germany.,Department of Neurology, Epilepsy Center Hessen, University Hospitals Giessen & Marburg, and University of Marburg, Marburg, Germany
| | - Emilio Perucca
- C. Mondino National Neurological Institute, Pavia, Italy.,Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Federico Zara
- Laboratory of Neurogenetics, Neuromuscular Disease Unit, Genova, Italy
| | - Yvonne G Weber
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Dennis Lal
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany.,Stanley Center for Psychiatric Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.,Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Richard AE, Scheffer IE, Wilson SJ. Features of the broader autism phenotype in people with epilepsy support shared mechanisms between epilepsy and autism spectrum disorder. Neurosci Biobehav Rev 2017; 75:203-233. [DOI: 10.1016/j.neubiorev.2016.12.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 12/15/2016] [Accepted: 12/20/2016] [Indexed: 12/29/2022]
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Advances in epilepsy gene discovery and implications for epilepsy diagnosis and treatment. Curr Opin Neurol 2017; 30:193-199. [DOI: 10.1097/wco.0000000000000433] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Ultra-rare genetic variation in common epilepsies: a case-control sequencing study. Lancet Neurol 2017; 16:135-143. [DOI: 10.1016/s1474-4422(16)30359-3] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/12/2016] [Accepted: 11/23/2016] [Indexed: 12/30/2022]
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40
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Scheffer IE, French J, Hirsch E, Jain S, Mathern GW, Moshé SL, Perucca E, Tomson T, Wiebe S, Zhang YH, Zuberi SM. Classification of the epilepsies: New concepts for discussion and debate-Special report of the ILAE Classification Task Force of the Commission for Classification and Terminology. Epilepsia Open 2016; 1:37-44. [PMID: 29588927 PMCID: PMC5867836 DOI: 10.1002/epi4.5] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2016] [Indexed: 12/17/2022] Open
Abstract
The ILAE Task Force on Classification presents a road map for the development of an updated, relevant classification of the epilepsies. Our objective is to explain the process to date and the plan moving forward as well as to invite further discussion about the newly proposed terms and concepts. Here, we present our response to feedback about the 2010 Organization of the Epilepsies and clarify the reintroduction of the word “classification” to map out a framework for epilepsy diagnosis. We introduce some new concepts and suggest four diagnostic levels: seizure type, epilepsy category, epilepsy syndrome, and epilepsy with (specific) etiology to denote specific levels of diagnosis. We expand the etiological categories to six, focusing on those with treatment implications. Finally, we discuss the changes in terminology originally suggested and modifications in response to comments from the epilepsy community. We welcome feedback and discussion from the global epilepsy community, particularly for the new suggested terms, so that we can cement a classification that both reflects current thinking and scientific understanding and provides a dynamic, evolving framework.
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Affiliation(s)
- Ingrid E Scheffer
- Departments of Medicine and Paediatrics The University of Melbourne and Florey Institute Melbourne Victoria Australia.,Austin Health Heidelberg Victoria Australia.,Royal Children's Hospital Parkville Victoria Australia
| | - Jacqueline French
- Department of Neurology Langone School of Medicine New York University New York New York U.S.A
| | - Edouard Hirsch
- University-Hospital-INSERM U 964 Strasbourg France.,IDÉE-Lyon Lyon France
| | | | - Gary W Mathern
- Departments of Neurosurgery, Psychiatry and Biobehavioral Medicine David Geffen School of Medicine UCLA Los Angeles California U.S.A
| | - Solomon L Moshé
- Department of Neurology Department of Neuroscience and Department of Pediatrics Albert Einstein College of Medicine and Montefiore Medical Center Bronx New York U.S.A
| | - Emilio Perucca
- Institute of Neurology IRCCS C. Mondino Foundation and Clinical Pharmacology Unit University of Pavia Pavia Italy
| | - Torbjorn Tomson
- Department of Clinical Neuroscience Karolinska Institute Stockholm Sweden
| | - Samuel Wiebe
- Departments of Clinical Neurosciences and Community Health Sciences University of Calgary Calgary Alberta Canada
| | - Yue-Hua Zhang
- Department of Pediatrics Peking University First Hospital Beijing China
| | - Sameer M Zuberi
- Paediatric Neurosciences Research Group Fraser of Allander Neurosciences Unit Royal Hospital for Children Glasgow United Kingdom.,School of Medicine University of Glasgow Glasgow United Kingdom
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Panjwani N, Wilson MD, Addis L, Crosbie J, Wirrell E, Auvin S, Caraballo RH, Kinali M, McCormick D, Oren C, Taylor J, Trounce J, Clarke T, Akman CI, Kugler SL, Mandelbaum DE, McGoldrick P, Wolf SM, Arnold P, Schachar R, Pal DK, Strug LJ. A microRNA-328 binding site in PAX6 is associated with centrotemporal spikes of rolandic epilepsy. Ann Clin Transl Neurol 2016; 3:512-22. [PMID: 27386500 PMCID: PMC4931716 DOI: 10.1002/acn3.320] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 04/28/2016] [Indexed: 12/21/2022] Open
Abstract
Objective Rolandic epilepsy is a common genetic focal epilepsy of childhood characterized by centrotemporal sharp waves on electroencephalogram. In previous genome‐wide analysis, we had reported linkage of centrotemporal sharp waves to chromosome 11p13, and fine mapping with 44 SNPs identified the ELP4‐PAX6 locus in two independent US and Canadian case–control samples. Here, we aimed to find a causative variant for centrotemporal sharp waves using a larger sample and higher resolution genotyping array. Methods We fine‐mapped the ELP4‐PAX6 locus in 186 individuals from rolandic epilepsy families and 1000 population controls of European origin using the Illumina HumanCoreExome‐12 v1.0 BeadChip. Controls were matched to cases on ethnicity using principal component analysis. We used generalized estimating equations to assess association, followed up with a bioinformatics survey and literature search to evaluate functional significance. Results Homozygosity at the T allele of SNP rs662702 in the 3′ untranslated region of PAX6 conferred increased risk of CTS: Odds ratio = 12.29 (95% CI: 3.20–47.22), P = 2.6 × 10−4 and is seen in 3.9% of cases but only 0.3% of controls. Interpretation The minor T allele of SNP rs662702 disrupts regulation by microRNA‐328, which is known to result in increased PAX6 expression in vitro. This study provides, for the first time, evidence of a noncoding genomic variant contributing to the etiology of a common human epilepsy via a posttranscriptional regulatory mechanism.
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Affiliation(s)
- Naim Panjwani
- Program in Genetics and Genome Biology The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada
| | - Michael D Wilson
- Program in Genetics and Genome Biology The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada; Department of Molecular Genetics University of Toronto Toronto Ontario M5S 1A1 Canada
| | - Laura Addis
- Department of Basic and Clinical Neuroscience Institute of Psychiatry, Psychology and Neuroscience King's College London London SE5 9RX United Kingdom; Neuroscience Discovery Research Eli Lilly and Company Erl Wood, Surrey GU20 6PH United Kingdom
| | - Jennifer Crosbie
- Neurosciences and Mental Health Program Research Institute The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada; Department of Psychiatry The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada
| | - Elaine Wirrell
- Division of Child and Adolescent Neurology Mayo Clinic Rochester Minnesota 55905
| | - Stéphane Auvin
- Service de neurologie pédiatrique/Inserm 1141 Hôpital Robert Debré AP-HP, 48 boulevard Sérurier Paris 75019 France
| | - Roberto H Caraballo
- Department of Neurology Hospital de Pediatría "Prof Dr Juan P Garrahan" Combate de los Pozos 1881 C1245AAM Buenos Aires Argentina
| | - Maria Kinali
- Chelsea and Westminster Hospital London SW10 9NH United Kingdom
| | | | - Caroline Oren
- Northwick Park Hospital Middlesex HA1 3UJ United Kingdom
| | - Jacqueline Taylor
- Barnet and Chase Farm Hospitals Enfield, Greater London EN2 8JL United Kingdom
| | - John Trounce
- Brighton and Sussex University Hospitals Brighton BN1 6AG United Kingdom
| | - Tara Clarke
- Department of Epidemiology Columbia University New York New York 10027
| | - Cigdem I Akman
- Neurological Institute Columbia University Medical Centre New York, New York 10032
| | - Steven L Kugler
- Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine Philadelphia Pennsylvania 19104
| | - David E Mandelbaum
- Hasbro Children's Hospital and the Warren Alpert Medical School of Brown University Providence Rhode Island 02903
| | | | | | - Paul Arnold
- Neurosciences and Mental Health Program Research Institute The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada; Department of Psychiatry The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada; Mathison Centre for Mental Health Research and Education University of Calgary Calgary Alberta T2N 4Z6 Canada
| | - Russell Schachar
- Neurosciences and Mental Health Program Research Institute The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada; Department of Psychiatry The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada
| | - Deb K Pal
- Department of Basic and Clinical Neuroscience Institute of Psychiatry, Psychology and Neuroscience King's College London London SE5 9RX United Kingdom; King's College Hospital London SE5 9RS United Kingdom; Evelina London Children's Hospita lLondon SE1 7EH United Kingdom
| | - Lisa J Strug
- Program in Genetics and Genome Biology The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada; Division of Biostatistics Dalla Lana School of Public Health University of Toronto Toronto Ontario M5T 3M7 Canada; The Centre for Applied Genomics The Hospital for Sick Children Toronto Ontario M5G 0A4 Canada
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Helbig I, Heinzen EL, Mefford HC. Primer Part 1-The building blocks of epilepsy genetics. Epilepsia 2016; 57:861-8. [PMID: 27226047 DOI: 10.1111/epi.13381] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2016] [Indexed: 12/15/2022]
Abstract
This is the first of a two-part primer on the genetics of the epilepsies within the Genetic Literacy Series of the Genetics Commission of the International League Against Epilepsy. In Part 1, we cover the foundations of epilepsy genetics including genetic epidemiology and the range of genetic variants that can affect the risk for developing epilepsy. We discuss various epidemiologic study designs that have been applied to the genetics of the epilepsies including population studies, which provide compelling evidence for a strong genetic contribution in many epilepsies. We discuss genetic risk factors varying in size, frequency, inheritance pattern, effect size, and phenotypic specificity, and provide examples of how genetic risk factors within the various categories increase the risk for epilepsy. We end by highlighting trends in epilepsy genetics including the increasing use of massive parallel sequencing technologies.
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Affiliation(s)
- Ingo Helbig
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.,Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Erin L Heinzen
- Institute for Genomic Medicine and Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, U.S.A
| | - Heather C Mefford
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, U.S.A
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Kim SH, Korff CM, Kim AJ, Nordli DR. A practical, simple, and useful method of categorizing interictal EEG features in children. Neurology 2015; 85:471-8. [PMID: 26138949 DOI: 10.1212/wnl.0000000000001805] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 04/02/2015] [Indexed: 11/15/2022] Open
Abstract
We introduce a simple scheme of categorizing interictal EEG in patients with pediatric epilepsy. Five patterns of EEG can be determined by using 2 interictal EEG domains: organization of the background activity and a morphology/topography of epileptiform discharges. These patterns relate to commonly recognized categories of pediatric epilepsy: familial epilepsies, genetic generalized epilepsies, self-limited epilepsies, epilepsies with encephalopathy, and focal structural epilepsies. Each group has distinguishable clinical presentations, inheritance patterns, and outcomes. This categorization may be a useful educational tool; it may also guide decisions about further testing and management.
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Affiliation(s)
- Se Hee Kim
- From the Department of Pediatrics (S.H.K., A.J.K., D.R.N.), Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, and the Northwestern University Feinberg School of Medicine, IL; and Pediatric Neurology (C.M.K.), Child and Adolescent Department, University Hospitals, Geneva, Switzerland
| | - Christian M Korff
- From the Department of Pediatrics (S.H.K., A.J.K., D.R.N.), Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, and the Northwestern University Feinberg School of Medicine, IL; and Pediatric Neurology (C.M.K.), Child and Adolescent Department, University Hospitals, Geneva, Switzerland
| | - Andrew J Kim
- From the Department of Pediatrics (S.H.K., A.J.K., D.R.N.), Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, and the Northwestern University Feinberg School of Medicine, IL; and Pediatric Neurology (C.M.K.), Child and Adolescent Department, University Hospitals, Geneva, Switzerland
| | - Douglas R Nordli
- From the Department of Pediatrics (S.H.K., A.J.K., D.R.N.), Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, and the Northwestern University Feinberg School of Medicine, IL; and Pediatric Neurology (C.M.K.), Child and Adolescent Department, University Hospitals, Geneva, Switzerland.
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Wolf P, Yacubian EMT, Avanzini G, Sander T, Schmitz B, Wandschneider B, Koepp M. Juvenile myoclonic epilepsy: A system disorder of the brain. Epilepsy Res 2015; 114:2-12. [DOI: 10.1016/j.eplepsyres.2015.04.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 04/14/2015] [Indexed: 12/28/2022]
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Lal D, Ruppert AK, Trucks H, Schulz H, de Kovel CG, Kasteleijn-Nolst Trenité D, Sonsma ACM, Koeleman BP, Lindhout D, Weber YG, Lerche H, Kapser C, Schankin CJ, Kunz WS, Surges R, Elger CE, Gaus V, Schmitz B, Helbig I, Muhle H, Stephani U, Klein KM, Rosenow F, Neubauer BA, Reinthaler EM, Zimprich F, Feucht M, Møller RS, Hjalgrim H, De Jonghe P, Suls A, Lieb W, Franke A, Strauch K, Gieger C, Schurmann C, Schminke U, Nürnberg P, Sander T. Burden analysis of rare microdeletions suggests a strong impact of neurodevelopmental genes in genetic generalised epilepsies. PLoS Genet 2015; 11:e1005226. [PMID: 25950944 PMCID: PMC4423931 DOI: 10.1371/journal.pgen.1005226] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/16/2015] [Indexed: 01/06/2023] Open
Abstract
Genetic generalised epilepsy (GGE) is the most common form of genetic epilepsy, accounting for 20% of all epilepsies. Genomic copy number variations (CNVs) constitute important genetic risk factors of common GGE syndromes. In our present genome-wide burden analysis, large (≥ 400 kb) and rare (< 1%) autosomal microdeletions with high calling confidence (≥ 200 markers) were assessed by the Affymetrix SNP 6.0 array in European case-control cohorts of 1,366 GGE patients and 5,234 ancestry-matched controls. We aimed to: 1) assess the microdeletion burden in common GGE syndromes, 2) estimate the relative contribution of recurrent microdeletions at genomic rearrangement hotspots and non-recurrent microdeletions, and 3) identify potential candidate genes for GGE. We found a significant excess of microdeletions in 7.3% of GGE patients compared to 4.0% in controls (P = 1.8 x 10-7; OR = 1.9). Recurrent microdeletions at seven known genomic hotspots accounted for 36.9% of all microdeletions identified in the GGE cohort and showed a 7.5-fold increased burden (P = 2.6 x 10-17) relative to controls. Microdeletions affecting either a gene previously implicated in neurodevelopmental disorders (P = 8.0 x 10-18, OR = 4.6) or an evolutionarily conserved brain-expressed gene related to autism spectrum disorder (P = 1.3 x 10-12, OR = 4.1) were significantly enriched in the GGE patients. Microdeletions found only in GGE patients harboured a high proportion of genes previously associated with epilepsy and neuropsychiatric disorders (NRXN1, RBFOX1, PCDH7, KCNA2, EPM2A, RORB, PLCB1). Our results demonstrate that the significantly increased burden of large and rare microdeletions in GGE patients is largely confined to recurrent hotspot microdeletions and microdeletions affecting neurodevelopmental genes, suggesting a strong impact of fundamental neurodevelopmental processes in the pathogenesis of common GGE syndromes.
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Affiliation(s)
- Dennis Lal
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Department of Neuropediatrics, University Medical Center Giessen and Marburg, Giessen, Germany
- EPICURE Consortium
| | - Ann-Kathrin Ruppert
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
- EPICURE Consortium
| | - Holger Trucks
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
- EPICURE Consortium
| | - Herbert Schulz
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
- EPICURE Consortium
| | - Carolien G. de Kovel
- EPICURE Consortium
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Anja C. M. Sonsma
- EPICURE Consortium
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bobby P. Koeleman
- EPICURE Consortium
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dick Lindhout
- EPICURE Consortium
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
- SEIN Epilepsy Institute in the Netherlands, Hoofddorp, The Netherlands
| | - Yvonne G. Weber
- EPICURE Consortium
- Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Holger Lerche
- EPICURE Consortium
- Department of Neurology and Epileptology, Hertie Institute of Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Claudia Kapser
- EPICURE Consortium
- Department of Neurology, University of Munich Hospital—Großhadern, Munich, Germany
| | - Christoph J. Schankin
- EPICURE Consortium
- Department of Neurology, University of Munich Hospital—Großhadern, Munich, Germany
| | - Wolfram S. Kunz
- EPICURE Consortium
- Department of Epileptology, University Clinics Bonn, Bonn, Germany
| | - Rainer Surges
- EPICURE Consortium
- Department of Epileptology, University Clinics Bonn, Bonn, Germany
| | - Christian E. Elger
- EPICURE Consortium
- Department of Epileptology, University Clinics Bonn, Bonn, Germany
| | - Verena Gaus
- EPICURE Consortium
- Department of Neurology, Charité University Medicine, Campus Virchow Clinic, Berlin, Germany
| | - Bettina Schmitz
- EPICURE Consortium
- Department of Neurology, Charité University Medicine, Campus Virchow Clinic, Berlin, Germany
- Department of Neurology, Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Ingo Helbig
- EPICURE Consortium
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein (Kiel Campus), Kiel, Germany
| | - Hiltrud Muhle
- EPICURE Consortium
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein (Kiel Campus), Kiel, Germany
| | - Ulrich Stephani
- EPICURE Consortium
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein (Kiel Campus), Kiel, Germany
| | - Karl M. Klein
- EPICURE Consortium
- Epilepsy-Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Epilepsy Center Frankfurt Rhein-Main, Department of Neurology, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Felix Rosenow
- EPICURE Consortium
- Epilepsy-Center Hessen, Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Epilepsy Center Frankfurt Rhein-Main, Department of Neurology, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Bernd A. Neubauer
- Department of Neuropediatrics, University Medical Center Giessen and Marburg, Giessen, Germany
| | - Eva M. Reinthaler
- EPICURE Consortium
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Zimprich
- EPICURE Consortium
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Martha Feucht
- EPICURE Consortium
- Department of Pediatrics and Neonatology, Medical University of Vienna, Vienna, Austria
| | - Rikke S. Møller
- EPICURE Consortium
- Department of Neurology, Danish Epilepsy Centre, Dianalund, Denmark
- Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark
| | - Helle Hjalgrim
- EPICURE Consortium
- Department of Neurology, Danish Epilepsy Centre, Dianalund, Denmark
- Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark
| | - Peter De Jonghe
- EPICURE Consortium
- Neurogenetics Group, VIB Department of Molecular Genetics, University of Antwerp, Antwerp, Belgium
- Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Arvid Suls
- EPICURE Consortium
- Neurogenetics Group, VIB Department of Molecular Genetics, University of Antwerp, Antwerp, Belgium
- Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Wolfgang Lieb
- Institute of Epidemiology and Biobank Popgen, Christian Albrechts University, Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Konstantin Strauch
- Institute of Genetic Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Medical Informatics, Biometry and Epidemiology, and Chair of Genetic Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Christian Gieger
- Institute of Genetic Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
| | - Claudia Schurmann
- Interfaculty Institute for Genetics and Functional Genomics, Ernst Moritz Arndt University, Greifswald, Germany
| | - Ulf Schminke
- Department of Neurology, University Medicine Greifswald, Ernst Moritz Arndt University, Greifswald, Germany
| | - Peter Nürnberg
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- EPICURE Consortium
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | | | - Thomas Sander
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
- EPICURE Consortium
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