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Mikati MA, Jiang YH, Carboni M, Shashi V, Petrovski S, Spillmann R, Milligan CJ, Li M, Grefe A, McConkie A, Berkovic S, Scheffer I, Mullen S, Bonner M, Petrou S, Goldstein D. Quinidine in the treatment of KCNT1-positive epilepsies. Ann Neurol 2015; 78:995-9. [PMID: 26369628 DOI: 10.1002/ana.24520] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 08/30/2015] [Accepted: 09/05/2015] [Indexed: 12/17/2022]
Abstract
We report 2 patients with drug-resistant epilepsy caused by KCNT1 mutations who were treated with quinidine. Both mutations manifested gain of function in vitro, showing increased current that was reduced by quinidine. One, who had epilepsy of infancy with migrating focal seizures, had 80% reduction in seizure frequency as recorded in seizure diaries, and partially validated by objective seizure evaluation on EEG. The other, who had a novel phenotype, with severe nocturnal focal and secondary generalized seizures starting in early childhood with developmental regression, did not improve. Although quinidine represents an encouraging opportunity for therapeutic benefits, our experience suggests caution in its application and supports the need to identify more targeted drugs for KCNT1 epilepsies.
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Affiliation(s)
- Mohamad A Mikati
- Division of Pediatric Neurology, Department of Pediatrics and Department of Neurobiology, Duke University School of Medicine, Durham, NC
| | - Yong-Hui Jiang
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Michael Carboni
- Division of Cardiology, Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Vandana Shashi
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Slave Petrovski
- Center for Human Genome Variation, Duke University School of Medicine, Durham, NC
| | - Rebecca Spillmann
- Center for Human Genome Variation, Duke University School of Medicine, Durham, NC
| | - Carol J Milligan
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Melody Li
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Annette Grefe
- Department of Neurology, Wake Forest University, Winston-Salem, NC
| | - Allyn McConkie
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Samuel Berkovic
- Epilepsy Research Centre, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Ingrid Scheffer
- Epilepsy Research Centre, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Saul Mullen
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Melanie Bonner
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Steven Petrou
- Epilepsy Research Centre, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - David Goldstein
- Center for Human Genome Variation, Duke University School of Medicine, Durham, NC
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