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Sparber P, Sharova M, Davydenko K, Pyankov D, Filatova A, Skoblov M. Deciphering the impact of coding and non-coding SCN1A gene variants on RNA splicing. Brain 2024; 147:1278-1293. [PMID: 37956038 DOI: 10.1093/brain/awad383] [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: 05/25/2023] [Revised: 09/26/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Variants that disrupt normal pre-mRNA splicing are increasingly being recognized as a major cause of monogenic disorders. The SCN1A gene, a key epilepsy gene that is linked to various epilepsy phenotypes, is no exception. Approximately 10% of all reported variants in the SCN1A gene are designated as splicing variants, with many located outside of the canonical donor and acceptor splice sites, and most have not been functionally investigated. However, given its restricted expression pattern, functional analysis of splicing variants in the SCN1A gene could not be routinely performed. In this study, we conducted a comprehensive analysis of all reported SCN1A variants and their potential to impact SCN1A splicing and conclude that splicing variants are substantially misannotated and under-represented. We created a splicing reporter system consisting of 18 splicing vectors covering all 26 protein-coding exons with different genomic contexts and several promoters of varying strengths in order to reproduce the wild-type splicing pattern of the SCN1A gene, revealing cis-regulatory elements essential for proper recognition of SCN1A exons. Functional analysis of 95 SCN1A variants was carried out, including all 68 intronic variants reported in the literature, located outside of the splice sites canonical dinucleotides; 21 exonic variants of different classes (synonymous, missense, nonsense and in-frame deletion) and six variants observed in patients with epilepsy. Interestingly, almost 20% of tested intronic variants had no influence on SCN1A splicing, despite being reported as causative in the literature. Moreover, we confirmed that the majority of predicted exonic variants affect splicing unravelling their true molecular mechanism. We used functional data to perform genotype-phenotype correlation, revealing distinct distribution patterns for missense and splice-affecting 'missense' variants and observed no difference in the phenotype severity of variants leading to in-frame and out-of-frame isoforms, indicating that the Nav1.1 protein is highly intolerant to structural variations. Our work demonstrates the importance of functional analysis in proper variant annotation and provides a tool for high-throughput delineation of splice-affecting variants in SCN1A in a whole-gene manner.
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Affiliation(s)
- Peter Sparber
- Research Centre for Medical Genetics, Laboratory of Functional Genomics, Moscow 115478, Russia
| | - Margarita Sharova
- Research Centre for Medical Genetics, Laboratory of Functional Genomics, Moscow 115478, Russia
| | - Ksenia Davydenko
- Research Centre for Medical Genetics, Laboratory of Functional Genomics, Moscow 115478, Russia
| | - Denis Pyankov
- Genomed Ltd., Research Department, Moscow 107014, Russia
| | - Alexandra Filatova
- Research Centre for Medical Genetics, Laboratory of Functional Genomics, Moscow 115478, Russia
| | - Mikhail Skoblov
- Research Centre for Medical Genetics, Laboratory of Functional Genomics, Moscow 115478, Russia
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Boßelmann CM, Ivaniuk A, St John M, Taylor SC, Krishnaswamy G, Milinovich A, Leu C, Gupta A, Pestana-Knight EM, Najm I, Lal D. Healthcare utilization and clinical characteristics of genetic epilepsy in electronic health records. Brain Commun 2024; 6:fcae090. [PMID: 38524155 PMCID: PMC10959483 DOI: 10.1093/braincomms/fcae090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/05/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
Understanding the clinical characteristics and medical treatment of individuals affected by genetic epilepsies is instrumental in guiding selection for genetic testing, defining the phenotype range of these rare disorders, optimizing patient care pathways and pinpointing unaddressed medical need by quantifying healthcare resource utilization. To date, a matched longitudinal cohort study encompassing the entire spectrum of clinical characteristics and medical treatment from childhood through adolescence has not been performed. We identified individuals with genetic and non-genetic epilepsies and onset at ages 0-5 years by linkage across the Cleveland Clinic Health System. We used natural language processing to extract medical terms and procedures from longitudinal electronic health records and tested for cross-sectional and temporal associations with genetic epilepsy. We implemented a two-stage design: in the discovery cohort, individuals were stratified as being 'likely genetic' or 'non-genetic' by a natural language processing algorithm, and controls did not receive genetic testing. The validation cohort consisted of cases with genetic epilepsy confirmed by manual chart review and an independent set of controls who received negative genetic testing. The discovery and validation cohorts consisted of 503 and 344 individuals with genetic epilepsy and matched controls, respectively. The median age at the first encounter was 0.1 years and 7.9 years at the last encounter, and the mean duration of follow-up was 8.2 years. We extracted 188,295 Unified Medical Language System annotations for statistical analysis across 9659 encounters. Individuals with genetic epilepsy received an earlier epilepsy diagnosis and had more frequent and complex encounters with the healthcare system. Notably, the highest enrichment of encounters compared with the non-genetic groups was found during the transition from paediatric to adult care. Our computational approach could validate established comorbidities of genetic epilepsies, such as behavioural abnormality and intellectual disability. We also revealed novel associations for genitourinary abnormalities (odds ratio 1.91, 95% confidence interval: 1.66-2.20, P = 6.16 × 10-19) linked to a spectrum of underrecognized epilepsy-associated genetic disorders. This case-control study leveraged real-world data to identify novel features associated with the likelihood of a genetic aetiology and quantified the healthcare utilization of genetic epilepsies compared with matched controls. Our results strongly recommend early genetic testing to stratify individuals into specialized care paths, thus improving the clinical management of people with genetic epilepsies.
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Affiliation(s)
- Christian M Boßelmann
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Alina Ivaniuk
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Mark St John
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Sara C Taylor
- Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | | | - Alex Milinovich
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, WC1N 3BG, UK
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Center for Neurogenetics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Ajay Gupta
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | | | - Imad Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Center for Neurogenetics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T., Cambridge, MA 02142, USA
- Cologne Center for Genomics (CCG), University of Cologne, 50931 Cologne, Germany
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Palacios-Ceña D, Güeita-Rodríguez J, Gil-Nagel A, Jimenez-Antona C, García-Bravo C, Velarde-García JF, Cuenca-Zaldivar JN, Aledo-Serrano Á. Health care concerns in parents of children with different genetic developmental and epileptic encephalopathies: A qualitative study. Dev Med Child Neurol 2024; 66:195-205. [PMID: 37482918 DOI: 10.1111/dmcn.15712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 07/25/2023]
Abstract
AIM To describe the experiences and unmet medical care needs of a group of parents of children with developmental and epileptic encephalopathies (DEEs) caused by the SCN1A, KCNQ2, CDKL5, PCDH19, and GNAO1 variants. METHOD A qualitative descriptive study was conducted. Participants were recruited using purposeful sampling. The inclusion criteria consisted of parents of children with DEEs caused by the SCN1A, KCNQ2, CDKL5, PCDH19, or GNAO1 variants, aged between 4 and 10 years old. In total, 21 parents were included. Data were acquired via researcher field notes and in-depth interviews. A thematic analysis was performed. RESULTS Three main themes were identified: (1) managing symptoms: epileptic seizures are experienced with great uncertainty and are accompanied by cognitive, behavioural, and motor symptoms; (2) accepting treatment: the ideal medication regimen is a challenge and the decision to withdraw or start a new therapy falls on the parents; and (3) therapeutic relationship and medical care: behaviours related to the health professional can hinder the therapeutic relationship with the parents. Parents are apprehensive about going to the emergency department. INTERPRETATION Professionals in emergency departments should acquire better knowledge of DEEs, welcome parents, and improve treatment for the children. The results of this study can serve as a starting point for a roadmap of relevant caregiver-reported outcomes in DEEs, to be implemented with new clinical trials and aetiology-targeted therapies. WHAT THIS PAPER ADDS Epileptic seizures are the symptom that is most experienced and feared by parents. The medication regime has no defined protocol and the decision to withdraw a medication is frequently left to parents.
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Affiliation(s)
- Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group of Humanities and Qualitative Research in Health Science, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Javier Güeita-Rodríguez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group of Humanities and Qualitative Research in Health Science, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Antonio Gil-Nagel
- Neurology Department, Epilepsy Program, Hospital Ruber Internacional, Madrid, Spain
| | - Carmen Jimenez-Antona
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group of Humanities and Qualitative Research in Health Science, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Cristina García-Bravo
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group in Evaluation and Assessment of Capacity, Functionality and Disability, Universidad Rey Juan Carlos, Alcorcón, Spain
| | | | - Juan Nicolas Cuenca-Zaldivar
- Department of Nursing and Physiotherapy, Research Group of Physiotherapy & Pain, Universidad de Alcalá, Madrid, Spain
| | - Ángel Aledo-Serrano
- Epilepsy and Neurogenetics Program, Vithas Madrid La Milagrosa University Hospital, Vithas Hospital Group, Madrid, Spain
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Palacios-Ceña D, Güeita-Rodríguez J, Gil-Nagel A, Jimenez-Antona C, García-Bravo C, Velarde-García JF, Cuenca-Zaldivar JN, Aledo-Serrano Á. Preocupaciones sobre la atención sanitaria en progenitores de niños con diferentes encefalopatías epilépticas genéticas del desarrollo: Un estudio cualitativo. Dev Med Child Neurol 2024; 66:e41-e51. [PMID: 37740612 DOI: 10.1111/dmcn.15755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
ResumenObjetivoDescribir las experiencias y las necesidades de atención médica de un grupo de progenitores de niños con encefalopatías epilépticas y del desarrollo (EED) causadas por las variantes SCN1A, KCNQ2, CDKL5, PCDH19 y GNAO1.MétodoSe realizó un estudio cualitativo descriptivo. Los participantes fueron reclutados mediante un muestreo intencional. Los criterios de inclusión consistieron en progenitores de niños con EED causadas por las variantes SCN1A, KCNQ2, CDKL5, PCDH19 o GNAO1, con edades comprendidas entre los 4 y los 10 años. En total, se incluyeron 21 progenitores. Los datos se obtuvieron mediante entrevistas en profundidad y notas de campo del investigador. Se realizó un análisis temático.ResultadosSe identificaron tres temas principales: (1) Manejando los síntomas, las crisis epilépticas se viven con gran incertidumbre, y se acompañan de síntomas cognitivos, conductuales y motores que limitan la vida del niño; b) Aceptando el tratamiento, la pauta de la medicación idónea es un reto, la decisión de retirar o comenzar una nueva terapia recae en los progenitores; y c) Relación terapéutica y atención médica, existen comportamientos y acciones del profesional que facilitan o dificultan la relación terapéutica con los progenitores. Acudir al servicio de urgencias es vivido con recelo por los progenitores.InterpretaciónLos profesionales de los servicios de urgencias deben conocer mejor las EED, acoger a los progenitores y mejorar el tratamiento de los niños. Los resultados de este estudio pueden servir como punto de partida para una hoja de ruta de los resultados relevantes reportados por los cuidadores de las EED, a implementar nuevos ensayos clínicos y terapias dirigidas a la etiología.Qué añade este documento
Las crisis epilépticas son el síntomas más experimentado y temido por los progenitores en las EED.
La pauta de la medicación no tiene un protocolo definido y la decisión de retirar una medicación recae en las manos de los progenitores.
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Affiliation(s)
- Domingo Palacios-Ceña
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Javier Güeita-Rodríguez
- Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Antonio Gil-Nagel
- Epilepsy program, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Carmen Jimenez-Antona
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Cristina García-Bravo
- Research Group in Evaluation and Assessment of Capacity, Functionality and Disability of Universidad Rey Juan Carlos (TO+IDI), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | | | | | - Ángel Aledo-Serrano
- Epilepsy and Neurogenetics program, Vithas Madrid La Milagrosa University Hospital, Vithas Hospital Group, Madrid, Spain
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Sedlackova L, Sterbova K, Vlckova M, Seeman P, Zarubova J, Marusic P, Krsek P, Krijtova H, Musilova A, Lassuthova P. Yield of exome sequencing in patients with developmental and epileptic encephalopathies and inconclusive targeted gene panel. Eur J Paediatr Neurol 2024; 48:17-29. [PMID: 38008000 DOI: 10.1016/j.ejpn.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE Developmental and epileptic encephalopathies (DEEs) are a group of severe, early-onset epilepsies characterised by refractory seizures, developmental delay, or regression and generally poor prognosis. DEE are now known to have an identifiable molecular genetic basis and are usually examined using a gene panel. However, for many patients, the genetic cause has still not been identified. The aims of this study were to identify causal variants for DEE in patients for whom the previous examination with a gene panel did not determine their genetic diagnosis. It also aims for a detailed description and broadening of the phenotypic spectrum of several rare DEEs. METHODS In the last five years (2015-2020), 141 patients from all over the Czech Republic were referred to our department for genetic testing in association with their diagnosis of epilepsy. All patients underwent custom-designed gene panel testing prior to enrolment into the study, and their results were inconclusive. We opted for whole exome sequencing (WES) to identify the cause of their disorder. If a causal or potentially causal variant was identified, we performed a detailed clinical evaluation and phenotype-genotype correlation study to better describe the specific rare subtypes. RESULTS Explanatory causative variants were detected in 20 patients (14%), likely pathogenic variants that explain the epilepsy in 5 patients (3.5%) and likely pathogenic variants that do not fully explain the epilepsy in 11 patients (7.5%), and variants in candidate genes in 4 patients (3%). Variants were mostly de novo 29/40 (72.5%). SIGNIFICANCE WES enables us to identify the cause of the disease in additional patients, even after gene panel testing. It is very important to perform a WES in DEE patients as soon as possible, since it will spare the patients and their families many years of a diagnostic odyssey. In particular, patients with rare epilepsies might significantly benefit from this approach, and we propose using WES as a new standard in the diagnosis of DEE instead of targeted gene panel testing.
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Affiliation(s)
- Lucie Sedlackova
- Neurogenetic Laboratory, Department of Paediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Full Member of the ERN EpiCARE, Czech Republic.
| | - Katalin Sterbova
- Department of Paediatric Neurology, Second Faculty of Medicine, Motol Epilepsy Center, Charles University and Motol University Hospital, Prague, Full Member of the ERN EpiCARE, Czech Republic.
| | - Marketa Vlckova
- Department of Biology and Medical Genetics, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Full Member of the ERN EpiCARE, Czech Republic.
| | - Pavel Seeman
- Neurogenetic Laboratory, Department of Paediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Full Member of the ERN EpiCARE, Czech Republic; Department of Medical Genetics, Masaryk Hospital, Ústí nad Labem, Czech Republic.
| | - Jana Zarubova
- Department of Neurology, Motol Epilepsy Center, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Full Member of the ERN EpiCARE, Czech Republic.
| | - Petr Marusic
- Department of Neurology, Motol Epilepsy Center, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Full Member of the ERN EpiCARE, Czech Republic.
| | - Pavel Krsek
- Department of Paediatric Neurology, Second Faculty of Medicine, Motol Epilepsy Center, Charles University and Motol University Hospital, Prague, Full Member of the ERN EpiCARE, Czech Republic.
| | - Hana Krijtova
- Department of Neurology, Motol Epilepsy Center, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Full Member of the ERN EpiCARE, Czech Republic.
| | - Alena Musilova
- Neurogenetic Laboratory, Department of Paediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Full Member of the ERN EpiCARE, Czech Republic.
| | - Petra Lassuthova
- Neurogenetic Laboratory, Department of Paediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Full Member of the ERN EpiCARE, Czech Republic.
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Salcedo-Perez-Juana M, Palacios-Ceña D, San-Martín-Gómez A, Aledo-Serrano Á, Florencio LL. Quality of life, socioeconomic and psychological concerns in parents of children with tuberous sclerosis complex, STXBP1 and SYNGAP1 encephalopathies: a mixed method study. Front Pediatr 2023; 11:1285377. [PMID: 38027293 PMCID: PMC10665567 DOI: 10.3389/fped.2023.1285377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Background Developmental and Epileptic Encephalopathies (DEEs) occur in childhood and are associated with severe epileptic seizures and neurological impairment. The aim of this study was to combine quantitative and qualitative methodologies to comprehensively describe factors related to quality of life, impact on the family and psychosocial factors in parents of children with TSC, STXBP1 and SYNGAP1 variants. Methods A convergent parallel mixed design including parents of children with DEE. In the cross-sectional study, 20 parents (10STXBP1, five SYNGAP1, five TSC) were given questionnaires on quality of life, impact on the family and psychological factors. In the descriptive qualitative study, in-depth interviews were conducted with 18 parents (nine STXBP1, five TSC, four SYNGAP1) using a semi-structured questionnaire. A thematic analysis was carried out. The results of the two studies were combined by showing similarities and differences through tables, figures, accounts, and joint displays. Results In terms of quality of life, the integrated results were consistent in highlighting the importance of family interaction, although in the qualitative section the influence of the relationship between the children's siblings, the relationship with health professionals and the difficulties in obtaining public aid were highlighted. In terms of impact, the integrated results show that the illness has a significant impact on the family; the financial burden is highlighted, and the experience of the illness is discussed in depth. Finally, the psychological aspects, symptoms such as anxiety, stress and strain, were consistent. Most of the participants reported sleep disturbance, as identified in the questionnaire, although not mentioned in the interviews. Conclusions The combined results of the mixed method provide an in-depth analysis of the impact of DEEs on parents of children with STXBP1, SYNGAP1 and TSC.
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Affiliation(s)
- María Salcedo-Perez-Juana
- Research Group of Humanities and Qualitative Research in Health Science (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid, Spain
| | - Domingo Palacios-Ceña
- Research Group of Humanities and Qualitative Research in Health Science (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid, Spain
| | - Ana San-Martín-Gómez
- Research Group of Humanities and Qualitative Research in Health Science (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid, Spain
| | - Ángel Aledo-Serrano
- Epilepsyand Neurogenetics Programme, Vithas Madrid La Milagrosa University Hospital, Vithas Hospital Group, Madrid, Spain
| | - Lidiane Lima Florencio
- Research Group of Manual Therapy, Dry Needling and Therapeutic Exercise (GITM-URJC), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid, Spain
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Corrales-Hernández MG, Villarroel-Hagemann SK, Mendoza-Rodelo IE, Palacios-Sánchez L, Gaviria-Carrillo M, Buitrago-Ricaurte N, Espinosa-Lugo S, Calderon-Ospina CA, Rodríguez-Quintana JH. Development of Antiepileptic Drugs throughout History: From Serendipity to Artificial Intelligence. Biomedicines 2023; 11:1632. [PMID: 37371727 DOI: 10.3390/biomedicines11061632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/24/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
This article provides a comprehensive narrative review of the history of antiepileptic drugs (AEDs) and their development over time. Firstly, it explores the significant role of serendipity in the discovery of essential AEDs that continue to be used today, such as phenobarbital and valproic acid. Subsequently, it delves into the historical progression of crucial preclinical models employed in the development of novel AEDs, including the maximal electroshock stimulation test, pentylenetetrazol-induced test, kindling models, and other animal models. Moving forward, a concise overview of the clinical advancement of major AEDs is provided, highlighting the initial milestones and the subsequent refinement of this process in recent decades, in line with the emergence of evidence-based medicine and the implementation of increasingly rigorous controlled clinical trials. Lastly, the article explores the contributions of artificial intelligence, while also offering recommendations and discussing future perspectives for the development of new AEDs.
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Affiliation(s)
- María Gabriela Corrales-Hernández
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
| | - Sebastián Kurt Villarroel-Hagemann
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
| | | | - Leonardo Palacios-Sánchez
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
| | - Mariana Gaviria-Carrillo
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
| | | | - Santiago Espinosa-Lugo
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
| | - Carlos-Alberto Calderon-Ospina
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
- Research Group in Applied Biomedical Sciences (UR Biomed), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
| | - Jesús Hernán Rodríguez-Quintana
- Fundacion CardioInfantil-Instituto de Cardiologia, Calle 163a # 13B-60, Bogotá 111156, Colombia
- Hospital Universitario Mayor Mederi, Calle 24 # 29-45, Bogotá 111411, Colombia
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Celdran de Castro A, Nascimento FA, Beltran-Corbellini Á, Toledano R, Garcia-Morales I, Gil-Nagel A, Aledo-Serrano Á. Levetiracetam, from broad-spectrum use to precision prescription: A narrative review and expert opinion. Seizure 2023; 107:121-131. [PMID: 37023625 DOI: 10.1016/j.seizure.2023.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/18/2023] [Accepted: 03/22/2023] [Indexed: 04/07/2023] Open
Abstract
Levetiracetam (LEV) is an antiseizure medication (ASM) whose mechanism of action involves the modulation of neurotransmitters release through binding to the synaptic vesicle glycoprotein 2A. It is a broad-spectrum ASM displaying favorable pharmacokinetic and tolerability profiles. Since its introduction in 1999, it has been widely prescribed, becoming the first-line treatment for numerous epilepsy syndromes and clinical scenarios. However, this might have resulted in overuse. Increasing evidence, including the recently published SANAD II trials, suggests that other ASMs are reasonable therapeutic options for generalized and focal epilepsies. Not infrequently, these ASMs show better safety and effectiveness profiles compared to LEV (partially due to the latter's well-known cognitive and behavioral adverse effects, present in up to 20% of patients). Moreover, it has been shown that the underlying etiology of epilepsy is significantly linked to ASMs response in particular scenarios, highlighting the importance of an etiology-based ASM choice. In the case of LEV, it has demonstrated an optimal effectiveness in Alzheimer's disease, Down syndrome, and PCDH19-related epilepsies whereas, in other etiologies such as malformations of cortical development, it may show negligible effects. This narrative review analyzes the current evidence related to the use of LEV for the treatment of seizures. Illustrative clinical scenarios and practical decision-making approaches are also addressed, therefore aiming to define a rational use of this ASM.
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Asadi-Pooya AA. Precision Medicine in Epilepsy Management; GET Application (Gene, Epilepsy, Treatment). Clin Neuropharmacol 2023; 46:95-97. [PMID: 37191562 DOI: 10.1097/wnf.0000000000000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVES The aim was to develop a prototype of an application (app) that identifies the significance of discovered genes for further consideration in the treatment plan of patients with epilepsy (precision medicine). METHODS MEDLINE was systematically searched for related publications from inception to April 1, 2022. The following search strategy was implemented (title/abstract): "epilepsy" AND "precision" AND "medicine." The following data were extracted: genes, phenotypes associated with those genes, and the recommended treatments. Two other databases were searched to cross-check the retrieved data and add to the data: https://www.genecards.org and https://medlineplus.gov/genetics. Also, the original articles of the identified genes were retrieved. Genes with specific treatment strategies (ie, any specific drug to be selected or to be avoided and also any other specific therapies [eg, diets, supplements, etc]) were selected. RESULTS A database of 93 genes, which are associated with various epilepsy syndromes and for which specific treatment strategies have been suggested, was developed. CONCLUSIONS A Web-based app (a search engine) was developed accordingly that is freely available at http://get.yektaparnian.ir/, GET (Gene, Epilepsy, Treatment). When a patient comes to the clinic with a genetic diagnosis and a specific gene is identified, the physician enters the gene name into the search box, and the app shows whether this genetic epilepsy needs a specific treatment. This endeavor would benefit from input by experts in the field, and the Web site should be developed more comprehensively.
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Affiliation(s)
- Ali A Asadi-Pooya
- Shiraz University of Medical Sciences, Shiraz, Iran; and Thomas Jefferson University, Philadelphia, PA
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10
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Xu T, Luong D, Zhong N. Familial Epilepsy Associated With Concurrent CHRNB2 Mutation and RBFOX1 Exon Deletion: A Case Report. Cureus 2023; 15:e35845. [PMID: 37033539 PMCID: PMC10076243 DOI: 10.7759/cureus.35845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/08/2023] Open
Abstract
Understanding the genetic basis of epilepsy may lead to an improved understanding of its etiology, more precise medical management, and ultimately improved outcomes. It is imperative for patients with epilepsy to obtain a molecular diagnosis, especially when strong familial epilepsy is discovered. We investigated a multi-generational family with epilepsy. The proband was a 19-year-old female who experienced focal onset seizures, with presenting symptoms of feeling dizzy, disorientation, and loss of consciousness. Her electroencephalography (EEG) studies revealed interictal focal slowing and sharp waves in both the left or right hemispheres independently. EEG monitoring showed that the seizures arose from the left fronto-temporal region and her brain MRI was normal. The proband's sister also suffered from focal onset seizures. Her EEG showed focal epileptiform discharge in the right temporal region, and her brain MRI was unrevealing. Two genetic tests were conducted for the proband: 1) array comparative genomic hybridization (CGH) revealed 16p13.3 deletion but no 22q deletion; and 2) next generation sequencing (NGS) Epilepsy Panel revealed a few variants of uncertain significance (VUS), including in CHRNB2 (c.1423A>G, p.Ile475Val) and RBFOX1 (RNA binding fox-1 homolog 1) (exon1-2 deletion). The proband's sister also carries both the CHRNB2 (cholinergic receptor nicotinic beta 2) variant and RBFOX1 deletion. The proband's father carries the CHRNB2 variant, and her brother and mother carry the deletion of RBFOX1. In this family, the co-expression of the CHRNB2 variant and RBFOX1 deletion may cause the clinical seizures seen in the proband and her sister. It is also possible that the RBFOX1 deletion is associated with an increased risk of seizure disorder with variable expressivity.
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11
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Owen MJ, Wright MS, Batalov S, Kwon Y, Ding Y, Chau KK, Chowdhury S, Sweeney NM, Kiernan E, Richardson A, Batton E, Baer RJ, Bandoli G, Gleeson JG, Bainbridge M, Chambers CD, Kingsmore SF. Reclassification of the Etiology of Infant Mortality With Whole-Genome Sequencing. JAMA Netw Open 2023; 6:e2254069. [PMID: 36757698 PMCID: PMC9912130 DOI: 10.1001/jamanetworkopen.2022.54069] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/27/2022] [Indexed: 02/10/2023] Open
Abstract
Importance Understanding the causes of infant mortality shapes public health, surveillance, and research investments. However, the association of single-locus (mendelian) genetic diseases with infant mortality is poorly understood. Objective To determine the association of genetic diseases with infant mortality. Design, Setting, and Participants This cohort study was conducted at a large pediatric hospital system in San Diego County (California) and included 546 infants (112 infant deaths [20.5%] and 434 infants [79.5%] with acute illness who survived; age, 0 to 1 year) who underwent diagnostic whole-genome sequencing (WGS) between January 2015 and December 2020. Data analysis was conducted between 2015 and 2022. Exposure Infants underwent WGS either premortem or postmortem with semiautomated phenotyping and diagnostic interpretation. Main Outcomes and Measures Proportion of infant deaths associated with single-locus genetic diseases. Results Among 112 infant deaths (54 girls [48.2%]; 8 [7.1%] African American or Black, 1 [0.9%] American Indian or Alaska Native, 8 [7.1%] Asian, 48 [42.9%] Hispanic, 1 [0.9%] Native Hawaiian or Pacific Islander, and 34 [30.4%] White infants) in San Diego County between 2015 and 2020, single-locus genetic diseases were the most common identifiable cause of infant mortality, with 47 genetic diseases identified in 46 infants (41%). Thirty-nine (83%) of these diseases had been previously reported to be associated with childhood mortality. Twenty-eight death certificates (62%) for 45 of the 46 infants did not mention a genetic etiology. Treatments that can improve outcomes were available for 14 (30%) of the genetic diseases. In 5 of 7 infants in whom genetic diseases were identified postmortem, death might have been avoided had rapid, diagnostic WGS been performed at time of symptom onset or regional intensive care unit admission. Conclusions and Relevance In this cohort study of 112 infant deaths, the association of genetic diseases with infant mortality was higher than previously recognized. Strategies to increase neonatal diagnosis of genetic diseases and immediately implement treatment may decrease infant mortality. Additional study is required to explore the generalizability of these findings and measure reduction in infant mortality.
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Affiliation(s)
- Mallory J. Owen
- Rady Children’s Institute for Genomic Medicine, Rady Children’s Hospital, San Diego, California
- Department of Pediatrics, University of California, San Diego, La Jolla
| | - Meredith S. Wright
- Rady Children’s Institute for Genomic Medicine, Rady Children’s Hospital, San Diego, California
| | - Sergey Batalov
- Rady Children’s Institute for Genomic Medicine, Rady Children’s Hospital, San Diego, California
| | - Yonghyun Kwon
- Rady Children’s Institute for Genomic Medicine, Rady Children’s Hospital, San Diego, California
| | - Yan Ding
- Rady Children’s Institute for Genomic Medicine, Rady Children’s Hospital, San Diego, California
| | - Kevin K. Chau
- Rady Children’s Institute for Genomic Medicine, Rady Children’s Hospital, San Diego, California
| | - Shimul Chowdhury
- Rady Children’s Institute for Genomic Medicine, Rady Children’s Hospital, San Diego, California
| | - Nathaly M. Sweeney
- Rady Children’s Institute for Genomic Medicine, Rady Children’s Hospital, San Diego, California
- Department of Pediatrics, University of California, San Diego, La Jolla
| | - Elizabeth Kiernan
- Rady Children’s Institute for Genomic Medicine, Rady Children’s Hospital, San Diego, California
| | - Andrew Richardson
- Rady Children’s Institute for Genomic Medicine, Rady Children’s Hospital, San Diego, California
| | - Emily Batton
- Department of Pediatrics, University of California, San Diego, La Jolla
| | - Rebecca J. Baer
- Department of Pediatrics, University of California, San Diego, La Jolla
- California Preterm Birth Initiative, University of California, San Francisco
| | - Gretchen Bandoli
- Department of Pediatrics, University of California, San Diego, La Jolla
| | - Joseph G. Gleeson
- Rady Children’s Institute for Genomic Medicine, Rady Children’s Hospital, San Diego, California
- Department of Pediatrics, University of California, San Diego, La Jolla
| | - Matthew Bainbridge
- Rady Children’s Institute for Genomic Medicine, Rady Children’s Hospital, San Diego, California
| | | | - Stephen F. Kingsmore
- Rady Children’s Institute for Genomic Medicine, Rady Children’s Hospital, San Diego, California
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12
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Sánchez-Villalobos JM, Aledo-Serrano Á, Villegas-Martínez I, Shaikh MF, Alcaraz M. Epilepsy treatment in neuro-oncology: A rationale for drug choice in common clinical scenarios. Front Pharmacol 2022; 13:991244. [PMID: 36278161 PMCID: PMC9583251 DOI: 10.3389/fphar.2022.991244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Epilepsy represents a challenge in the management of patients with brain tumors. Epileptic seizures are one of the most frequent comorbidities in neuro-oncology and may be the debut symptom of a brain tumor or a complication during its evolution. Epileptogenic mechanisms of brain tumors are not yet fully elucidated, although new factors related to the underlying pathophysiological process with possible treatment implications have been described. In recent years, the development of new anti-seizure medications (ASM), with better pharmacokinetic profiles and fewer side effects, has become a paradigm shift in many clinical scenarios in neuro-oncology, being able, for instance, to adapt epilepsy treatment to specific features of each patient. This is crucial in several situations, such as patients with cognitive/psychiatric comorbidity, pregnancy, or advanced age, among others. In this narrative review, we provide a rationale for decision-making in ASM choice for neuro-oncologic patients, highlighting the strengths and weaknesses of each drug. In addition, according to current literature evidence, we try to answer some of the most frequent questions that arise in daily clinical practice in patients with epilepsy related to brain tumors, such as, which patients are the best candidates for ASM and when to start it, what is the best treatment option for each patient, and what are the major pitfalls to be aware of during follow-up.
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Affiliation(s)
- José Manuel Sánchez-Villalobos
- Department of Neurology, University Hospital Complex of Cartagena, Murcia, Spain
- Department of Cell Biology and Histology, School of Medicine, Regional Campus of International Excellence, “Campus Mare Nostrum”, IMIB-Arrixaca, University of Murcia, Murcia, Spain
| | - Ángel Aledo-Serrano
- Epilepsy Program, Department of Neurology, Ruber International Hospital, Madrid, Spain
- *Correspondence: Ángel Aledo-Serrano,
| | | | - Mohd Farooq Shaikh
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Miguel Alcaraz
- Department of Radiology and Physical Medicine, School of Medicine, Regional Campus of International Excellence, “Campus Mare Nostrum”, IMIB-Arrixaca, University of Murcia, Murcia, Spain
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13
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Kingsmore SF, Smith LD, Kunard CM, Bainbridge M, Batalov S, Benson W, Blincow E, Caylor S, Chambers C, Del Angel G, Dimmock DP, Ding Y, Ellsworth K, Feigenbaum A, Frise E, Green RC, Guidugli L, Hall KP, Hansen C, Hobbs CA, Kahn SD, Kiel M, Van Der Kraan L, Krilow C, Kwon YH, Madhavrao L, Le J, Lefebvre S, Mardach R, Mowrey WR, Oh D, Owen MJ, Powley G, Scharer G, Shelnutt S, Tokita M, Mehtalia SS, Oriol A, Papadopoulos S, Perry J, Rosales E, Sanford E, Schwartz S, Tran D, Reese MG, Wright M, Veeraraghavan N, Wigby K, Willis MJ, Wolen AR, Defay. T. A genome sequencing system for universal newborn screening, diagnosis, and precision medicine for severe genetic diseases. Am J Hum Genet 2022; 109:1605-1619. [PMID: 36007526 PMCID: PMC9502059 DOI: 10.1016/j.ajhg.2022.08.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/01/2022] [Indexed: 12/31/2022] Open
Abstract
Newborn screening (NBS) dramatically improves outcomes in severe childhood disorders by treatment before symptom onset. In many genetic diseases, however, outcomes remain poor because NBS has lagged behind drug development. Rapid whole-genome sequencing (rWGS) is attractive for comprehensive NBS because it concomitantly examines almost all genetic diseases and is gaining acceptance for genetic disease diagnosis in ill newborns. We describe prototypic methods for scalable, parentally consented, feedback-informed NBS and diagnosis of genetic diseases by rWGS and virtual, acute management guidance (NBS-rWGS). Using established criteria and the Delphi method, we reviewed 457 genetic diseases for NBS-rWGS, retaining 388 (85%) with effective treatments. Simulated NBS-rWGS in 454,707 UK Biobank subjects with 29,865 pathogenic or likely pathogenic variants associated with 388 disorders had a true negative rate (specificity) of 99.7% following root cause analysis. In 2,208 critically ill children with suspected genetic disorders and 2,168 of their parents, simulated NBS-rWGS for 388 disorders identified 104 (87%) of 119 diagnoses previously made by rWGS and 15 findings not previously reported (NBS-rWGS negative predictive value 99.6%, true positive rate [sensitivity] 88.8%). Retrospective NBS-rWGS diagnosed 15 children with disorders that had been undetected by conventional NBS. In 43 of the 104 children, had NBS-rWGS-based interventions been started on day of life 5, the Delphi consensus was that symptoms could have been avoided completely in seven critically ill children, mostly in 21, and partially in 13. We invite groups worldwide to refine these NBS-rWGS conditions and join us to prospectively examine clinical utility and cost effectiveness.
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Affiliation(s)
- Stephen F. Kingsmore
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA,Keck Graduate Institute, Claremont, CA 91711, USA,Corresponding author
| | - Laurie D. Smith
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA
| | | | - Matthew Bainbridge
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Sergey Batalov
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Wendy Benson
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Eric Blincow
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Sara Caylor
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Christina Chambers
- Department of Pediatrics, University of California San Diego, San Diego, CA 92093, USA
| | | | - David P. Dimmock
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Yan Ding
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Katarzyna Ellsworth
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Annette Feigenbaum
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA,Department of Pediatrics, University of California San Diego, San Diego, CA 92093, USA
| | - Erwin Frise
- Fabric Genomics, Inc., Oakland, CA 94612, USA
| | - Robert C. Green
- Mass General Brigham, Broad Institute, Ariadne Labs and Harvard Medical School, Boston, MA 02115, USA
| | - Lucia Guidugli
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | | | - Christian Hansen
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Charlotte A. Hobbs
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | | | - Mark Kiel
- Genomenon Inc., Ann Arbor, MI 48108, USA
| | - Lucita Van Der Kraan
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | | | - Yong H. Kwon
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Lakshminarasimha Madhavrao
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Jennie Le
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | | | - Rebecca Mardach
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA,Department of Pediatrics, University of California San Diego, San Diego, CA 92093, USA
| | | | - Danny Oh
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Mallory J. Owen
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | | | - Gunter Scharer
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA
| | | | - Mari Tokita
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | | | - Albert Oriol
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | | | - James Perry
- Rady Children’s Hospital, San Diego, CA 92123, USA,Department of Pediatrics, University of California San Diego, San Diego, CA 92093, USA
| | - Edwin Rosales
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Erica Sanford
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA
| | | | - Duke Tran
- Illumina, Inc., San Diego, CA 92122, USA
| | | | - Meredith Wright
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Narayanan Veeraraghavan
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA
| | - Kristen Wigby
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA,Rady Children’s Hospital, San Diego, CA 92123, USA,Department of Pediatrics, University of California San Diego, San Diego, CA 92093, USA
| | - Mary J. Willis
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA
| | | | - Thomas Defay.
- Alexion, Astra Zeneca Rare Disease, Boston, MA 02210, USA
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14
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Epigenetic genes and epilepsy - emerging mechanisms and clinical applications. Nat Rev Neurol 2022; 18:530-543. [PMID: 35859062 DOI: 10.1038/s41582-022-00693-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 12/21/2022]
Abstract
An increasing number of epilepsies are being attributed to variants in genes with epigenetic functions. The products of these genes include factors that regulate the structure and function of chromatin and the placing, reading and removal of epigenetic marks, as well as other epigenetic processes. In this Review, we provide an overview of the various epigenetic processes, structuring our discussion around five function-based categories: DNA methylation, histone modifications, histone-DNA crosstalk, non-coding RNAs and chromatin remodelling. We provide background information on each category, describing the general mechanism by which each process leads to altered gene expression. We also highlight key clinical and mechanistic aspects, providing examples of genes that strongly associate with epilepsy within each class. We consider the practical applications of these findings, including tissue-based and biofluid-based diagnostics and precision medicine-based treatments. We conclude that variants in epigenetic genes are increasingly found to be causally involved in the epilepsies, with implications for disease mechanisms, treatments and diagnostics.
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Aledo-Serrano Á, Cabal-Paz B, Gardella E, Gómez-Porro P, Martínez-Múgica O, Beltrán-Corbellini A, Toledano R, García-Morales I, Gil-Nagel A. Effect of Fenfluramine on Seizures and Comorbidities in SCN8A-Developmental and Epileptic Encephalopathy: A Case Series. Epilepsia Open 2022; 7:525-531. [PMID: 35802036 PMCID: PMC9436303 DOI: 10.1002/epi4.12623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/02/2022] [Indexed: 11/06/2022] Open
Abstract
SCN8A-developmental and epileptic encephalopathy is caused by mutations in the SCN8A gene encoding the Nav 1.6 sodium channel, and is characterized by intractable multivariate seizures and developmental regression. Fenfluramine is a repurposed drug with proven antiseizure efficacy in Dravet syndrome and Lennox-Gastaut syndrome. The effect of fenfluramine treatment was assessed in a retrospective series of three patients with intractable SCN8A epilepsy and severe neurodevelopmental comorbidity (n=2 females; age 2.8-13 years; 8-16 prior failed antiseizure medications (ASM); treatment duration: 0.75-4.2 years). In the 6 months prior to receiving fenfluramine, patients experienced multiple seizure types, including generalized tonic-clonic, focal and myoclonic seizures, and status epilepticus. Overall seizure reduction was 60%-90% in the last 3, 6, and 12 months of fenfluramine treatment. Clinically meaningful improvement was noted in ≥1 non-seizure comorbidity per patient after fenfluramine, as assessed by physician-ratings of ≥"Much Improved" on the Clinical Global Impression of Improvement scale. Improvements included ambulation in a previously non-ambulant patient and better attention, sleep, and language. One patient showed mild irritability which resolved; no other treatment-related adverse events were reported. There were no reports of valvular heart disease or pulmonary arterial hypertension. Fenfluramine may be a promising ASM for randomized clinical trials in SCN8A-related disorders.
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Affiliation(s)
- Ángel Aledo-Serrano
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain
| | - Borja Cabal-Paz
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain.,Neurology Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Elena Gardella
- Department of Epilepsy Genetics and Personalized Treatment, Danish Epilepsy Center, Dianalund, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Pablo Gómez-Porro
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain.,Neurology Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Otilia Martínez-Múgica
- Pediatric Neurology Section, Pediatrics Department, Donostia University Hospital, San Sebastian, Spain
| | | | - Rafael Toledano
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain.,Epilepsy Unit, Neurology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Irene García-Morales
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain.,Epilepsy Unit, Neurology Department, Clínico San Carlos University Hospital, Madrid, Spain
| | - Antonio Gil-Nagel
- Epilepsy Program, Neurology Department, Ruber Internacional Hospital, Madrid, Spain
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16
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The Genetic Diagnosis of Ultrarare DEEs: An Ongoing Challenge. Genes (Basel) 2022; 13:genes13030500. [PMID: 35328054 PMCID: PMC8953579 DOI: 10.3390/genes13030500] [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: 02/16/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 02/06/2023] Open
Abstract
Epileptic encephalopathies (EEs) and developmental and epileptic encephalopathies (DEEs) are a group of severe early-onset neurodevelopmental disorders (NDDs). In recent years, next-generation equencing (NGS) technologies enabled the discovery of numerous genes involved in these conditions. However, more than 50% of patients remained undiagnosed. A major obstacle lies in the high degree of genetic heterogeneity and the wide phenotypic variability that has characterized these disorders. Interpreting a large amount of NGS data is also a crucial challenge. This study describes a dynamic diagnostic procedure used to investigate 17 patients with DEE or EE with previous negative or inconclusive genetic testing by whole-exome sequencing (WES), leading to a definite diagnosis in about 59% of participants. Biallelic mutations caused most of the diagnosed cases (50%), and a pathogenic somatic mutation resulted in 10% of the subjects. The high diagnostic yield reached highlights the relevance of the scientific approach, the importance of the reverse phenotyping strategy, and the involvement of a dedicated multidisciplinary team. The study emphasizes the role of recessive and somatic variants, new genetic mechanisms, and the complexity of genotype–phenotype associations. In older patients, WES results could end invasive diagnostic procedures and allow a more accurate transition. Finally, an early pursued diagnosis is essential for comprehensive care of patients, precision approach, knowledge of prognosis, patient and family planning, and quality of life.
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