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Montanucci L, Brünger T, Lal D. Reply: Follow the allosteric transitions to predict variant pathogenicity: a channel-specific approach. Brain 2024; 147:e41-e42. [PMID: 38207091 DOI: 10.1093/brain/awae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024] Open
Affiliation(s)
- Ludovica Montanucci
- Department of Neurology, McGovern Medical School at UTHealth Houston, Houston, TX 77030, USA
- Center for Neurogenetics, UTHealth Houston, Houston, TX 77030, USA
| | - Tobias Brünger
- Cologne Center for Genomics (CCG), University of Cologne, Cologne 50937, Germany
| | - Dennis Lal
- Department of Neurology, McGovern Medical School at UTHealth Houston, Houston, TX 77030, USA
- Center for Neurogenetics, UTHealth Houston, Houston, TX 77030, USA
- Cologne Center for Genomics (CCG), University of Cologne, Cologne 50937, Germany
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Stanley Center of Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
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Gallagher D, Pérez-Palma E, Bruenger T, Ghanty I, Brilstra E, Ceulemans B, Chemaly N, de Lange I, Depienne C, Guerrini R, Mei D, Møller RS, Nabbout R, Regan BM, Schneider AL, Scheffer IE, Schoonjans AS, Symonds JD, Weckhuysen S, Zuberi SM, Lal D, Brunklaus A. Genotype-phenotype associations in 1018 individuals with SCN1A-related epilepsies. Epilepsia 2024; 65:1046-1059. [PMID: 38410936 DOI: 10.1111/epi.17882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE SCN1A variants are associated with epilepsy syndromes ranging from mild genetic epilepsy with febrile seizures plus (GEFS+) to severe Dravet syndrome (DS). Many variants are de novo, making early phenotype prediction difficult, and genotype-phenotype associations remain poorly understood. METHODS We assessed data from a retrospective cohort of 1018 individuals with SCN1A-related epilepsies. We explored relationships between variant characteristics (position, in silico prediction scores: Combined Annotation Dependent Depletion (CADD), Rare Exome Variant Ensemble Learner (REVEL), SCN1A genetic score), seizure characteristics, and epilepsy phenotype. RESULTS DS had earlier seizure onset than other GEFS+ phenotypes (5.3 vs. 12.0 months, p < .001). In silico variant scores were higher in DS versus GEFS+ (p < .001). Patients with missense variants in functionally important regions (conserved N-terminus, S4-S6) exhibited earlier seizure onset (6.0 vs. 7.0 months, p = .003) and were more likely to have DS (280/340); those with missense variants in nonconserved regions had later onset (10.0 vs. 7.0 months, p = .036) and were more likely to have GEFS+ (15/29, χ2 = 19.16, p < .001). A minority of protein-truncating variants were associated with GEFS+ (10/393) and more likely to be located in the proximal first and last exon coding regions than elsewhere in the gene (9.7% vs. 1.0%, p < .001). Carriers of the same missense variant exhibited less variability in age at seizure onset compared with carriers of different missense variants for both DS (1.9 vs. 2.9 months, p = .001) and GEFS+ (8.0 vs. 11.0 months, p = .043). Status epilepticus as presenting seizure type is a highly specific (95.2%) but nonsensitive (32.7%) feature of DS. SIGNIFICANCE Understanding genotype-phenotype associations in SCN1A-related epilepsies is critical for early diagnosis and management. We demonstrate an earlier disease onset in patients with missense variants in important functional regions, the occurrence of GEFS+ truncating variants, and the value of in silico prediction scores. Status epilepticus as initial seizure type is a highly specific, but not sensitive, early feature of DS.
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Affiliation(s)
- Declan Gallagher
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
| | - Eduardo Pérez-Palma
- Universidad del Desarrollo, Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana, Santiago, Chile
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Tobias Bruenger
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Ismael Ghanty
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
| | - Eva Brilstra
- Department of Genetics, University Medical Center, Utrecht, the Netherlands
| | - Berten Ceulemans
- Department of Child Neurology, University Hospital Antwerp, Antwerp, Belgium
| | - Nicole Chemaly
- Reference Center for Rare Epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France
| | - Iris de Lange
- Department of Genetics, University Medical Center, Utrecht, the Netherlands
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Renzo Guerrini
- Neuroscience Department, Children's Hospital A. Meyer Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) and University of Florence, Florence, Italy
| | - Davide Mei
- Neuroscience Department, Children's Hospital A. Meyer Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) and University of Florence, Florence, Italy
| | - Rikke S Møller
- Danish Epilepsy Center, Filadelfia, Dianalund, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Rima Nabbout
- Reference Center for Rare Epilepsies, Department of Pediatric Neurology, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France
| | - Brigid M Regan
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Amy L Schneider
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Ingrid E Scheffer
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Austin Health, Melbourne, Victoria, Australia
- University of Melbourne, Royal Children's Hospital, Florey and Murdoch Children's Research Institutes, Melbourne, Victoria, Australia
| | - An-Sofie Schoonjans
- Department of Child Neurology, University Hospital Antwerp, Antwerp, Belgium
| | - Joseph D Symonds
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
| | - Sarah Weckhuysen
- Applied & Translational Neurogenomics Group, VIB Center for Molecular Neurology, Antwerp, Belgium
- Neurology Department, University Hospital Antwerp, Antwerp, Belgium
- Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Sameer M Zuberi
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
| | - Dennis Lal
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Stanley Center for Psychiatric Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Neurology, McGovern Medical School, UTHealth Houston, Houston, Texas, USA
| | - Andreas Brunklaus
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
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Arrotta K, Ferguson L, Thompson N, Smuk V, Najm IM, Leu C, Lal D, Busch RM. Polygenic burden and its association with baseline cognitive function and postoperative cognitive outcome in temporal lobe epilepsy. Epilepsy Behav 2024; 153:109692. [PMID: 38394790 DOI: 10.1016/j.yebeh.2024.109692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/29/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Demographic and disease factors are associated with cognitive deficits and postoperative cognitive declines in adults with pharmacoresistant temporal lobe epilepsy (TLE), but the role of genetic factors in cognition in TLE is not well understood. Polygenic scores (PGS) for neurological and neuropsychiatric disorders and IQ have been associated with cognition in patient and healthy populations. In this exploratory study, we examined the relationship between PGS for Alzheimer's disease (AD), depression, and IQ and cognitive outcomes in adults with TLE. METHODS 202 adults with pharmacoresistant TLE had genotyping and completed neuropsychological evaluations as part of a presurgical work-up. A subset (n = 116) underwent temporal lobe resection and returned for postoperative cognitive testing. Logistic regression was used to determine if PGS for AD, depression, and IQ predicted baseline domain-specific cognitive function and cognitive phenotypes as well as postoperative language and memory decline. RESULTS No significant findings survived correction for multiple comparisons. Prior to correction, higher PGS for AD and depression (i.e., increased genetic risk for the disorder), but lower PGS for IQ (i.e., decreased genetic likelihood of high IQ) appeared possibly associated with baseline cognitive impairment in TLE. In comparison, higher PGS for AD and IQ appeared as possible risk factors for cognitive decline following temporal lobectomy, while the possible relationship between PGS for depression and post-operative cognitive outcome was mixed. SIGNIFICANCE We did not observe any relationships of large effect between PGS and cognitive function or postsurgical outcome; however, results highlight several promising trends in the data that warrant future investigation in larger samples better powered to detect small genetic effects.
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Affiliation(s)
- Kayela Arrotta
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Departments of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Nicolas Thompson
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Victoria Smuk
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Imad M Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Departments of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK.
| | - Dennis Lal
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T., Cambridge, MA, USA.
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Departments of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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5
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Perry MS, Scheffer IE, Sullivan J, Brunklaus A, Boronat S, Wheless JW, Laux L, Patel AD, Roberts CM, Dlugos D, Holder D, Knupp KG, Lallas M, Phillips S, Segal E, Smeyers P, Lal D, Wirrell E, Zuberi S, Brünger T, Wojnaroski M, Maru B, O'Donnell P, Morton M, James E, Vila MC, Huang N, Gofshteyn JS, Rico S. Severe communication delays are independent of seizure burden and persist despite contemporary treatments in SCN1A+ Dravet syndrome: Insights from the ENVISION natural history study. Epilepsia 2024; 65:322-337. [PMID: 38049202 DOI: 10.1111/epi.17850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE Dravet syndrome (DS) is a developmental and epileptic encephalopathy characterized by high seizure burden, treatment-resistant epilepsy, and developmental stagnation. Family members rate communication deficits among the most impactful disease manifestations. We evaluated seizure burden and language/communication development in children with DS. METHODS ENVISION was a prospective, observational study evaluating children with DS associated with SCN1A pathogenic variants (SCN1A+ DS) enrolled at age ≤5 years. Seizure burden and antiseizure medications were assessed every 3 months and communication and language every 6 months with the Bayley Scales of Infant and Toddler Development 3rd edition and the parent-reported Vineland Adaptive Behavior Scales 3rd edition. We report data from the first year of observation, including analyses stratified by age at Baseline: 0:6-2:0 years:months (Y:M; youngest), 2:1-3:6 Y:M (middle), and 3:7-5:0 Y:M (oldest). RESULTS Between December 2020 and March 2023, 58 children with DS enrolled at 16 sites internationally. Median follow-up was 17.5 months (range = .0-24.0), with 54 of 58 (93.1%) followed for at least 6 months and 51 of 58 (87.9%) for 12 months. Monthly countable seizure frequency (MCSF) increased with age (median [minimum-maximum] = 1.0 in the youngest [1.0-70.0] and middle [1.0-242.0] age groups and 4.5 [.0-2647.0] in the oldest age group), and remained high, despite use of currently approved antiseizure medications. Language/communication delays were observed early, and developmental stagnation occurred after age 2 years with both instruments. In predictive modeling, chronologic age was the only significant covariate of seizure frequency (effect size = .52, p = .024). MCSF, number of antiseizure medications, age at first seizure, and convulsive status epilepticus were not predictors of language/communication raw scores. SIGNIFICANCE In infants and young children with SCN1A+ DS, language/communication delay and stagnation were independent of seizure burden. Our findings emphasize that the optimal therapeutic window to prevent language/communication delay is before 3 years of age.
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Affiliation(s)
- M Scott Perry
- Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Ingrid E Scheffer
- University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - Joseph Sullivan
- University of California, San Francisco, San Francisco, California, USA
| | | | | | | | - Linda Laux
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Anup D Patel
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Dennis Dlugos
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Deborah Holder
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Matt Lallas
- Nicklaus Children's Hospital, Miami, Florida, USA
| | | | - Eric Segal
- Northeast Regional Epilepsy Group & Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA
| | | | | | | | - Sameer Zuberi
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | | | | | | | | | - Magda Morton
- Encoded Therapeutics, South San Francisco, California, USA
| | - Emma James
- Encoded Therapeutics, South San Francisco, California, USA
| | | | - Norman Huang
- Encoded Therapeutics, South San Francisco, California, USA
| | | | - Salvador Rico
- Encoded Therapeutics, South San Francisco, California, USA
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6
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Stefanski A, Pérez-Palma E, Brünger T, Montanucci L, Gati C, Klöckner C, Johannesen KM, Goodspeed K, Macnee M, Deng AT, Aledo-Serrano Á, Borovikov A, Kava M, Bouman AM, Hajianpour MJ, Pal DK, Engelen M, Hagebeuk EEO, Shinawi M, Heidlebaugh AR, Oetjens K, Hoffman TL, Striano P, Freed AS, Futtrup L, Balslev T, Abulí A, Danvoye L, Lederer D, Balci T, Nouri MN, Butler E, Drewes S, van Engelen K, Howell KB, Khoury J, May P, Trinidad M, Froelich S, Lemke JR, Tiller J, Freed AN, Kang JQ, Wuster A, Møller RS, Lal D. SLC6A1 variant pathogenicity, molecular function and phenotype: a genetic and clinical analysis. Brain 2023; 146:5198-5208. [PMID: 37647852 PMCID: PMC10689929 DOI: 10.1093/brain/awad292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/05/2023] [Accepted: 07/08/2023] [Indexed: 09/01/2023] Open
Abstract
Genetic variants in the SLC6A1 gene can cause a broad phenotypic disease spectrum by altering the protein function. Thus, systematically curated clinically relevant genotype-phenotype associations are needed to understand the disease mechanism and improve therapeutic decision-making. We aggregated genetic and clinical data from 172 individuals with likely pathogenic/pathogenic (lp/p) SLC6A1 variants and functional data for 184 variants (14.1% lp/p). Clinical and functional data were available for a subset of 126 individuals. We explored the potential associations of variant positions on the GAT1 3D structure with variant pathogenicity, altered molecular function and phenotype severity using bioinformatic approaches. The GAT1 transmembrane domains 1, 6 and extracellular loop 4 (EL4) were enriched for patient over population variants. Across functionally tested missense variants (n = 156), the spatial proximity from the ligand was associated with loss-of-function in the GAT1 transporter activity. For variants with complete loss of in vitro GABA uptake, we found a 4.6-fold enrichment in patients having severe disease versus non-severe disease (P = 2.9 × 10-3, 95% confidence interval: 1.5-15.3). In summary, we delineated associations between the 3D structure and variant pathogenicity, variant function and phenotype in SLC6A1-related disorders. This knowledge supports biology-informed variant interpretation and research on GAT1 function. All our data can be interactively explored in the SLC6A1 portal (https://slc6a1-portal.broadinstitute.org/).
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Affiliation(s)
- Arthur Stefanski
- Genomic Medicine Institute and Epilepsy Center, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Eduardo Pérez-Palma
- Universidad del Desarrollo, Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana, Santiago de Chile 7610658, Chile
| | - Tobias Brünger
- Cologne Center for Genomics (CCG), Medical Faculty of the University of Cologne, University Hospital of Cologne, Cologne 50931, Germany
| | - Ludovica Montanucci
- Genomic Medicine Institute and Epilepsy Center, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Cornelius Gati
- Department of Biological Sciences, Bridge Institute, USC Michelson Center for Convergent Bioscience, University of Southern California, Los Angeles, CA 90089, USA
| | - Chiara Klöckner
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig 04103, Germany
| | - Katrine M Johannesen
- Department of Epilepsy Genetics and Personalized Medicine, The Danish Epilepsy Centre, Dianalund 4293, Denmark
- Department of Genetics, University Hospital of Copenhagen, Rigshispitalet, Copenhagen 2100, Denmark
| | - Kimberly Goodspeed
- Children’s Health, Medical Center, Dallas, TX 75235, USA
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Marie Macnee
- Cologne Center for Genomics (CCG), Medical Faculty of the University of Cologne, University Hospital of Cologne, Cologne 50931, Germany
| | - Alexander T Deng
- Clinical Genetics, Guys and St Thomas NHS Trust, London SE19RT, UK
| | - Ángel Aledo-Serrano
- Epilepsy Program, Neurology Department, Hospital Ruber Internacional, Madrid 28034, Spain
| | - Artem Borovikov
- Research and Counseling Department, Research Centre for Medical Genetics, Moscow 115478, Russia
| | - Maina Kava
- Department of Neurology and Metabolic Medicine, Perth Children’s Hospital, Perth 6009, Australia
- School of Paediatrics and Child Health, UWA Medical School, University of Western Australia, Perth 6009, Australia
| | - Arjan M Bouman
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam 3015GD, The Netherlands
| | - M J Hajianpour
- Department of Pediatrics, Division of Medical Genetics and Genomics, Albany Medical College, Albany Med Health System, Albany, NY 12208, USA
| | - Deb K Pal
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE58AF, UK
- Department of Basic and Clinical Neurosciences, King’s College Hospital, London SE59RS, UK
| | - Marc Engelen
- Department of Pediatric Neurology, Amsterdam Public Health, Amsterdam University Medical Center, Amsterdam 1081HV, The Netherlands
| | - Eveline E O Hagebeuk
- Department of Pediatric Neurology, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede and Zwolle 2103SW, The Netherlands
| | - Marwan Shinawi
- Division of Genetics and Genomic Medicine, Department of Pediatrics, St.Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | - Kathryn Oetjens
- Autism and Developmental Medicine Institute, Geisinger, Danville, PA 17837, USA
| | - Trevor L Hoffman
- Department of Regional Genetics, Anaheim, Southern California Kaiser Permanente Medical Group, CA 92806, USA
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16132, Italy
| | - Amanda S Freed
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA 91101, USA
| | - Line Futtrup
- Department of Paediatrics, Regional Hospital of Central Jutland, Viborg 8800, Denmark
| | - Thomas Balslev
- Department of Paediatrics, Regional Hospital of Central Jutland, Viborg 8800, Denmark
- Centre for Educational Development, Aarhus University, Aarhus 8200, Denmark
| | - Anna Abulí
- Department of Clinical and Molecular Genetics and Medicine Genetics Group, VHIR, University Hospital Vall d’Hebron, Barcelona 08035, Spain
| | - Leslie Danvoye
- Department of Neurology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels 1200, Belgium
| | - Damien Lederer
- Centre for Human Genetics, Institute for Pathology and Genetics, Gosselies 6041, Belgium
| | - Tugce Balci
- Department of Pediatrics, Division of Medical Genetics, Western University, London, ON N6A3K7, Canada
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre and Children's Health Research Institute, London, ON N6A5A5, Canada
| | - Maryam Nabavi Nouri
- Department of Paediatrics, Division of Pediatric Neurology, London Health Sciences Centre, London, ON N6A5W9, Canada
| | | | - Sarah Drewes
- Department of Medical Genetics, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Kalene van Engelen
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, ON N6A5W9, Canada
| | - Katherine B Howell
- Department of Neurology, Royal Children’s Hospital, Melbourne, VIC 3052, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Jean Khoury
- Genomic Medicine Institute and Epilepsy Center, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Patrick May
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette 4362, Luxembourg
| | - Marena Trinidad
- Translational Genomics, BioMarin Pharmaceutical Inc., Novato, CA 94949, USA
| | - Steven Froelich
- Translational Genomics, BioMarin Pharmaceutical Inc., Novato, CA 94949, USA
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig 04103, Germany
- Center for Rare Diseases, University of Leipzig Medical Center, Leipzig 04103, Germany
| | | | | | - Jing-Qiong Kang
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37240, USA
- Neuroscience Graduate Program, Vanderbilt University, Nashville, TN 37235, USA
- Department of Neurology, Vanderbilt Brain Institute, Nashville, TN 37235, USA
- Department of Pharmacology, Vanderbilt University, Nashville, TN 37232, USA
- Vanderbilt Kennedy Center of Human Development, Nashville, TN 37203, USA
| | - Arthur Wuster
- Translational Genomics, BioMarin Pharmaceutical Inc., Novato, CA 94949, USA
| | - Rikke S Møller
- Department of Epilepsy Genetics and Personalized Medicine, The Danish Epilepsy Centre, Dianalund 4293, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense 5000, Denmark
| | - Dennis Lal
- Genomic Medicine Institute and Epilepsy Center, Cleveland Clinic, Cleveland, OH 44195, USA
- Stanley Center of Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
- Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA
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7
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Honke J, Hoffmann L, Coras R, Kobow K, Leu C, Pieper T, Hartlieb T, Bien CG, Woermann F, Cloppenborg T, Kalbhenn T, Gaballa A, Hamer H, Brandner S, Rössler K, Dörfler A, Rampp S, Lemke JR, Baldassari S, Baulac S, Lal D, Nürnberg P, Blümcke I. Deep histopathology genotype-phenotype analysis of focal cortical dysplasia type II differentiates between the GATOR1-altered autophagocytic subtype IIa and MTOR-altered migration deficient subtype IIb. Acta Neuropathol Commun 2023; 11:179. [PMID: 37946310 PMCID: PMC10633947 DOI: 10.1186/s40478-023-01675-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/21/2023] [Indexed: 11/12/2023] Open
Abstract
Focal cortical dysplasia type II (FCDII) is the most common cause of drug-resistant focal epilepsy in children. Herein, we performed a deep histopathology-based genotype-phenotype analysis to further elucidate the clinico-pathological and genetic presentation of FCDIIa compared to FCDIIb. Seventeen individuals with histopathologically confirmed diagnosis of FCD ILAE Type II and a pathogenic variant detected in brain derived DNA whole-exome sequencing or mTOR gene panel sequencing were included in this study. Clinical data were directly available from each contributing centre. Histopathological analyses were performed from formalin-fixed, paraffin-embedded tissue samples using haematoxylin-eosin and immunohistochemistry for NF-SMI32, NeuN, pS6, p62, and vimentin. Ten individuals carried loss-of-function variants in the GATOR1 complex encoding genes DEPDC5 (n = 7) and NPRL3 (n = 3), or gain-of-function variants in MTOR (n = 7). Whereas individuals with GATOR1 variants only presented with FCDIIa, i.e., lack of balloon cells, individuals with MTOR variants presented with both histopathology subtypes, FCDIIa and FCDIIb. Interestingly, 50% of GATOR1-positive cases showed a unique and predominantly vacuolizing phenotype with p62 immunofluorescent aggregates in autophagosomes. All cases with GATOR1 alterations had neurosurgery in the frontal lobe and the majority was confined to the cortical ribbon not affecting the white matter. This pattern was reflected by subtle or negative MRI findings in seven individuals with GATOR1 variants. Nonetheless, all individuals were seizure-free after surgery except four individuals carrying a DEPDC5 variant. We describe a yet underrecognized genotype-phenotype correlation of GATOR1 variants with FCDIIa in the frontal lobe. These lesions were histopathologically characterized by abnormally vacuolizing cells suggestive of an autophagy-altered phenotype. In contrast, individuals with FCDIIb and brain somatic MTOR variants showed larger lesions on MRI including the white matter, suggesting compromised neural cell migration.
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Affiliation(s)
- Jonas Honke
- Department of Neuropathology, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
- Partner of the European Reference Network (ERN) EpiCARE, Barcelona, Spain
| | - Lucas Hoffmann
- Department of Neuropathology, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
- Partner of the European Reference Network (ERN) EpiCARE, Barcelona, Spain
| | - Roland Coras
- Department of Neuropathology, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
- Partner of the European Reference Network (ERN) EpiCARE, Barcelona, Spain
| | - Katja Kobow
- Department of Neuropathology, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
- Partner of the European Reference Network (ERN) EpiCARE, Barcelona, Spain
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
- Department of Neurology, McGovern Medical School, UTHealth Houston, University of Texas, Houston, USA
| | - Tom Pieper
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, Germany
| | - Till Hartlieb
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, Germany
- Research Institute for Rehabilitation, Transition, and Palliation, Paracelsus Medical University, Salzburg, Austria
| | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Friedrich Woermann
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Thomas Cloppenborg
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Thilo Kalbhenn
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
- Department of Neurosurgery (Evangelisches Klinikum Bethel), Medical School, Bielefeld University, Bielefeld, Germany
| | - Ahmed Gaballa
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Hajo Hamer
- Partner of the European Reference Network (ERN) EpiCARE, Barcelona, Spain
- Epilepsy Center, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
| | - Sebastian Brandner
- Department of Neurosurgery, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Arnd Dörfler
- Department of Neuroradiology, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Rampp
- Department of Neurosurgery, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
- Department of Neuroradiology, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
- Center for Rare Diseases, University of Leipzig Medical Center, Leipzig, Germany
| | - Sara Baldassari
- Inserm, CNRS, APHP, Institut du Cerveau - Paris Brain Institute - ICM, Hôpital de La Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Stéphanie Baulac
- Inserm, CNRS, APHP, Institut du Cerveau - Paris Brain Institute - ICM, Hôpital de La Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, 02142, USA
- Cologne Center for Genomics (CCG), Medical Faculty of the University of Cologne, University Hospital of Cologne, 50931, Cologne, Germany
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
- Department of Neurology, McGovern Medical School, UTHealth Houston, University of Texas, Houston, USA
| | - Peter Nürnberg
- Cologne Center for Genomics (CCG), Medical Faculty of the University of Cologne, University Hospital of Cologne, 50931, Cologne, Germany
| | - Ingmar Blümcke
- Department of Neuropathology, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany.
- Partner of the European Reference Network (ERN) EpiCARE, Barcelona, Spain.
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, 02142, USA.
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8
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Brunklaus A, George AL, Lal D, Heinzen EL, Goldman AM. Prophecy or empiricism? Clinical value of predicting versus determining genetic variant functions. Epilepsia 2023; 64:2909-2913. [PMID: 37562820 DOI: 10.1111/epi.17743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/12/2023]
Abstract
The recent explosion of epilepsy genetic testing has created challenges for interpretation of gene variants. Assessments of the functional consequences of genetic variants either by predictive or experimental strategies can contribute to estimating pathogenicity, but there is no consensus on which approach is best. The Special Interest Group on Epilepsy Genetics hosted a session during the Annual American Epilepsy Society Meeting in December 2022 to discuss this topic. The session featured a debate of the relative advantages and limitations of predicting (prophecy) versus experimentally determining (empiricism) variant function using ion channel gene variants as examples. This commentary summarizes these discussions.
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Affiliation(s)
- Andreas Brunklaus
- Royal Hospital for Children, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alfred L George
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Erin L Heinzen
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Genetics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Alica M Goldman
- Department of Neurology, Peter Kellaway Neurophysiology Section, Baylor College of Medicine, Houston, Texas, USA
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9
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Myers SJ, Yuan H, Perszyk RE, Zhang J, Kim S, Nocilla KA, Allen JP, Bain JM, Lemke JR, Lal D, Benke TA, Traynelis SF. Classification of missense variants in the N-methyl-d-aspartate receptor GRIN gene family as gain- or loss-of-function. Hum Mol Genet 2023; 32:2857-2871. [PMID: 37369021 PMCID: PMC10508039 DOI: 10.1093/hmg/ddad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Advances in sequencing technology have generated a large amount of genetic data from patients with neurological conditions. These data have provided diagnosis of many rare diseases, including a number of pathogenic de novo missense variants in GRIN genes encoding N-methyl-d-aspartate receptors (NMDARs). To understand the ramifications for neurons and brain circuits affected by rare patient variants, functional analysis of the variant receptor is necessary in model systems. For NMDARs, this functional analysis needs to assess multiple properties in order to understand how variants could impact receptor function in neurons. One can then use these data to determine whether the overall actions will increase or decrease NMDAR-mediated charge transfer. Here, we describe an analytical and comprehensive framework by which to categorize GRIN variants as either gain-of-function (GoF) or loss-of-function (LoF) and apply this approach to GRIN2B variants identified in patients and the general population. This framework draws on results from six different assays that assess the impact of the variant on NMDAR sensitivity to agonists and endogenous modulators, trafficking to the plasma membrane, response time course and channel open probability. We propose to integrate data from multiple in vitro assays to arrive at a variant classification, and suggest threshold levels that guide confidence. The data supporting GoF and LoF determination are essential to assessing pathogenicity and patient stratification for clinical trials as personalized pharmacological and genetic agents that can enhance or reduce receptor function are advanced. This approach to functional variant classification can generalize to other disorders associated with missense variants.
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Affiliation(s)
- Scott J Myers
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA 30322, USA
- The Center for Functional Evaluation of Rare Variants (CFERV), Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Hongjie Yuan
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA 30322, USA
- The Center for Functional Evaluation of Rare Variants (CFERV), Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Riley E Perszyk
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jing Zhang
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Sukhan Kim
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Kelsey A Nocilla
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - James P Allen
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA 30322, USA
- The Center for Functional Evaluation of Rare Variants (CFERV), Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Jennifer M Bain
- Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig 04103, Germany
- Center for Rare Diseases, University of Leipzig Medical Center, Leipzig 04103, Germany
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44106, USA
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Cologne Center for Genomics (CCG), Medical Faculty of the University of Cologne, Köln 50923, Germany
| | - Timothy A Benke
- Department of Pediatrics, Pharmacology and Neurology, University of Colorado School of Medicine, and Children’s Hospital Colorado, Aurora, CO 80045, USA
| | - Stephen F Traynelis
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA 30322, USA
- The Center for Functional Evaluation of Rare Variants (CFERV), Emory University School of Medicine, Atlanta, GA 30322, USA
- Emory Neurodegenerative Disease Center, Emory University School of Medicine, Atlanta, GA 30322, USA
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10
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Stevelink R, Campbell C, Chen S, Abou-Khalil B, Adesoji OM, Afawi Z, Amadori E, Anderson A, Anderson J, Andrade DM, Annesi G, Auce P, Avbersek A, Bahlo M, Baker MD, Balagura G, Balestrini S, Barba C, Barboza K, Bartolomei F, Bast T, Baum L, Baumgartner T, Baykan B, Bebek N, Becker AJ, Becker F, Bennett CA, Berghuis B, Berkovic SF, Beydoun A, Bianchini C, Bisulli F, Blatt I, Bobbili DR, Borggraefe I, Bosselmann C, Braatz V, Bradfield JP, Brockmann K, Brody LC, Buono RJ, Busch RM, Caglayan H, Campbell E, Canafoglia L, Canavati C, Cascino GD, Castellotti B, Catarino CB, Cavalleri GL, Cerrato F, Chassoux F, Cherny SS, Cheung CL, Chinthapalli K, Chou IJ, Chung SK, Churchhouse C, Clark PO, Cole AJ, Compston A, Coppola A, Cosico M, Cossette P, Craig JJ, Cusick C, Daly MJ, Davis LK, de Haan GJ, Delanty N, Depondt C, Derambure P, Devinsky O, Di Vito L, Dlugos DJ, Doccini V, Doherty CP, El-Naggar H, Elger CE, Ellis CA, Eriksson JG, Faucon A, Feng YCA, Ferguson L, Ferraro TN, Ferri L, Feucht M, Fitzgerald M, Fonferko-Shadrach B, Fortunato F, Franceschetti S, Franke A, French JA, Freri E, Gagliardi M, Gambardella A, Geller EB, Giangregorio T, Gjerstad L, Glauser T, Goldberg E, Goldman A, Granata T, Greenberg DA, Guerrini R, Gupta N, Haas KF, Hakonarson H, Hallmann K, Hassanin E, Hegde M, Heinzen EL, Helbig I, Hengsbach C, Heyne HO, Hirose S, Hirsch E, Hjalgrim H, Howrigan DP, Hucks D, Hung PC, Iacomino M, Imbach LL, Inoue Y, Ishii A, Jamnadas-Khoda J, Jehi L, Johnson MR, Kälviäinen R, Kamatani Y, Kanaan M, Kanai M, Kantanen AM, Kara B, Kariuki SM, Kasperavičiūte D, Kasteleijn-Nolst Trenite D, Kato M, Kegele J, Kesim Y, Khoueiry-Zgheib N, King C, Kirsch HE, Klein KM, Kluger G, Knake S, Knowlton RC, Koeleman BPC, Korczyn AD, Koupparis A, Kousiappa I, Krause R, Krenn M, Krestel H, Krey I, Kunz WS, Kurki MI, Kurlemann G, Kuzniecky R, Kwan P, Labate A, Lacey A, Lal D, Landoulsi Z, Lau YL, Lauxmann S, Leech SL, Lehesjoki AE, Lemke JR, Lerche H, Lesca G, Leu C, Lewin N, Lewis-Smith D, Li GHY, Li QS, Licchetta L, Lin KL, Lindhout D, Linnankivi T, Lopes-Cendes I, Lowenstein DH, Lui CHT, Madia F, Magnusson S, Marson AG, May P, McGraw CM, Mei D, Mills JL, Minardi R, Mirza N, Møller RS, Molloy AM, Montomoli M, Mostacci B, Muccioli L, Muhle H, Müller-Schlüter K, Najm IM, Nasreddine W, Neale BM, Neubauer B, Newton CRJC, Nöthen MM, Nothnagel M, Nürnberg P, O’Brien TJ, Okada Y, Ólafsson E, Oliver KL, Özkara C, Palotie A, Pangilinan F, Papacostas SS, Parrini E, Pato CN, Pato MT, Pendziwiat M, Petrovski S, Pickrell WO, Pinsky R, Pippucci T, Poduri A, Pondrelli F, Powell RHW, Privitera M, Rademacher A, Radtke R, Ragona F, Rau S, Rees MI, Regan BM, Reif PS, Rhelms S, Riva A, Rosenow F, Ryvlin P, Saarela A, Sadleir LG, Sander JW, Sander T, Scala M, Scattergood T, Schachter SC, Schankin CJ, Scheffer IE, Schmitz B, Schoch S, Schubert-Bast S, Schulze-Bonhage A, Scudieri P, Sham P, Sheidley BR, Shih JJ, Sills GJ, Sisodiya SM, Smith MC, Smith PE, Sonsma ACM, Speed D, Sperling MR, Stefansson H, Stefansson K, Steinhoff BJ, Stephani U, Stewart WC, Stipa C, Striano P, Stroink H, Strzelczyk A, Surges R, Suzuki T, Tan KM, Taneja RS, Tanteles GA, Taubøll E, Thio LL, Thomas GN, Thomas RH, Timonen O, Tinuper P, Todaro M, Topaloğlu P, Tozzi R, Tsai MH, Tumiene B, Turkdogan D, Unnsteinsdóttir U, Utkus A, Vaidiswaran P, Valton L, van Baalen A, Vetro A, Vining EPG, Visscher F, von Brauchitsch S, von Wrede R, Wagner RG, Weber YG, Weckhuysen S, Weisenberg J, Weller M, Widdess-Walsh P, Wolff M, Wolking S, Wu D, Yamakawa K, Yang W, Yapıcı Z, Yücesan E, Zagaglia S, Zahnert F, Zara F, Zhou W, Zimprich F, Zsurka G, Zulfiqar Ali Q. GWAS meta-analysis of over 29,000 people with epilepsy identifies 26 risk loci and subtype-specific genetic architecture. Nat Genet 2023; 55:1471-1482. [PMID: 37653029 PMCID: PMC10484785 DOI: 10.1038/s41588-023-01485-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/21/2023] [Indexed: 09/02/2023]
Abstract
Epilepsy is a highly heritable disorder affecting over 50 million people worldwide, of which about one-third are resistant to current treatments. Here we report a multi-ancestry genome-wide association study including 29,944 cases, stratified into three broad categories and seven subtypes of epilepsy, and 52,538 controls. We identify 26 genome-wide significant loci, 19 of which are specific to genetic generalized epilepsy (GGE). We implicate 29 likely causal genes underlying these 26 loci. SNP-based heritability analyses show that common variants explain between 39.6% and 90% of genetic risk for GGE and its subtypes. Subtype analysis revealed markedly different genetic architectures between focal and generalized epilepsies. Gene-set analyses of GGE signals implicate synaptic processes in both excitatory and inhibitory neurons in the brain. Prioritized candidate genes overlap with monogenic epilepsy genes and with targets of current antiseizure medications. Finally, we leverage our results to identify alternate drugs with predicted efficacy if repurposed for epilepsy treatment.
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11
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Montanucci L, Lewis-Smith D, Collins RL, Niestroj LM, Parthasarathy S, Xian J, Ganesan S, Macnee M, Brünger T, Thomas RH, Talkowski M, Helbig I, Leu C, Lal D. Genome-wide identification and phenotypic characterization of seizure-associated copy number variations in 741,075 individuals. Nat Commun 2023; 14:4392. [PMID: 37474567 PMCID: PMC10359300 DOI: 10.1038/s41467-023-39539-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 06/16/2023] [Indexed: 07/22/2023] Open
Abstract
Copy number variants (CNV) are established risk factors for neurodevelopmental disorders with seizures or epilepsy. With the hypothesis that seizure disorders share genetic risk factors, we pooled CNV data from 10,590 individuals with seizure disorders, 16,109 individuals with clinically validated epilepsy, and 492,324 population controls and identified 25 genome-wide significant loci, 22 of which are novel for seizure disorders, such as deletions at 1p36.33, 1q44, 2p21-p16.3, 3q29, 8p23.3-p23.2, 9p24.3, 10q26.3, 15q11.2, 15q12-q13.1, 16p12.2, 17q21.31, duplications at 2q13, 9q34.3, 16p13.3, 17q12, 19p13.3, 20q13.33, and reciprocal CNVs at 16p11.2, and 22q11.21. Using genetic data from additional 248,751 individuals with 23 neuropsychiatric phenotypes, we explored the pleiotropy of these 25 loci. Finally, in a subset of individuals with epilepsy and detailed clinical data available, we performed phenome-wide association analyses between individual CNVs and clinical annotations categorized through the Human Phenotype Ontology (HPO). For six CNVs, we identified 19 significant associations with specific HPO terms and generated, for all CNVs, phenotype signatures across 17 clinical categories relevant for epileptologists. This is the most comprehensive investigation of CNVs in epilepsy and related seizure disorders, with potential implications for clinical practice.
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Affiliation(s)
- Ludovica Montanucci
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - David Lewis-Smith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Clinical Neurosciences, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ryan L Collins
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, USA
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology (M.I.T.) and Harvard, Cambridge, USA
| | | | - Shridhar Parthasarathy
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Julie Xian
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shiva Ganesan
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marie Macnee
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Tobias Brünger
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Rhys H Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Clinical Neurosciences, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Michael Talkowski
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, USA
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology (M.I.T.) and Harvard, Cambridge, USA
| | - Ingo Helbig
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, USA.
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK.
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, USA.
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, US.
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, USA.
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology (M.I.T.) and Harvard, Cambridge, USA.
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, USA.
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, US.
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12
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Bundalian L, Su YY, Chen S, Velluva A, Kirstein AS, Garten A, Biskup S, Battke F, Lal D, Heyne HO, Platzer K, Lin CC, Lemke JR, Le Duc D. Epilepsies of presumed genetic etiology show enrichment of rare variants that occur in the general population. Am J Hum Genet 2023; 110:1110-1122. [PMID: 37369202 PMCID: PMC10357498 DOI: 10.1016/j.ajhg.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Previous studies suggested that severe epilepsies, e.g., developmental and epileptic encephalopathies (DEEs), are mainly caused by ultra-rare de novo genetic variants. For milder disease, rare genetic variants could contribute to the phenotype. To determine the importance of rare variants for different epilepsy types, we analyzed a whole-exome sequencing cohort of 9,170 epilepsy-affected individuals and 8,436 control individuals. Here, we separately analyzed three different groups of epilepsies: severe DEEs, genetic generalized epilepsy (GGE), and non-acquired focal epilepsy (NAFE). We required qualifying rare variants (QRVs) to occur in control individuals with an allele count ≥ 1 and a minor allele frequency ≤ 1:1,000, to be predicted as deleterious (CADD ≥ 20), and to have an odds ratio in individuals with epilepsy ≥ 2. We identified genes enriched with QRVs primarily in NAFE (n = 72), followed by GGE (n = 32) and DEE (n = 21). This suggests that rare variants may play a more important role for causality of NAFE than for DEE. Moreover, we found that genes harboring QRVs, e.g., HSGP2, FLNA, or TNC, encode proteins that are involved in structuring the brain extracellular matrix. The present study confirms an involvement of rare variants for NAFE that occur also in the general population, while in DEE and GGE, the contribution of such variants appears more limited.
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Affiliation(s)
- Linnaeus Bundalian
- Institute of Human Genetics, University of Leipzig Medical Center, 04103 Leipzig, Germany.
| | - Yin-Yuan Su
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Siwei Chen
- Analytic and Translational Genetics Unit, Department of Medicine, Boston, MA, USA; Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Akhil Velluva
- Division of General Biochemistry, Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, Leipzig University, 04103 Leipzig, Germany; Department of Evolutionary Genetics, Max Planck Institute for Evolutionary Anthropology, 04103 Leipzig, Germany
| | - Anna Sophia Kirstein
- Pediatric Research Center, University Hospital for Children and Adolescents, Leipzig University, 04103 Leipzig, Germany
| | - Antje Garten
- Pediatric Research Center, University Hospital for Children and Adolescents, Leipzig University, 04103 Leipzig, Germany
| | - Saskia Biskup
- CeGaT GmbH, 72076 Tuebingen, Germany; Hertie-Institute for Clinical Brain Research, 72070 Tubingen, Germany
| | | | - Dennis Lal
- Analytic and Translational Genetics Unit, Department of Medicine, Boston, MA, USA; Massachusetts General Hospital, Boston, MA 02114, USA; Cologne Center for Genomics, University of Cologne, 50937 Cologne, Germany
| | - Henrike O Heyne
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Hasso-Plattner-Institut for Digital Engineering, University of Potsdam, Potsdam, Germany; Hasso Plattner Institute at Mount Sinai, Mount Sinai School of Medicine, New York, NY, USA; Institute for Molecular Medicine Finland: FIMM, University of Helsinki, Helsinki, Finland
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Chen-Ching Lin
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Medical Center, 04103 Leipzig, Germany; Center for Rare Diseases, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Diana Le Duc
- Institute of Human Genetics, University of Leipzig Medical Center, 04103 Leipzig, Germany; Department of Evolutionary Genetics, Max Planck Institute for Evolutionary Anthropology, 04103 Leipzig, Germany.
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13
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Pablo JLB, Cornett SL, Wang LA, Jo S, Brünger T, Budnik N, Hegde M, DeKeyser JM, Thompson CH, Doench JG, Lal D, George AL, Pan JQ. Scanning mutagenesis of the voltage-gated sodium channel Na V1.2 using base editing. Cell Rep 2023; 42:112563. [PMID: 37267104 PMCID: PMC10592450 DOI: 10.1016/j.celrep.2023.112563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 03/24/2023] [Accepted: 05/08/2023] [Indexed: 06/04/2023] Open
Abstract
It is challenging to apply traditional mutational scanning to voltage-gated sodium channels (NaVs) and functionally annotate the large number of coding variants in these genes. Using a cytosine base editor and a pooled viability assay, we screen a library of 368 guide RNAs (gRNAs) tiling NaV1.2 to identify more than 100 gRNAs that change NaV1.2 function. We sequence base edits made by a subset of these gRNAs to confirm specific variants that drive changes in channel function. Electrophysiological characterization of these channel variants validates the screen results and provides functional mechanisms of channel perturbation. Most of the changes caused by these gRNAs are classifiable as loss of function along with two missense mutations that lead to gain of function in NaV1.2 channels. This two-tiered strategy to functionally characterize ion channel protein variants at scale identifies a large set of loss-of-function mutations in NaV1.2.
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Affiliation(s)
- Juan Lorenzo B Pablo
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.
| | - Savannah L Cornett
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Lei A Wang
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Sooyeon Jo
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Tobias Brünger
- Cologne Center for Genomics, University of Cologne, 51149 Cologne, Germany; Genomic Medicine Institute, Lerner Research Institute, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Nikita Budnik
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Mudra Hegde
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Jean-Marc DeKeyser
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Christopher H Thompson
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - John G Doench
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Dennis Lal
- Cologne Center for Genomics, University of Cologne, 51149 Cologne, Germany; Genomic Medicine Institute, Lerner Research Institute, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA; Department of Neurology, McGovern Medical School, UTHealth, Houston, TX 77030, USA
| | - Alfred L George
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Jen Q Pan
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.
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14
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Boßelmann CM, Leu C, Lal D. Technological and computational approaches to detect somatic mosaicism in epilepsy. Neurobiol Dis 2023:106208. [PMID: 37343892 DOI: 10.1016/j.nbd.2023.106208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/03/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023] Open
Abstract
Lesional epilepsy is a common and severe disease commonly associated with malformations of cortical development, including focal cortical dysplasia and hemimegalencephaly. Recent advances in sequencing and variant calling technologies have identified several genetic causes, including both short/single nucleotide and structural somatic variation. In this review, we aim to provide a comprehensive overview of the methodological advancements in this field while highlighting the unresolved technological and computational challenges that persist, including ultra-low variant allele fractions in bulk tissue, low availability of paired control samples, spatial variability of mutational burden within the lesion, and the issue of false-positive calls and validation procedures. Information from genetic testing in focal epilepsy may be integrated into clinical care to inform histopathological diagnosis, postoperative prognosis, and candidate precision therapies.
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Affiliation(s)
- Christian M Boßelmann
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK.
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T., Cambridge, MA, USA; Cologne Center for Genomics (CCG), University of Cologne, Cologne, DE, USA
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15
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Macnee M, Pérez-Palma E, Brünger T, Klöckner C, Platzer K, Stefanski A, Montanucci L, Bayat A, Radtke M, Collins RL, Talkowski M, Blankenberg D, Møller RS, Lemke JR, Nothnagel M, May P, Lal D. CNV-ClinViewer: enhancing the clinical interpretation of large copy-number variants online. Bioinformatics 2023; 39:btad290. [PMID: 37104749 PMCID: PMC10174702 DOI: 10.1093/bioinformatics/btad290] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/17/2023] [Accepted: 04/26/2023] [Indexed: 04/29/2023] Open
Abstract
MOTIVATION Pathogenic copy-number variants (CNVs) can cause a heterogeneous spectrum of rare and severe disorders. However, most CNVs are benign and are part of natural variation in human genomes. CNV pathogenicity classification, genotype-phenotype analyses, and therapeutic target identification are challenging and time-consuming tasks that require the integration and analysis of information from multiple scattered sources by experts. RESULTS Here, we introduce the CNV-ClinViewer, an open-source web application for clinical evaluation and visual exploration of CNVs. The application enables real-time interactive exploration of large CNV datasets in a user-friendly designed interface and facilitates semi-automated clinical CNV interpretation following the ACMG guidelines by integrating the ClassifCNV tool. In combination with clinical judgment, the application enables clinicians and researchers to formulate novel hypotheses and guide their decision-making process. Subsequently, the CNV-ClinViewer enhances for clinical investigators' patient care and for basic scientists' translational genomic research. AVAILABILITY AND IMPLEMENTATION The web application is freely available at https://cnv-ClinViewer.broadinstitute.org and the open-source code can be found at https://github.com/LalResearchGroup/CNV-clinviewer.
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Affiliation(s)
- Marie Macnee
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Eduardo Pérez-Palma
- Universidad del Desarrollo, Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana, Santiago, Chile
| | - Tobias Brünger
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Chiara Klöckner
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Arthur Stefanski
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ludovica Montanucci
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Allan Bayat
- Department of Epilepsy Genetics and Personalized Medicine, Member of ERN Epicare, Danish Epilepsy Centre, Dianalund, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Maximilian Radtke
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Ryan L Collins
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Talkowski
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Blankenberg
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rikke S Møller
- Department of Epilepsy Genetics and Personalized Medicine, Member of ERN Epicare, Danish Epilepsy Centre, Dianalund, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Michael Nothnagel
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
- University Hospital Cologne, Cologne, Germany
| | - Patrick May
- Luxembourg Centre for Systems Biomedicine, University Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Dennis Lal
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
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16
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Hoffmann L, Coras R, Kobow K, López-Rivera JA, Lal D, Leu C, Najm I, Nürnberg P, Herms J, Harter PN, Bien CG, Kalbhenn T, Müller M, Pieper T, Hartlieb T, Kudernatsch M, Hamer H, Brandner S, Rössler K, Blümcke I, Jabari S. Correction to: Ganglioglioma with adverse clinical outcome and atypical histopathological features were defined by alterations in PTPN11/KRAS/NF1 and other RAS-/MAP-Kinase pathway genes. Acta Neuropathol 2023; 145:851-855. [PMID: 37115209 PMCID: PMC10175382 DOI: 10.1007/s00401-023-02577-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Lucas Hoffmann
- Department of Neuropathology, Partner of the European Reference Network (ERN) EpiCARE, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, 91054, Germany
| | - Roland Coras
- Department of Neuropathology, Partner of the European Reference Network (ERN) EpiCARE, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, 91054, Germany
| | - Katja Kobow
- Department of Neuropathology, Partner of the European Reference Network (ERN) EpiCARE, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, 91054, Germany
| | - Javier A López-Rivera
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, USA
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, 02142, USA
- Cologne Center for Genomics (CCG), Medical Faculty of the University of Cologne, University Hospital of Cologne, 50931, Cologne, Germany
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, 02142, USA
- Cologne Center for Genomics (CCG), Medical Faculty of the University of Cologne, University Hospital of Cologne, 50931, Cologne, Germany
| | - Imad Najm
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Peter Nürnberg
- Cologne Center for Genomics (CCG), Medical Faculty of the University of Cologne, University Hospital of Cologne, 50931, Cologne, Germany
| | - Jochen Herms
- Center for Neuropathology and Prion Research, LMU Munich, Munich, Germany
| | - Patrick N Harter
- Center for Neuropathology and Prion Research, LMU Munich, Munich, Germany
| | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, 33617, Germany
| | - Thilo Kalbhenn
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, 33617, Germany
- Department of Neurosurgery (Evangelisches Klinikum Bethel), Medical School, Bielefeld University, Bielefeld, 33617, Germany
| | - Markus Müller
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, 33617, Germany
| | - Tom Pieper
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, 83569, Rosenheim, Germany
| | - Till Hartlieb
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, 83569, Rosenheim, Germany
| | - Manfred Kudernatsch
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, 83569, Rosenheim, Germany
| | - Hajo Hamer
- Epilepsy Center, EpiCARE Partner, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, 91054, Germany
| | - Sebastian Brandner
- Department of Neurosurgery, EpiCARE Partner, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, EpiCARE Partner, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
- Department of Neurosurgery, EpiCARE Partner, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Ingmar Blümcke
- Department of Neuropathology, Partner of the European Reference Network (ERN) EpiCARE, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, 91054, Germany
| | - Samir Jabari
- Department of Neuropathology, Partner of the European Reference Network (ERN) EpiCARE, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, 91054, Germany.
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17
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Hoffmann L, Coras R, Kobow K, López-Rivera JA, Lal D, Leu C, Najm I, Nürnberg P, Herms J, Harter PN, Bien CG, Kalbhenn T, Müller M, Pieper T, Hartlieb T, Kudernatsch M, Hamer H, Brandner S, Rössler K, Blümcke I, Jabari S. Ganglioglioma with adverse clinical outcome and atypical histopathological features were defined by alterations in PTPN11/KRAS/NF1 and other RAS-/MAP-Kinase pathway genes. Acta Neuropathol 2023; 145:815-827. [PMID: 36973520 PMCID: PMC10175344 DOI: 10.1007/s00401-023-02561-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/27/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
Exome-wide sequencing studies recently described PTPN11 as a novel brain somatic epilepsy gene. In contrast, germline mutations of PTPN11 are known to cause Noonan syndrome, a multisystem disorder characterized by abnormal facial features, developmental delay, and sporadically, also brain tumors. Herein, we performed a deep phenotype-genotype analysis of a comprehensive series of ganglioglioma (GG) with brain somatic alterations of the PTPN11/KRAS/NF1 genes compared to GG with common MAP-Kinase signaling pathway alterations, i.e., BRAFV600E. Seventy-two GG were submitted to whole exome sequencing and genotyping and 84 low grade epilepsy associated tumors (LEAT) to DNA-methylation analysis. In 28 tumours, both analyses were available from the same sample. Clinical data were retrieved from hospital files including disease onset, age at surgery, brain localization, and seizure outcome. A comprehensive histopathology staining panel was available in all cases. We identified eight GG with PTPN11 alterations, copy number variant (CNV) gains of chromosome 12, and the commonality of additional CNV gains in NF1, KRAS, FGFR4 and RHEB, as well as BRAFV600E alterations. Histopathology revealed an atypical glio-neuronal phenotype with subarachnoidal tumor spread and large, pleomorphic, and multinuclear cellular features. Only three out of eight patients with GG and PTPN11/KRAS/NF1 alterations were free of disabling-seizures 2 years after surgery (38% had Engel I). This was remarkably different from our series of GG with only BRAFV600E mutations (85% had Engel I). Unsupervised cluster analysis of DNA methylation arrays separated these tumours from well-established LEAT categories. Our data point to a subgroup of GG with cellular atypia in glial and neuronal cell components, adverse postsurgical outcome, and genetically characterized by complex alterations in PTPN11 and other RAS-/MAP-Kinase and/or mTOR signaling pathways. These findings need prospective validation in clinical practice as they argue for an adaptation of the WHO grading system in developmental, glio-neuronal tumors associated with early onset focal epilepsy.
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Affiliation(s)
- Lucas Hoffmann
- Department of Neuropathology, Partner of the European Reference Network (ERN) EpiCARE, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, 91054, Germany
| | - Roland Coras
- Department of Neuropathology, Partner of the European Reference Network (ERN) EpiCARE, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, 91054, Germany
| | - Katja Kobow
- Department of Neuropathology, Partner of the European Reference Network (ERN) EpiCARE, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, 91054, Germany
| | - Javier A López-Rivera
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, USA
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, 02142, USA
- Cologne Center for Genomics (CCG), Medical Faculty of the University of Cologne, University Hospital of Cologne, 50931, Cologne, Germany
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, 02142, USA
- Cologne Center for Genomics (CCG), Medical Faculty of the University of Cologne, University Hospital of Cologne, 50931, Cologne, Germany
| | - Imad Najm
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Peter Nürnberg
- Cologne Center for Genomics (CCG), Medical Faculty of the University of Cologne, University Hospital of Cologne, 50931, Cologne, Germany
| | - Jochen Herms
- Center for Neuropathology and Prion Research, LMU Munich, Munich, Germany
| | - Patrick N Harter
- Center for Neuropathology and Prion Research, LMU Munich, Munich, Germany
| | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, 33617, Germany
| | - Thilo Kalbhenn
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, 33617, Germany
- Department of Neurosurgery (Evangelisches Klinikum Bethel), Medical School, Bielefeld University, Bielefeld, 33617, Germany
| | - Markus Müller
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, 33617, Germany
| | - Tom Pieper
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, 83569, Rosenheim, Germany
| | - Till Hartlieb
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, 83569, Rosenheim, Germany
| | - Manfred Kudernatsch
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, 83569, Rosenheim, Germany
| | - Hajo Hamer
- Epilepsy Center, EpiCARE Partner, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, 91054, Germany
| | - Sebastian Brandner
- Department of Neurosurgery, EpiCARE Partner, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, EpiCARE Partner, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, Germany
- Department of Neurosurgery, EpiCARE Partner, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Ingmar Blümcke
- Department of Neuropathology, Partner of the European Reference Network (ERN) EpiCARE, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, 91054, Germany
| | - Samir Jabari
- Department of Neuropathology, Partner of the European Reference Network (ERN) EpiCARE, Universitätsklinikum Erlangen, FAU Erlangen-Nürnberg, Erlangen, 91054, Germany.
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18
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Bundalian L, Su YY, Chen S, Velluva A, Kirstein AS, Garten A, Biskup S, Battke F, Lal D, Heyne HO, Platzer K, Lin CC, Lemke JR, Le Duc D. The role of rare genetic variants enrichment in epilepsies of presumed genetic etiology. medRxiv 2023:2023.01.17.23284702. [PMID: 36974069 PMCID: PMC10041669 DOI: 10.1101/2023.01.17.23284702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Previous studies suggested that severe epilepsies e.g., developmental and epileptic encephalopathies (DEE) are mainly caused by ultra-rare de novo genetic variants. For milder phenotypes, rare genetic variants could contribute to the phenotype. To determine the importance of rare variants for different epilepsy types, we analyzed a whole-exome sequencing cohort of 9,170 epilepsy-affected individuals and 8,436 controls. Here, we separately analyzed three different groups of epilepsies : severe DEEs, genetic generalized epilepsy (GGE), and non-acquired focal epilepsy (NAFE). We required qualifying rare variants (QRVs) to occur in controls at a minor allele frequency ≤ 1:1,000, to be predicted as deleterious (CADD≥20), and to have an odds ratio in epilepsy cases ≥2. We identified genes enriched with QRVs in DEE (n=21), NAFE (n=72), and GGE (n=32) - the number of enriched genes are found greatest in NAFE and least in DEE. This suggests that rare variants may play a more important role for causality of NAFE than in DEE. Moreover, we found that QRV-carrying genes e.g., HSGP2, FLNA or TNC are involved in structuring the brain extracellular matrix. The present study confirms an involvement of rare variants for NAFE, while in DEE and GGE, the contribution of such variants appears more limited.
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Affiliation(s)
- Linnaeus Bundalian
- Institute of Human Genetics, University of Leipzig Medical Center, 4103 Leipzig, Germany
| | - Yin-Yuan Su
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Siwei Chen
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Akhil Velluva
- Division of General Biochemistry, Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, Leipzig University, 04103, Leipzig, Germany
- Department of Evolutionary Genetics, Max Planck Institute for Evolutionary Anthropology, 04103, Leipzig, Germany
| | - Anna Sophia Kirstein
- Pediatric Research Center, University Hospital for Children and Adolescents, Leipzig University, 04103, Leipzig, Germany
| | - Antje Garten
- Pediatric Research Center, University Hospital for Children and Adolescents, Leipzig University, 04103, Leipzig, Germany
| | - Saskia Biskup
- CeGaT GmbH, 72076, Tuebingen, Germany
- Hertie-Institute for Clinical Brain Research, 72070, Tubingen, Germany
| | | | - Dennis Lal
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Cologne Center for Genomics, University of Cologne, 50937 Cologne, Germany
| | - Henrike O Heyne
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Hasso-Plattner-Institut for Digital Engineering, University of Potsdam, Potsdam, Germany
- Hasso Plattner Institute at Mount Sinai, Mount Sinai School of Medicine, NY, US
- Institute for Molecular Medicine Finland: FIMM, University of Helsinki, Helsinki, Finland
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, 4103 Leipzig, Germany
| | - Chen-Ching Lin
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Medical Center, 4103 Leipzig, Germany
- Center for Rare Diseases, University of Leipzig Medical Center, 4103 Leipzig, Germany
| | - Diana Le Duc
- Institute of Human Genetics, University of Leipzig Medical Center, 4103 Leipzig, Germany
- Department of Evolutionary Genetics, Max Planck Institute for Evolutionary Anthropology, 04103, Leipzig, Germany
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19
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Boßelmann CM, Leu C, Lal D. Are AI language models such as ChatGPT ready to improve the care of individuals with epilepsy? Epilepsia 2023; 64:1195-1199. [PMID: 36869421 DOI: 10.1111/epi.17570] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Christian M Boßelmann
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T., Cambridge, Massachusetts, USA.,Cologne Center for Genomics (CCG), University of Cologne, Cologne, Delaware, USA
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20
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Brünger T, Pérez-Palma E, Montanucci L, Nothnagel M, Møller RS, Schorge S, Zuberi S, Symonds J, Lemke JR, Brunklaus A, Traynelis SF, May P, Lal D. Conserved patterns across ion channels correlate with variant pathogenicity and clinical phenotypes. Brain 2023; 146:923-934. [PMID: 36036558 PMCID: PMC9976975 DOI: 10.1093/brain/awac305] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
Clinically identified genetic variants in ion channels can be benign or cause disease by increasing or decreasing the protein function. As a consequence, therapeutic decision-making is challenging without molecular testing of each variant. Our biophysical knowledge of ion-channel structures and function is just emerging, and it is currently not well understood which amino acid residues cause disease when mutated. We sought to systematically identify biological properties associated with variant pathogenicity across all major voltage and ligand-gated ion-channel families. We collected and curated 3049 pathogenic variants from hundreds of neurodevelopmental and other disorders and 12 546 population variants for 30 ion channel or channel subunits for which a high-quality protein structure was available. Using a wide range of bioinformatics approaches, we computed 163 structural features and tested them for pathogenic variant enrichment. We developed a novel 3D spatial distance scoring approach that enables comparisons of pathogenic and population variant distribution across protein structures. We discovered and independently replicated that several pore residue properties and proximity to the pore axis were most significantly enriched for pathogenic variants compared to population variants. Using our 3D scoring approach, we showed that the strongest pathogenic variant enrichment was observed for pore-lining residues and alpha-helix residues within 5Å distance from the pore axis centre and not involved in gating. Within the subset of residues located at the pore, the hydrophobicity of the pore was the feature most strongly associated with variant pathogenicity. We also found an association between the identified properties and both clinical phenotypes and functional in vitro assays for voltage-gated sodium channels (SCN1A, SCN2A, SCN8A) and N-methyl-D-aspartate receptor (GRIN1, GRIN2A, GRIN2B) encoding genes. In an independent expert-curated dataset of 1422 neurodevelopmental disorder pathogenic patient variants and 679 electrophysiological experiments, we show that pore axis distance is associated with seizure age of onset and cognitive performance as well as differential gain versus loss-of-channel function. In summary, we identified biological properties associated with ion-channel malfunction and show that these are correlated with in vitro functional readouts and clinical phenotypes in patients with neurodevelopmental disorders. Our results suggest that clinical decision support algorithms that predict variant pathogenicity and function are feasible in the future.
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Affiliation(s)
- Tobias Brünger
- Cologne Center for Genomics, University of Cologne, 50931 Cologne, Germany
| | - Eduardo Pérez-Palma
- Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana, Universidad de Desarrollo, Santiago 7590943, Chile
| | - Ludovica Montanucci
- Lerner Research Institute Cleveland Clinic, Genomic Medicine Institute, Cleveland, OH 44195, USA
| | - Michael Nothnagel
- Cologne Center for Genomics, University of Cologne, 50931 Cologne, Germany
- University Hospital Cologne, 50937 Cologne, Germany
| | - Rikke S Møller
- Department of Epilepsy Genetics and Personalized Treatment, the Danish Epilepsy Center, DK 4293 Dianalund, Denmark
| | - Stephanie Schorge
- Department of Neuroscience, Physiology and Pharmacology, UCL, London WC1E 6BT, UK
| | - Sameer Zuberi
- The Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, UK
| | - Joseph Symonds
- The Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, UK
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Medical Center, 04103 Leipzig, Germany
- Center for Rare Diseases, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Andreas Brunklaus
- The Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, UK
| | - Stephen F Traynelis
- Department of Pharmacology, Emory University School of Medicine, Rollins Research Center, Atlanta, GA 30322-3090, USA
| | - Patrick May
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, L-4362 Esch-sur-Alzette, Luxembourg
| | - Dennis Lal
- Cologne Center for Genomics, University of Cologne, 50931 Cologne, Germany
- Lerner Research Institute Cleveland Clinic, Genomic Medicine Institute, Cleveland, OH 44195, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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21
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Iqbal S, Brünger T, Pérez-Palma E, Macnee M, Brunklaus A, Daly MJ, Campbell AJ, Hoksza D, May P, Lal D. Delineation of functionally essential protein regions for 242 neurodevelopmental genes. Brain 2023; 146:519-533. [PMID: 36256779 PMCID: PMC9924913 DOI: 10.1093/brain/awac381] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/12/2022] [Accepted: 09/04/2022] [Indexed: 01/25/2023] Open
Abstract
Neurodevelopmental disorders (NDDs), including severe paediatric epilepsy, autism and intellectual disabilities are heterogeneous conditions in which clinical genetic testing can often identify a pathogenic variant. For many of them, genetic therapies will be tested in this or the coming years in clinical trials. In contrast to first-generation symptomatic treatments, the new disease-modifying precision medicines require a genetic test-informed diagnosis before a patient can be enrolled in a clinical trial. However, even in 2022, most identified genetic variants in NDD genes are 'variants of uncertain significance'. To safely enrol patients in precision medicine clinical trials, it is important to increase our knowledge about which regions in NDD-associated proteins can 'tolerate' missense variants and which ones are 'essential' and will cause a NDD when mutated. In addition, knowledge about functionally indispensable regions in the 3D structure context of proteins can also provide insights into the molecular mechanisms of disease variants. We developed a novel consensus approach that overlays evolutionary, and population based genomic scores to identify 3D essential sites (Essential3D) on protein structures. After extensive benchmarking of AlphaFold predicted and experimentally solved protein structures, we generated the currently largest expert curated protein structure set for 242 NDDs and identified 14 377 Essential3D sites across 189 gene disorders associated proteins. We demonstrate that the consensus annotation of Essential3D sites improves prioritization of disease mutations over single annotations. The identified Essential3D sites were enriched for functional features such as intermembrane regions or active sites and discovered key inter-molecule interactions in protein complexes that were otherwise not annotated. Using the currently largest autism, developmental disorders, and epilepsies exome sequencing studies including >360 000 NDD patients and population controls, we found that missense variants at Essential3D sites are 8-fold enriched in patients. In summary, we developed a comprehensive protein structure set for 242 NDDs and identified 14 377 Essential3D sites in these. All data are available at https://es-ndd.broadinstitute.org for interactive visual inspection to enhance variant interpretation and development of mechanistic hypotheses for 242 NDDs genes. The provided resources will enhance clinical variant interpretation and in silico drug target development for NDD-associated genes and encoded proteins.
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Affiliation(s)
- Sumaiya Iqbal
- The Center for the Development of Therapeutics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Tobias Brünger
- Cologne Center for Genomics, University of Cologne, 50923 Köln, Germany
| | - Eduardo Pérez-Palma
- Universidad del Desarrollo, Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana, 7610658 Las Condes, Santiago de Chile, Chile
| | - Marie Macnee
- Cologne Center for Genomics, University of Cologne, 50923 Köln, Germany
| | - Andreas Brunklaus
- The Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow G12 8QQ, UK
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Mark J Daly
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Institute for Molecular Medicine Finland (FIMM), Centre of Excellence in Complex Disease Genetics, University of Helsinki, 00100 Helsinki, Finland
| | - Arthur J Campbell
- The Center for the Development of Therapeutics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - David Hoksza
- Department of Software Engineering, Faculty of Mathematics and Physics, Charles University, 110 00 Staré Město, Czechia, Czech Republic
| | - Patrick May
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
| | - Dennis Lal
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Cologne Center for Genomics, University of Cologne, 50923 Köln, Germany
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Genomic Medicine Institute, Lerner Research Institute Cleveland Clinic, Cleveland, OH 44106, USA
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22
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Smuk V, López-Rivera JA, Leu C, Lal D. The phenotypic spectrum associated with loss-of-function variants in monogenic epilepsy genes in the general population. Eur J Hum Genet 2023; 31:243-247. [PMID: 36253532 PMCID: PMC9905533 DOI: 10.1038/s41431-022-01211-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/17/2022] [Accepted: 10/03/2022] [Indexed: 11/08/2022] Open
Abstract
Variants in monogenic epilepsy genes can cause phenotypes of varying severity. For example, pathogenic variants in the SCN1A gene can cause the severe, sporadic, and drug-resistant Dravet syndrome or the milder familiar GEFS + syndrome. We hypothesized that coding variants in epilepsy-associated genes could lead to other disease-related phenotypes in the general population. We selected 127 established monogenic epilepsy genes and explored rare loss-of-function (LoF) variant associations with 3700 phenotypes across 281,850 individuals from the UK Biobank with whole-exome sequencing data. For 5.5% of epilepsy genes, we found significant associations of LoF variants with non-epilepsy phenotypes, mostly related to mental health. These findings suggest that LoF variants in epilepsy genes are associated with neurological or psychiatric phenotypes in the general population. The evidence provided may warrant further research and genetic screening of patients with atypical presentation and inform clinical care of comorbid disorders in individuals with monogenic epilepsy forms.
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Affiliation(s)
- Victoria Smuk
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Javier A López-Rivera
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
- Cologne Center for Genomics, University of Cologne, Cologne, NRW, Germany.
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23
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Barba C, Blumcke I, Winawer MR, Hartlieb T, Kang HC, Grisotto L, Chipaux M, Bien CG, Heřmanovská B, Porter BE, Lidov HGW, Cetica V, Woermann FG, Lopez-Rivera JA, Canoll PD, Mader I, D'Incerti L, Baldassari S, Yang E, Gaballa A, Vogel H, Straka B, Macconi L, Polster T, Grant GA, Krsková L, Shin HJ, Ko A, Crino PB, Krsek P, Lee JH, Lal D, Baulac S, Poduri A, Guerrini R. Clinical Features, Neuropathology, and Surgical Outcome in Patients With Refractory Epilepsy and Brain Somatic Variants in the SLC35A2 Gene. Neurology 2023; 100:e528-e542. [PMID: 36307217 PMCID: PMC9931085 DOI: 10.1212/wnl.0000000000201471] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/09/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The SLC35A2 gene, located at chromosome Xp11.23, encodes for a uridine diphosphate-galactose transporter. We describe clinical, genetic, neuroimaging, EEG, and histopathologic findings and assess possible predictors of postoperative seizure and cognitive outcome in 47 patients with refractory epilepsy and brain somatic SLC35A2 gene variants. METHODS This is a retrospective multicenter study where we performed a descriptive analysis and classical hypothesis testing. We included the variables of interest significantly associated with the outcomes in the generalized linear models. RESULTS Two main phenotypes were associated with brain somatic SLC35A2 variants: (1) early epileptic encephalopathy (EE, 39 patients) with epileptic spasms as the predominant seizure type and moderate to severe intellectual disability and (2) drug-resistant focal epilepsy (DR-FE, 8 patients) associated with normal/borderline cognitive function and specific neuropsychological deficits. Brain MRI was abnormal in all patients with EE and in 50% of those with DR-FE. Histopathology review identified mild malformation of cortical development with oligodendroglial hyperplasia in epilepsy in 44/47 patients and was inconclusive in 3. The 47 patients harbored 42 distinct mosaic SLC35A2 variants, including 14 (33.3%) missense, 13 (30.9%) frameshift, 10 (23.8%) nonsense, 4 (9.5%) in-frame deletions/duplications, and 1 (2.4%) splicing variant. Variant allele frequencies (VAFs) ranged from 1.4% to 52.6% (mean VAF: 17.3 ± 13.5). At last follow-up (35.5 ± 21.5 months), 30 patients (63.8%) were in Engel Class I, of which 26 (55.3%) were in Class IA. Cognitive performances remained unchanged in most patients after surgery. Regression analyses showed that the probability of achieving both Engel Class IA and Class I outcomes, adjusted by age at seizure onset, was lower when the duration of epilepsy increased and higher when postoperative EEG was normal or improved. Lower brain VAF was associated with improved postoperative cognitive outcome in the analysis of associations, but this finding was not confirmed in regression analyses. DISCUSSION Brain somatic SLC35A2 gene variants are associated with 2 main clinical phenotypes, EE and DR-FE, and a histopathologic diagnosis of MOGHE. Additional studies will be needed to delineate any possible correlation between specific genetic variants, mutational load in the epileptogenic tissue, and surgical outcomes.
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Affiliation(s)
- Carmen Barba
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Ingmar Blumcke
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Melodie R Winawer
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Till Hartlieb
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Hoon-Chul Kang
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Laura Grisotto
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Mathilde Chipaux
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Christian G Bien
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Barbora Heřmanovská
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Brenda E Porter
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Hart G W Lidov
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Valentina Cetica
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Friedrich G Woermann
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Javier A Lopez-Rivera
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Peter D Canoll
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Irina Mader
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Ludovico D'Incerti
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Sara Baldassari
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Edward Yang
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Ahmed Gaballa
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Hannes Vogel
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Barbora Straka
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Letizia Macconi
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Tilman Polster
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Gerald A Grant
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Lenka Krsková
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Hui Jin Shin
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Ara Ko
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Peter B Crino
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Pavel Krsek
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Jeong Ho Lee
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Dennis Lal
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Stéphanie Baulac
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Annapurna Poduri
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
| | - Renzo Guerrini
- From the IRCCS Meyer Children's Hospital (C.B., V.C., L.D.I., L.M., R.G.), Florence, Italy; University of Florence (C.B., L.G., R.G.), Florence, Italy; University Hospital Erlangen (I.B.), Germany; Columbia University (M.R.W., P.D.C.), New York, NY; Neurorehabilitation and Epileptology (T.H., I.M.), Vogtareuth, Germany; PMU Salzburg (T.H.), Austria; Yonsei University College of Medicine (H.-C.K., H.J.S.), Seoul, Republic of Korea; Rothschild Foundation Hospital (M.C.), Paris, France; Krankenhaus Mara (C.G.B., F.G.W., A.G., T.P.), Bielefeld University, Medical School, Germany; Charles University (B.H., B.S., L.K., P.K.), 2nd Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Stanford University (B.E.P., H.V.), School of Medicine Stanford, CA; Boston Children's Hospital and Harvard Medical School (H.G.W.L., E.Y., A.P.), MA; Society of Epilepsy Research (F.G.W.), Bielefeld, Germany; Case Western Reserve University (J.A.L.-R.), OH; Cleveland Clinic (J.A.L.-R., D.L.), Cleveland, OH; Sorbonne University (Sara Baldassari, Stéphanie Baulac), Paris Brain Institute (ICM), INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, France; Lucile Packard Children's Hospital at Stanford University (G.A.G.), School of Medicine Stanford, CA; Korea Advanced Institute of Science and Technology (A.K., J.H.L.), Daejeon, South Korea; University of Maryland School of Medicine (P.B.C.), Baltimore, MD; and Broad Institute of Harvard and M.I.T (D.L.), Cambridge, MA
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Brunklaus A, Feng T, Brünger T, Perez-Palma E, Heyne H, Matthews E, Semsarian C, Symonds JD, Zuberi SM, Lal D, Schorge S. Gene variant effects across sodium channelopathies predict function and guide precision therapy. Brain 2022; 145:4275-4286. [PMID: 35037686 PMCID: PMC9897196 DOI: 10.1093/brain/awac006] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/27/2021] [Accepted: 12/10/2021] [Indexed: 11/14/2022] Open
Abstract
Pathogenic variants in the voltage-gated sodium channel gene family lead to early onset epilepsies, neurodevelopmental disorders, skeletal muscle channelopathies, peripheral neuropathies and cardiac arrhythmias. Disease-associated variants have diverse functional effects ranging from complete loss-of-function to marked gain-of-function. Therapeutic strategy is likely to depend on functional effect. Experimental studies offer important insights into channel function but are resource intensive and only performed in a minority of cases. Given the evolutionarily conserved nature of the sodium channel genes, we investigated whether similarities in biophysical properties between different voltage-gated sodium channels can predict function and inform precision treatment across sodium channelopathies. We performed a systematic literature search identifying functionally assessed variants in any of the nine voltage-gated sodium channel genes until 28 April 2021. We included missense variants that had been electrophysiologically characterized in mammalian cells in whole-cell patch-clamp recordings. We performed an alignment of linear protein sequences of all sodium channel genes and correlated variants by their overall functional effect on biophysical properties. Of 951 identified records, 437 sodium channel-variants met our inclusion criteria and were reviewed for functional properties. Of these, 141 variants were epilepsy-associated (SCN1/2/3/8A), 79 had a neuromuscular phenotype (SCN4/9/10/11A), 149 were associated with a cardiac phenotype (SCN5/10A) and 68 (16%) were considered benign. We detected 38 missense variant pairs with an identical disease-associated variant in a different sodium channel gene. Thirty-five out of 38 of those pairs resulted in similar functional consequences, indicating up to 92% biophysical agreement between corresponding sodium channel variants (odds ratio = 11.3; 95% confidence interval = 2.8 to 66.9; P < 0.001). Pathogenic missense variants were clustered in specific functional domains, whereas population variants were significantly more frequent across non-conserved domains (odds ratio = 18.6; 95% confidence interval = 10.9-34.4; P < 0.001). Pore-loop regions were frequently associated with loss-of-function variants, whereas inactivation sites were associated with gain-of-function (odds ratio = 42.1, 95% confidence interval = 14.5-122.4; P < 0.001), whilst variants occurring in voltage-sensing regions comprised a range of gain- and loss-of-function effects. Our findings suggest that biophysical characterisation of variants in one SCN-gene can predict channel function across different SCN-genes where experimental data are not available. The collected data represent the first gain- versus loss-of-function topological map of SCN proteins indicating shared patterns of biophysical effects aiding variant analysis and guiding precision therapy. We integrated our findings into a free online webtool to facilitate functional sodium channel gene variant interpretation (http://SCN-viewer.broadinstitute.org).
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Affiliation(s)
- Andreas Brunklaus
- Correspondence to: Dr Andreas Brunklaus, MD Fraser of Allander Neurosciences Unit Office Block, Ground Floor, Zone 2 Royal Hospital for Children 1345 Govan Road Glasgow G51 4TF, UK E-mail:
| | | | | | - Eduardo Perez-Palma
- Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Henrike Heyne
- Genomic and Personalized Medicine, Digital Health Center, Hasso Plattner Institute, Potsdam, Germany
- Hasso Plattner Institute, Mount Sinai School of Medicine, New York, NY, USA
- Institute for Molecular Medicine Finland: FIMM, Helsinki, Finland
| | - Emma Matthews
- Atkinson Morley Neuromuscular Centre, St George’s University Hospitals NHS Foundation Trust, London, UK
- Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
- Sydney Medical School Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Joseph D Symonds
- The Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sameer M Zuberi
- The Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Dennis Lal
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
- Stanley Center for Psychiatric Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Stephanie Schorge
- Correspondence may also be addressed to: Professor Stephanie Schorge, PhD Department of Neuroscience Physiology and Pharmacology UCL, London WC1E 6BT, UK E-mail:
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25
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Brunklaus A, Brünger T, Feng T, Fons C, Lehikoinen A, Panagiotakaki E, Vintan MA, Symonds J, Andrew J, Arzimanoglou A, Delima S, Gallois J, Hanrahan D, Lesca G, MacLeod S, Marjanovic D, McTague A, Nuñez-Enamorado N, Perez-Palma E, Scott Perry M, Pysden K, Russ-Hall SJ, Scheffer IE, Sully K, Syrbe S, Vaher U, Velayutham M, Vogt J, Weiss S, Wirrell E, Zuberi SM, Lal D, Møller RS, Mantegazza M, Cestèle S. The gain of function SCN1A disorder spectrum: novel epilepsy phenotypes and therapeutic implications. Brain 2022; 145:3816-3831. [PMID: 35696452 PMCID: PMC9679167 DOI: 10.1093/brain/awac210] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/14/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022] Open
Abstract
Brain voltage-gated sodium channel NaV1.1 (SCN1A) loss-of-function variants cause the severe epilepsy Dravet syndrome, as well as milder phenotypes associated with genetic epilepsy with febrile seizures plus. Gain of function SCN1A variants are associated with familial hemiplegic migraine type 3. Novel SCN1A-related phenotypes have been described including early infantile developmental and epileptic encephalopathy with movement disorder, and more recently neonatal presentations with arthrogryposis. Here we describe the clinical, genetic and functional evaluation of affected individuals. Thirty-five patients were ascertained via an international collaborative network using a structured clinical questionnaire and from the literature. We performed whole-cell voltage-clamp electrophysiological recordings comparing sodium channels containing wild-type versus variant NaV1.1 subunits. Findings were related to Dravet syndrome and familial hemiplegic migraine type 3 variants. We identified three distinct clinical presentations differing by age at onset and presence of arthrogryposis and/or movement disorder. The most severely affected infants (n = 13) presented with congenital arthrogryposis, neonatal onset epilepsy in the first 3 days of life, tonic seizures and apnoeas, accompanied by a significant movement disorder and profound intellectual disability. Twenty-one patients presented later, between 2 weeks and 3 months of age, with a severe early infantile developmental and epileptic encephalopathy and a movement disorder. One patient presented after 3 months with developmental and epileptic encephalopathy only. Associated SCN1A variants cluster in regions of channel inactivation associated with gain of function, different to Dravet syndrome variants (odds ratio = 17.8; confidence interval = 5.4-69.3; P = 1.3 × 10-7). Functional studies of both epilepsy and familial hemiplegic migraine type 3 variants reveal alterations of gating properties in keeping with neuronal hyperexcitability. While epilepsy variants result in a moderate increase in action current amplitude consistent with mild gain of function, familial hemiplegic migraine type 3 variants induce a larger effect on gating properties, in particular the increase of persistent current, resulting in a large increase of action current amplitude, consistent with stronger gain of function. Clinically, 13 out of 16 (81%) gain of function variants were associated with a reduction in seizures in response to sodium channel blocker treatment (carbamazepine, oxcarbazepine, phenytoin, lamotrigine or lacosamide) without evidence of symptom exacerbation. Our study expands the spectrum of gain of function SCN1A-related epilepsy phenotypes, defines key clinical features, provides novel insights into the underlying disease mechanisms between SCN1A-related epilepsy and familial hemiplegic migraine type 3, and identifies sodium channel blockers as potentially efficacious therapies. Gain of function disease should be considered in early onset epilepsies with a pathogenic SCN1A variant and non-Dravet syndrome phenotype.
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Affiliation(s)
- Andreas Brunklaus
- Correspondence to: Professor Andreas Brunklaus, MD Institute of Health and Wellbeing University of Glasgow Paediatric Neurosciences Research Group Office Block, Ground Floor, Zone 2 Royal Hospital for Children 1345 Govan Road, Glasgow G51 4TF, UK E-mail:
| | - Tobias Brünger
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Tony Feng
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- The Paediatric Neurosciences Research Group, Royal Hospital for Children, Member of the ERN EpiCARE, Glasgow, UK
| | - Carmen Fons
- Pediatric Neurology Department, CIBERER-ISCIII, Sant Joan de Déu Universitary Hospital, Institut de Recerca Sant Joan de Déu, Member of the ERN EpiCARE, Barcelona, Spain
| | - Anni Lehikoinen
- Pediatric Neurology Department, Kuopio University Hospital, Member of the ERN EpiCARE, Kuopio, Finland
| | - Eleni Panagiotakaki
- Department of Paediatric Clinical Epileptology, sleep disorders and functional neurology, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL) and Inserm U1028/CNRS UMR5292, Lyon, France
| | - Mihaela-Adela Vintan
- ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology and Pediatric Neurology, Victor Babes, 43, 400012 Cluj-Napoca, Romania
| | - Joseph Symonds
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- The Paediatric Neurosciences Research Group, Royal Hospital for Children, Member of the ERN EpiCARE, Glasgow, UK
| | - James Andrew
- The Paediatric Neurosciences Research Group, Royal Hospital for Children, Member of the ERN EpiCARE, Glasgow, UK
| | - Alexis Arzimanoglou
- Pediatric Neurology Department, CIBERER-ISCIII, Sant Joan de Déu Universitary Hospital, Institut de Recerca Sant Joan de Déu, Member of the ERN EpiCARE, Barcelona, Spain
- Department of Paediatric Clinical Epileptology, sleep disorders and functional neurology, Member of the ERN EpiCARE, University Hospitals of Lyon (HCL) and Inserm U1028/CNRS UMR5292, Lyon, France
| | - Sarah Delima
- Indiana University School of Medicine, IU Health Riley Hospital for Children, Department of Neurology, Division of Pediatric Neurology, Indianapolis, IN, USA
| | - Julie Gallois
- Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - Donncha Hanrahan
- Department of Paediatric Neurology, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Gaetan Lesca
- Department of Medical Genetics, Lyon University Hospital, Member of the ERN EpiCARE, Université Claude Bernard Lyon 1, Lyon, France
| | - Stewart MacLeod
- The Paediatric Neurosciences Research Group, Royal Hospital for Children, Member of the ERN EpiCARE, Glasgow, UK
| | - Dragan Marjanovic
- The Danish Epilepsy Centre, Member of the ERN EpiCARE, Dianalund, Denmark
| | - Amy McTague
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Neurology, Great Ormond Street Hospital for Children, Member of the ERN EpiCARE, London, UK
| | | | - Eduardo Perez-Palma
- Universidad del Desarrollo, Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana, Santiago, Chile
| | - M Scott Perry
- Jane and John Justin Neurosciences Center, Cook Children’s Medical Center, Ft Worth, TX, USA
| | - Karen Pysden
- Paediatric Neurology Department, Leeds Teaching Hospitals, Leeds General Infirmary, Leeds, UK
| | - Sophie J Russ-Hall
- Epilepsy Research Centre, Department of Medicine, University of Melbourne, Austin Health, Melbourne, Australia
| | - Ingrid E Scheffer
- Epilepsy Research Centre, Department of Medicine, University of Melbourne, Austin Health, Melbourne, Australia
- Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
- Murdoch Children’s Research Institute and Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, Melbourne, Australia
| | - Krystal Sully
- Baylor College of Medicine, Houston, TX, USA
- Texas Children’s Hospital, Houston, TX, USA
| | - Steffen Syrbe
- Division of Pediatric Epileptology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulvi Vaher
- Children’s Clinic of Tartu University Hospital, Faculty of Medicine of Tartu University, Member of the ERN EpiCARE, Tartu, Estonia
| | | | - Julie Vogt
- West Midlands Regional Genetics Service, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Shelly Weiss
- Division of Neurology, SickKids, University of Toronto, Toronto, Canada
| | - Elaine Wirrell
- Divisions of Epilepsy and Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Sameer M Zuberi
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- The Paediatric Neurosciences Research Group, Royal Hospital for Children, Member of the ERN EpiCARE, Glasgow, UK
| | - Dennis Lal
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Stanley Center for Psychiatric Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Rikke S Møller
- Correspondence may also be addressed to: Professor Rikke Steensbjerre Møller, PhD E-mail: ; Professor Massimo Mantegazza, PhD E-mail: ; Professor Sandrine Cestèle, PhD E-mail:
| | - Massimo Mantegazza
- Correspondence may also be addressed to: Professor Rikke Steensbjerre Møller, PhD E-mail: ; Professor Massimo Mantegazza, PhD E-mail: ; Professor Sandrine Cestèle, PhD E-mail:
| | - Sandrine Cestèle
- Correspondence may also be addressed to: Professor Rikke Steensbjerre Møller, PhD E-mail: ; Professor Massimo Mantegazza, PhD E-mail: ; Professor Sandrine Cestèle, PhD E-mail:
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26
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López-Rivera JA, Leu C, Macnee M, Khoury J, Hoffmann L, Coras R, Kobow K, Bhattarai N, Pérez-Palma E, Hamer H, Brandner S, Rössler K, Bien CG, Kalbhenn T, Pieper T, Hartlieb T, Butler E, Genovese G, Becker K, Altmüller J, Niestroj LM, Ferguson L, Busch RM, Nürnberg P, Najm I, Blümcke I, Lal D. The genomic landscape across 474 surgically accessible epileptogenic human brain lesions. Brain 2022; 146:1342-1356. [PMID: 36226386 PMCID: PMC10115236 DOI: 10.1093/brain/awac376] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/11/2022] [Accepted: 10/12/2022] [Indexed: 11/12/2022] Open
Abstract
Understanding the exact molecular mechanisms involved in the etiology of epileptogenic pathologies with or without tumor activity is essential for improving treatment of drug-resistant focal epilepsy. Here, we characterize the landscape of somatic genetic variants in resected brain specimens from 474 individuals with drug-resistant focal epilepsy using deep whole-exome sequencing (>350×) and whole-genome genotyping. Across the exome, we observe a greater number of somatic single-nucleotide variants (SNV) in low-grade epilepsy-associated tumors (LEAT; 7.92 ± 5.65 SNV) than in brain tissue from malformations of cortical development (MCD; 6.11 ± 4 SNV) or hippocampal sclerosis (HS; 5.1 ± 3.04 SNV). Tumor tissues also had the largest number of likely pathogenic variant carrying cells. LEAT had the highest proportion of samples with one or more somatic copy number variants (CNV; 24.7%), followed by MCD (5.4%) and HS (4.1%). Recurring somatic whole chromosome duplications affecting Chromosome 7 (16.8%), chromosome 5 (10.9%), and chromosome 20 (9.9%) were observed among LEAT. For germline variant-associated MCD genes such as TSC2, DEPDC5, and PTEN, germline SNV were frequently identified within large loss of heterozygosity regions, supporting the recently proposed 'second hit' disease mechanism in these genes. We detect somatic variants in twelve established lesional epilepsy genes and demonstrate exome-wide statistical support for three of these in the etiology of LEAT (e.g., BRAF) and MCD (e.g., SLC35A2 and MTOR). We also identify novel significant associations for PTPN11 with LEAT and NRAS Q61 mutated protein with a complex MCD characterized by polymicrogyria and nodular heterotopia. The variants identified in NRAS are known from cancer studies to lead to hyperactivation of NRAS, which can be targeted pharmacologically. We identify large recurrent 1q21-q44 duplication including AKT3 in association with focal cortical dysplasia type 2a with hyaline astrocytic inclusions, another rare and possibly under-recognized brain lesion. The clinical genetic analyses showed that the numbers of somatic SNV across the exome and the fraction of affected cells were positively correlated with the age at seizure onset and surgery in individuals with LEAT. In summary, our comprehensive genetic screen sheds light on the genome-scale landscape of genetic variants in epileptic brain lesions, informs the design of gene panels for clinical diagnostic screening, and guides future directions for clinical implementation of epilepsy surgery genetics.
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Affiliation(s)
- Javier A López-Rivera
- Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, USA.,Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.,Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.,Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA 02142, USA.,Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - Marie Macnee
- Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50931 Cologne, Germany
| | - Jean Khoury
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Lucas Hoffmann
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany, and partner of the European Reference Network (ERN) EpiCARE
| | - Roland Coras
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany, and partner of the European Reference Network (ERN) EpiCARE
| | - Katja Kobow
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany, and partner of the European Reference Network (ERN) EpiCARE
| | - Nisha Bhattarai
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.,Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Eduardo Pérez-Palma
- Universidad del Desarrollo, Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana. Santiago 7610658, Chile
| | - Hajo Hamer
- Epilepsy Center, University Hospital Erlangen, Erlangen, Germany, and EpiCARE partner
| | - Sebastian Brandner
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany, and EpiCARE partner
| | - Karl Rössler
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria, and EpiCARE partner
| | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Thilo Kalbhenn
- Department of Neurosurgery - Epilepsy surgery, Evangelisches Klinikum Bethel, Universitätsklinikum OWL, Bielefeld University, Bielefeld, Germany
| | - Tom Pieper
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, Germany
| | - Till Hartlieb
- Center for Pediatric Neurology, Neurorehabilitation, and Epileptology, Schoen-Clinic, Vogtareuth, Germany.,Research Institute "Rehabilitation, Transition, Palliation", PMU Salzburg, Salzburg, Austria
| | - Elizabeth Butler
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Giulio Genovese
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA 02142, USA
| | - Kerstin Becker
- Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50931 Cologne, Germany
| | - Janine Altmüller
- Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50931 Cologne, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Core Facility Genomics, Charitéplatz 1, 10117 Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Lisa Marie Niestroj
- Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50931 Cologne, Germany
| | - Lisa Ferguson
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Robyn M Busch
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.,Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Peter Nürnberg
- Cologne Center for Genomics (CCG), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50931 Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50931 Cologne, Germany
| | - Imad Najm
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA
| | - Ingmar Blümcke
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, USA.,Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany, and partner of the European Reference Network (ERN) EpiCARE
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.,Charles Shor Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, 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, Faculty of Medicine and University Hospital Cologne, 50931 Cologne, Germany
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Louis S, Busch RM, Lal D, Hockings J, Hogue O, Morita-Sherman M, Vegh D, Najm I, Ghosh C, Bazeley P, Eng C, Jehi L, Rotroff DM. Genetic and molecular features of seizure-freedom following surgical resections for focal epilepsy: A pilot study. Front Neurol 2022; 13:942643. [PMID: 36188379 PMCID: PMC9524264 DOI: 10.3389/fneur.2022.942643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Seizure outcomes after brain surgery for drug-resistant epilepsy (DRE) are very heterogeneous and difficult to predict with models utilizing the current clinical, imaging, and electrophysiological variables. In this pilot study, we investigated whether genetic and molecular biomarkers (e.g., genomic, transcriptomic) can provide additional insight into differential response to surgery. Methods Post-operative seizure-outcomes were collected at last follow-up (>6 months) for 201 adult patients with DRE who underwent surgery between 2004 and 2020. Resected tissue was sent for miRNA sequencing (n = 132) and mRNA sequencing (n = 135). Following the selection of 10 genes (SCN1A, NBEA, PTEN, GABRA1, LGL1, DEPDC5, IL1A, ABCB1, C3, CALHM1), we investigated SNPs in those 10 genes from previously acquired exome sequencing data (n = 106). Logistic regression was performed to test for associations between individual features (mRNAs, miRNAs, and SNPs) and post-operative seizure-outcome with an exploratory FDR P < 0.25 as the threshold for significance. Post-operative time-to-seizure analyses were performed for each SNP using a Cox proportional hazards model. Results The majority of patients (83%) had temporal lobe epilepsy. Mean age at surgery was 38.3 years, and 56% were female. Three SNPs (rs10276036, rs11975994, rs1128503) in multi-drug resistance gene, ABCB1, were associated with post-operative seizure outcomes. Patients with alternate alleles in ABCB1 were more likely to be seizure-free at last follow-up (52–56% reduction in seizure recurrence; FDR P = 0.24). All three SNPs were in linkage disequilibrium and highly correlated with each other. Median post-operative time-to-seizure was 63 months for patients with 2 alternate alleles, 24–33 months with 1 alternate allele, and 10–11 months with 0 alternate alleles. These SNPs improved outcome prediction beyond MRI and sex alone. No independent miRNAs or mRNAs were significantly associated with seizure-outcome (P > 0.05). However, pathway analysis identified “cancer drug resistance by drug efflux” (mir-154 and mir-379) as enriched (P = 0.02), supporting the role of drug response genes in post-operative seizure recurrence. Significance ABCB1 may have a role in epileptogenesis and surgery outcomes independent of its drug efflux activity necessitating further investigation. SNPs in ABCB1 may serve as independent predictors of post-operative outcome.
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Affiliation(s)
- Shreya Louis
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Robyn M. Busch
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Dennis Lal
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jennifer Hockings
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Center for Personalized Genetic Healthcare, Community Care and Population Health, Cleveland Clinic, Cleveland, OH, United States
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, United States
| | - Olivia Hogue
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Marcia Morita-Sherman
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Deborah Vegh
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Imad Najm
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Chaitali Ghosh
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Peter Bazeley
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Charis Eng
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Center for Personalized Genetic Healthcare, Community Care and Population Health, Cleveland Clinic, Cleveland, OH, United States
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Lara Jehi
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Lara Jehi
| | - Daniel M. Rotroff
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, United States
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, United States
- *Correspondence: Daniel M. Rotroff
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Johannesen KM, Liu Y, Koko M, Gjerulfsen CE, Sonnenberg L, Schubert J, Fenger CD, Eltokhi A, Rannap M, Koch NA, Lauxmann S, Krüger J, Kegele J, Canafoglia L, Franceschetti S, Mayer T, Rebstock J, Zacher P, Ruf S, Alber M, Sterbova K, Lassuthová P, Vlckova M, Lemke JR, Platzer K, Krey I, Heine C, Wieczorek D, Kroell-Seger J, Lund C, Klein KM, Au PYB, Rho JM, Ho AW, Masnada S, Veggiotti P, Giordano L, Accorsi P, Hoei-Hansen CE, Striano P, Zara F, Verhelst H, Verhoeven JS, Braakman HMH, van der Zwaag B, Harder AVE, Brilstra E, Pendziwiat M, Lebon S, Vaccarezza M, Le NM, Christensen J, Grønborg S, Scherer SW, Howe J, Fazeli W, Howell KB, Leventer R, Stutterd C, Walsh S, Gerard M, Gerard B, Matricardi S, Bonardi CM, Sartori S, Berger A, Hoffman-Zacharska D, Mastrangelo M, Darra F, Vøllo A, Motazacker MM, Lakeman P, Nizon M, Betzler C, Altuzarra C, Caume R, Roubertie A, Gélisse P, Marini C, Guerrini R, Bilan F, Tibussek D, Koch-Hogrebe M, Perry MS, Ichikawa S, Dadali E, Sharkov A, Mishina I, Abramov M, Kanivets I, Korostelev S, Kutsev S, Wain KE, Eisenhauer N, Wagner M, Savatt JM, Müller-Schlüter K, Bassan H, Borovikov A, Nassogne MC, Destrée A, Schoonjans AS, Meuwissen M, Buzatu M, Jansen A, Scalais E, Srivastava S, Tan WH, Olson HE, Loddenkemper T, Poduri A, Helbig KL, Helbig I, Fitzgerald MP, Goldberg EM, Roser T, Borggraefe I, Brünger T, May P, Lal D, Lederer D, Rubboli G, Heyne HO, Lesca G, Hedrich UBS, Benda J, Gardella E, Lerche H, Møller RS. Genotype-phenotype correlations in SCN8A-related disorders reveal prognostic and therapeutic implications. Brain 2022; 145:2991-3009. [PMID: 34431999 PMCID: PMC10147326 DOI: 10.1093/brain/awab321] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/24/2021] [Accepted: 07/22/2021] [Indexed: 11/13/2022] Open
Abstract
We report detailed functional analyses and genotype-phenotype correlations in 392 individuals carrying disease-causing variants in SCN8A, encoding the voltage-gated Na+ channel Nav1.6, with the aim of describing clinical phenotypes related to functional effects. Six different clinical subgroups were identified: Group 1, benign familial infantile epilepsy (n = 15, normal cognition, treatable seizures); Group 2, intermediate epilepsy (n = 33, mild intellectual disability, partially pharmaco-responsive); Group 3, developmental and epileptic encephalopathy (n = 177, severe intellectual disability, majority pharmaco-resistant); Group 4, generalized epilepsy (n = 20, mild to moderate intellectual disability, frequently with absence seizures); Group 5, unclassifiable epilepsy (n = 127); and Group 6, neurodevelopmental disorder without epilepsy (n = 20, mild to moderate intellectual disability). Those in Groups 1-3 presented with focal or multifocal seizures (median age of onset: 4 months) and focal epileptiform discharges, whereas the onset of seizures in patients with generalized epilepsy was later (median: 42 months) with generalized epileptiform discharges. We performed functional studies expressing missense variants in ND7/23 neuroblastoma cells and primary neuronal cultures using recombinant tetrodotoxin-insensitive human Nav1.6 channels and whole-cell patch-clamping. Two variants causing developmental and epileptic encephalopathy showed a strong gain-of-function (hyperpolarizing shift of steady-state activation, strongly increased neuronal firing rate) and one variant causing benign familial infantile epilepsy or intermediate epilepsy showed a mild gain-of-function (defective fast inactivation, less increased firing). In contrast, all three variants causing generalized epilepsy induced a loss-of-function (reduced current amplitudes, depolarizing shift of steady-state activation, reduced neuronal firing). Functional effects were known for 170 individuals. All 136 individuals carrying a functionally tested gain-of-function variant had either focal (n = 97, Groups 1-3) or unclassifiable (n = 39) epilepsy, whereas 34 individuals with a loss-of-function variant had either generalized (n = 14), no (n = 11) or unclassifiable (n = 6) epilepsy; only three had developmental and epileptic encephalopathy. Computational modelling in the gain-of-function group revealed a significant correlation between the severity of the electrophysiological and clinical phenotypes. Gain-of-function variant carriers responded significantly better to sodium channel blockers than to other anti-seizure medications, and the same applied for all individuals in Groups 1-3. In conclusion, our data reveal clear genotype-phenotype correlations between age at seizure onset, type of epilepsy and gain- or loss-of-function effects of SCN8A variants. Generalized epilepsy with absence seizures is the main epilepsy phenotype of loss-of-function variant carriers and the extent of the electrophysiological dysfunction of the gain-of-function variants is a main determinant of the severity of the clinical phenotype in focal epilepsies. Our pharmacological data indicate that sodium channel blockers present a treatment option in SCN8A-related focal epilepsy with onset in the first year of life.
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Affiliation(s)
- Katrine M Johannesen
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Center, 4293 Dianalund, Denmark
- Institute for Regional Health Services, University of Southern Denmark, 5230 Odense, Denmark
| | - Yuanyuan Liu
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, 72072 Tuebingen, Germany
| | - Mahmoud Koko
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, 72072 Tuebingen, Germany
| | - Cathrine E Gjerulfsen
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Center, 4293 Dianalund, Denmark
| | - Lukas Sonnenberg
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, 72072 Tuebingen, Germany
- Institute for Neurobiology, University of Tuebingen, 72072 Tuebingen, Germany
| | - Julian Schubert
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, 72072 Tuebingen, Germany
| | - Christina D Fenger
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Center, 4293 Dianalund, Denmark
| | - Ahmed Eltokhi
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, 72072 Tuebingen, Germany
| | - Maert Rannap
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, 72072 Tuebingen, Germany
| | - Nils A Koch
- Institute for Neurobiology, University of Tuebingen, 72072 Tuebingen, Germany
| | - Stephan Lauxmann
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, 72072 Tuebingen, Germany
- Institute for Neurobiology, University of Tuebingen, 72072 Tuebingen, Germany
| | - Johanna Krüger
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, 72072 Tuebingen, Germany
| | - Josua Kegele
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, 72072 Tuebingen, Germany
| | - Laura Canafoglia
- Department of Diagnostics and Technology, Fondazione IRCCS Istituto Neurologio Carlo Besta, 20125 Milan, Italy
| | - Silvana Franceschetti
- Department of Diagnostics and Technology, Fondazione IRCCS Istituto Neurologio Carlo Besta, 20125 Milan, Italy
| | - Thomas Mayer
- Epilepsy Center Kleinwachau, 01454 Dresden-Radeberg, Germany
| | | | - Pia Zacher
- Epilepsy Center Kleinwachau, 01454 Dresden-Radeberg, Germany
| | - Susanne Ruf
- Department of Pediatric Neurology and Developmental Medicine, University Children’s Hospital, 72072 Tuebingen, Germany
| | - Michael Alber
- Department of Pediatric Neurology and Developmental Medicine, University Children’s Hospital, 72072 Tuebingen, Germany
| | - Katalin Sterbova
- Department of Child Neurology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, 10000 Prague, Czech Republic
| | - Petra Lassuthová
- Department of Child Neurology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, 10000 Prague, Czech Republic
| | - Marketa Vlckova
- Department of Child Neurology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, 10000 Prague, Czech Republic
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Hospitals and Clinics, 4275 Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Hospitals and Clinics, 4275 Leipzig, Germany
| | - Ilona Krey
- Institute of Human Genetics, University of Leipzig Hospitals and Clinics, 4275 Leipzig, Germany
| | - Constanze Heine
- Institute of Human Genetics, University of Leipzig Hospitals and Clinics, 4275 Leipzig, Germany
| | - Dagmar Wieczorek
- Institute of Human Genetics, University Clinic, Heinrich-Heine-University, 40210 Düsseldorf, Germany
| | - Judith Kroell-Seger
- Children’s Department, Swiss Epilepsy Centre, Clinic Lengg, 8001 Zurich, Switzerland
| | - Caroline Lund
- National Centre for Rare Epilepsy-Related Disorders, Oslo University Hospital, 0001 Oslo, Norway
| | - Karl Martin Klein
- Departments of Clinical Neurosciences, Medical Genetics and Community Health Sciences, Hotchkiss Brain Institute and Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2P 0A1, Canada
| | - P Y Billie Au
- Department of Medical Genetics, Alberta Children’s Hospital Research Institute, University of Calgary, AB T6G 2T4, Canada
| | - Jong M Rho
- Section of Pediatric Neurology, Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB T2P 0A1, Canada
| | - Alice W Ho
- Section of Pediatric Neurology, Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB T2P 0A1, Canada
| | - Silvia Masnada
- Department of Child Neurology, V. Buzzi Children’s Hospital, 20125 Milan, Italy
| | - Pierangelo Veggiotti
- Department of Child Neurology, V. Buzzi Children’s Hospital, 20125 Milan, Italy
- ‘L. Sacco’ Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Lucio Giordano
- Child Neuropsychiatric Unit, Civilian Hospital, 25100 Brescia, Italy
| | - Patrizia Accorsi
- Child Neuropsychiatric Unit, Civilian Hospital, 25100 Brescia, Italy
| | - Christina E Hoei-Hansen
- Department of Pediatrics, Copenhagen University Hospital Rigshospitalet, 2200 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16121 Genova, Italy
- IRCCS ‘G. Gaslini’ Institute, 16121 Genoa, Italy
| | | | - Helene Verhelst
- Department of Pediatrics, Division of Pediatric Neurology, Gent University Hospital, 9042 Gent, Belgium
| | - Judith S Verhoeven
- Academic Center for Epileptology, Kempenhaeghe/Maastricht University Medical Center, 5591 Heeze, The Netherlands
| | - Hilde M H Braakman
- Department of Pediatric Neurology, Amalia Children’s Hospital, Radboud University Medical Center, 6525 Nijmegen, The Netherlands
| | - Bert van der Zwaag
- Department of Genetics, University Medical Center Utrecht, Utrecht University, 3553 Utrecht, The Netherlands
| | - Aster V E Harder
- Department of Genetics, University Medical Center Utrecht, Utrecht University, 3553 Utrecht, The Netherlands
| | - Eva Brilstra
- Department of Genetics, University Medical Center Utrecht, Utrecht University, 3553 Utrecht, The Netherlands
| | - Manuela Pendziwiat
- Department of Neuropediatrics, Universitätsklinikum Schleswig Holstein Campus Kiel, 24106 Kiel, Germany
| | - Sebastian Lebon
- Pediatric Neurology and Neurorehabilitation Unit, Woman Mother Child Department, Lausanne University Hospital (CHUV), 1000 Lausanne, Switzerland
- University of Lausanne, 1000 Lausanne, Switzerland
| | - Maria Vaccarezza
- Department of Pediatric Neurology, Hospital Italiano de Buenos Aires, C1428 Buenos Aires, Argentina
| | - Ngoc Minh Le
- Center for Pediatric Neurology, Cleveland Clinic, Cleveland, OH 44102, USA
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, 8000 Aarhus, Denmark
| | - Sabine Grønborg
- Center for Rare Diseases, Department of Pediatrics and Department of Clinical Genetics, Copenhagen University Hospital Rigshospitalet, 2200 Copenhagen, Denmark
| | - Stephen W Scherer
- McLaughlin Centre and Department of Molecular Genetics, University of Toronto, Toronto, ON 66777, Canada
- The Centre for Applied Genomics and Department of Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON 66777, Canada
| | - Jennifer Howe
- Department of Neuropediatrics, University Hospital Bonn, 53229 Bonn, Germany
| | - Walid Fazeli
- Institute for Molecular and Behavioral Neuroscience, University of Cologne, 50667 Cologne, Germany
- Neurology Department, The Royal Children’s Hospital Melbourne, 3002 Melbourne, Australia
| | - Katherine B Howell
- Neurology Department, The Royal Children’s Hospital Melbourne, 3002 Melbourne, Australia
- Murdoch Children’s Research Institute, 3052 Parkville, Australia
- Department of Pediatrics, University of Melbourne, Royal Children’s Hospital, 3052 Parkville, Australia
| | - Richard Leventer
- Neurology Department, The Royal Children’s Hospital Melbourne, 3002 Melbourne, Australia
- Murdoch Children’s Research Institute, 3052 Parkville, Australia
- Department of Pediatrics, University of Melbourne, Royal Children’s Hospital, 3052 Parkville, Australia
| | - Chloe Stutterd
- Murdoch Children’s Research Institute, 3052 Parkville, Australia
- Department of Pediatrics, University of Melbourne, Royal Children’s Hospital, 3052 Parkville, Australia
| | - Sonja Walsh
- Department of Neuropediatrics, Children’s Hospital, University Hospital Carl Gustav Carus, Technical University, 1099 Dresden, Germany
| | - Marion Gerard
- Genetics Department, CHU Côte de Nacre, 14118 Caen, France
| | | | - Sara Matricardi
- Child Neurology and Psychiatry Unit, Children’s Hospital G. Salesi, 60121 Ancona, Italy
| | - Claudia M Bonardi
- Department of Woman’s and Child’s Health, Padova University Hospital, 35100 Padova, Italy
| | - Stefano Sartori
- Child Neurology and Clinical Neurophysiology Unit, Padova University Hospital, 35100 Padova, Italy
| | - Andrea Berger
- Department of Neuropediatrics, Klinikum Weiden, Kliniken Nordoberpfalz AG, 92637 Weiden, Germany
| | | | - Massimo Mastrangelo
- Pediatric Neurology Unit, Vittore Buzzi Hospital, ASST Fatebenefratelli Sacco, 20100 Milan, Italy
| | - Francesca Darra
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37121 Verona, Italy
| | - Arve Vøllo
- Department of Pediatrics, Oestfold Hospital, 1712 Graalum, Norway
| | - M Mahdi Motazacker
- Laboratory of Genome Diagnostics, Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, 1019 Amsterdam, Netherlands
| | - Phillis Lakeman
- Department of Clinical Genetics, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, 1019 Amsterdam, Netherlands
| | - Mathilde Nizon
- Service de Génétique Médicale, CHU Nantes, 44093 Nantes, France
| | - Cornelia Betzler
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik, 83569 Vogtareuth, Germany
- Research Institute ‘Rehabilitation, Transition, Palliation’, PMU Salzburg, 5020 Salzburg, Austria
| | - Cecilia Altuzarra
- Department of Pediatrics, St. Jacques Hospital, 25000 Besançon, France
| | - Roseline Caume
- Clinique de Génétique Guy Fontaine, CHU Lille, 59000, Lille, France
| | - Agathe Roubertie
- Département de Neuropédiatrie, INSERM, CHU Montpellier, 34000 Montpellier, France
| | - Philippe Gélisse
- Département de Neuropédiatrie, INSERM, CHU Montpellier, 34000 Montpellier, France
| | - Carla Marini
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Meyer Children’s Hospital, University of Florence, 50131 Florence, Italy
| | | | - Frederic Bilan
- Service de Génétique, Centre Hospitalier Universitaire de Poitiers, 86021 Poitiers, France
| | - Daniel Tibussek
- Child Neurology, Center for Pediatric and Teenage Health Care, 53757 Sankt Augustin, Germany
| | | | - M Scott Perry
- Justin Neurosciences Center, Cook Children’s Medical Center, Fort Worth, TX 76101, USA
| | - Shoji Ichikawa
- Department of Clinical Diagnostics, Ambry Genetics, Aliso Viejo, CA 92637, USA
| | - Elena Dadali
- Research Centre for Medical Genetics, 115522 Moscow, Russia
- Veltischev Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, 125412 Moscow, Russia
| | - Artem Sharkov
- Veltischev Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, 125412 Moscow, Russia
- Genomed Ltd., 100000 Moscow, Russia
| | - Irina Mishina
- Research Centre for Medical Genetics, 115522 Moscow, Russia
| | - Mikhail Abramov
- Veltischev Research and Clinical Institute for Pediatrics, Pirogov Russian National Research Medical University, 125412 Moscow, Russia
| | - Ilya Kanivets
- Svt. Luka’s Institute of Child Neurology & Epilepsy, 100000 Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, 100000 Moscow, Russia
| | - Sergey Korostelev
- Svt. Luka’s Institute of Child Neurology & Epilepsy, 100000 Moscow, Russia
- I.M. Sechenov First Moscow State Medical University, 100000 Moscow, Russia
| | - Sergey Kutsev
- Research Centre for Medical Genetics, 115522 Moscow, Russia
| | - Karen E Wain
- Geisinger Autism & Developmental Medicine Institute, Lewisburg, PA 17837, USA
| | - Nancy Eisenhauer
- Geisinger Autism & Developmental Medicine Institute, Lewisburg, PA 17837, USA
| | - Monisa Wagner
- Geisinger Autism & Developmental Medicine Institute, Lewisburg, PA 17837, USA
| | - Juliann M Savatt
- Geisinger Autism & Developmental Medicine Institute, Lewisburg, PA 17837, USA
| | - Karen Müller-Schlüter
- Epilepsy Center for Children, University Hospital Neuruppin, Brandenburg Medical School, 16816 Neuruppin, Germany
| | - Haim Bassan
- Pediatric Neurology & Development Center, Shamir Medical Center (Assaf Harofe), Be'er Ya'akov, Israel
- Sackler Faculty of Medicine, Tel Aviv University, 5296001 Tel Aviv, Israel
| | | | - Marie Cecile Nassogne
- Pediatric Neurology Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1000 Brussels, Belgium
| | - Anne Destrée
- Institute for Pathology and Genetics, 6040 Gosselies, Belgium
| | - An Sofie Schoonjans
- Department of Pediatrics and Pediatric Neurology, Antwerp University Hospital, University of Antwerp, 2650 Edegem, Belgium
| | - Marije Meuwissen
- Pediatric Neurology, Marie Curie Hospital—CHU Charleroi, 6032 Charleroi, Belgium
| | - Marga Buzatu
- Pediatric Neurology, Marie Curie Hospital—CHU Charleroi, 6032 Charleroi, Belgium
| | - Anna Jansen
- Pediatric Neurology Unit, Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Emmanuel Scalais
- Pediatric Neurology Unit, Department of Pediatrics, Centre Hospitalier de Luxembourg, 1313 Luxembourg, Luxembourg
| | - Siddharth Srivastava
- Department of Neurology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02108, USA
| | - Wen Hann Tan
- Department of Genetics, Boston Children’s Hospital, Boston, MA 02108, USA
| | - Heather E Olson
- Department of Neurology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02108, USA
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, MA 02108, USA
| | - Tobias Loddenkemper
- Department of Neurology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02108, USA
| | - Annapurna Poduri
- Department of Neurology, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02108, USA
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, MA 02108, USA
| | - Katherine L Helbig
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- The Epilepsy Neurogenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Ingo Helbig
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- The Epilepsy Neurogenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA 19104 USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
- Institute of Clinical Molecular Biology, Kiel University, 24105 Kiel, Germany
- Department of Neuropediatrics, Kiel University, 24105 Kiel, Germany
| | - Mark P Fitzgerald
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- The Epilepsy Neurogenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA 19104 USA
- Institute of Clinical Molecular Biology, Kiel University, 24105 Kiel, Germany
| | - Ethan M Goldberg
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- The Epilepsy Neurogenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Timo Roser
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Haunersches Children’s Hospital, Ludwig-Maximilian-University of Munich, 80331 Munich, Germany
| | - Ingo Borggraefe
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Haunersches Children’s Hospital, Ludwig-Maximilian-University of Munich, 80331 Munich, Germany
- Comprehensive Epilepsy Center, Ludwig-Maximilian- University of Munich, 80331 Munich, Germany
| | - Tobias Brünger
- Luxembourg Centre for Systems Biomedicine (LCSB), University Luxembourg, L-4243 Esch-sur-Alzette, Luxembourg
| | - Patrick May
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44102, USA
| | - Dennis Lal
- Luxembourg Centre for Systems Biomedicine (LCSB), University Luxembourg, L-4243 Esch-sur-Alzette, Luxembourg
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44102, USA
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T., Cambridge, MA 02138, USA
- Cologne Center for Genomics (CCG), University of Cologne, 50667 Cologne, Germany
| | - Damien Lederer
- Institute for Pathology and Genetics, 6040 Gosselies, Belgium
| | - Guido Rubboli
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Center, 4293 Dianalund, Denmark
- University of Copenhagen, 2200 Copenhagen, Denmark
| | - Henrike O Heyne
- Institute of Human Genetics, University of Leipzig Hospitals and Clinics, 4275 Leipzig, Germany
- Finnish Institute for Molecular Medicine (FIMM), University of Helsinki, 320 Helsinki, Finland
- Program for Medical and Population Genetics/Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02138, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02108, USA
| | - Gaetan Lesca
- Department of Medical Genetics, Groupement Hospitalier Est and ERN EpiCARE, University Hospitals of Lyon (HCL), 69001 Lyon, France
- Institut Neuromyogène, CNRS UMR 5310 - INSERM U1217, Université de Lyon, Université Claude Bernard Lyon 1, 69001 Lyon, France
| | - Ulrike B S Hedrich
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, 72072 Tuebingen, Germany
| | - Jan Benda
- Institute for Neurobiology, University of Tuebingen, 72072 Tuebingen, Germany
| | - Elena Gardella
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Center, 4293 Dianalund, Denmark
- Institute for Regional Health Services, University of Southern Denmark, 5230 Odense, Denmark
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, 72072 Tuebingen, Germany
| | - Rikke S Møller
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Center, 4293 Dianalund, Denmark
- Institute for Regional Health Services, University of Southern Denmark, 5230 Odense, Denmark
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29
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Collins RL, Glessner JT, Porcu E, Lepamets M, Brandon R, Lauricella C, Han L, Morley T, Niestroj LM, Ulirsch J, Everett S, Howrigan DP, Boone PM, Fu J, Karczewski KJ, Kellaris G, Lowther C, Lucente D, Mohajeri K, Nõukas M, Nuttle X, Samocha KE, Trinh M, Ullah F, Võsa U, Hurles ME, Aradhya S, Davis EE, Finucane H, Gusella JF, Janze A, Katsanis N, Matyakhina L, Neale BM, Sanders D, Warren S, Hodge JC, Lal D, Ruderfer DM, Meck J, Mägi R, Esko T, Reymond A, Kutalik Z, Hakonarson H, Sunyaev S, Brand H, Talkowski ME. A cross-disorder dosage sensitivity map of the human genome. Cell 2022; 185:3041-3055.e25. [PMID: 35917817 PMCID: PMC9742861 DOI: 10.1016/j.cell.2022.06.036] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/17/2022] [Accepted: 06/20/2022] [Indexed: 02/06/2023]
Abstract
Rare copy-number variants (rCNVs) include deletions and duplications that occur infrequently in the global human population and can confer substantial risk for disease. In this study, we aimed to quantify the properties of haploinsufficiency (i.e., deletion intolerance) and triplosensitivity (i.e., duplication intolerance) throughout the human genome. We harmonized and meta-analyzed rCNVs from nearly one million individuals to construct a genome-wide catalog of dosage sensitivity across 54 disorders, which defined 163 dosage sensitive segments associated with at least one disorder. These segments were typically gene dense and often harbored dominant dosage sensitive driver genes, which we were able to prioritize using statistical fine-mapping. Finally, we designed an ensemble machine-learning model to predict probabilities of dosage sensitivity (pHaplo & pTriplo) for all autosomal genes, which identified 2,987 haploinsufficient and 1,559 triplosensitive genes, including 648 that were uniquely triplosensitive. This dosage sensitivity resource will provide broad utility for human disease research and clinical genetics.
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Affiliation(s)
- Ryan L Collins
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA; Division of Medical Sciences and Department of Medicine, Harvard Medical School, Boston, MA 02115, USA.
| | - Joseph T Glessner
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Pediatrics, Division of Human Genetics, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Eleonora Porcu
- Center for Integrative Genomics, University of Lausanne, 1015 Lausanne, Switzerland; Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Maarja Lepamets
- Estonian Genome Centre, Institute of Genomics, University of Tartu, 51010 Tartu, Estonia; Institute of Molecular and Cell Biology, University of Tartu, 51010 Tartu, Estonia
| | | | | | - Lide Han
- Division of Genetic Medicine, Department of Medicine, and Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Theodore Morley
- Division of Genetic Medicine, Department of Medicine, and Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | | | - Jacob Ulirsch
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA; Division of Medical Sciences and Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Selin Everett
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA
| | - Daniel P Howrigan
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Philip M Boone
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA
| | - Jack Fu
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Konrad J Karczewski
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Georgios Kellaris
- Advanced Center for Translational and Genetic Medicine, Stanley Manne Children's Research Institute, Lurie Children's Hospital, Chicago, IL 60611, USA; Departments of Pediatrics and Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Chelsea Lowther
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Diane Lucente
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kiana Mohajeri
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA; Division of Medical Sciences and Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Margit Nõukas
- Estonian Genome Centre, Institute of Genomics, University of Tartu, 51010 Tartu, Estonia; Institute of Molecular and Cell Biology, University of Tartu, 51010 Tartu, Estonia
| | - Xander Nuttle
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Kaitlin E Samocha
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA; Division of Medical Sciences and Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; Human Genetics Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10, UK
| | - Mi Trinh
- Human Genetics Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10, UK
| | - Farid Ullah
- Advanced Center for Translational and Genetic Medicine, Stanley Manne Children's Research Institute, Lurie Children's Hospital, Chicago, IL 60611, USA; Departments of Pediatrics and Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Urmo Võsa
- Estonian Genome Centre, Institute of Genomics, University of Tartu, 51010 Tartu, Estonia
| | | | | | - Matthew E Hurles
- Human Genetics Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge CB10, UK
| | | | - Erica E Davis
- Advanced Center for Translational and Genetic Medicine, Stanley Manne Children's Research Institute, Lurie Children's Hospital, Chicago, IL 60611, USA; Departments of Pediatrics and Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Hilary Finucane
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - James F Gusella
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA
| | | | - Nicholas Katsanis
- Advanced Center for Translational and Genetic Medicine, Stanley Manne Children's Research Institute, Lurie Children's Hospital, Chicago, IL 60611, USA; Departments of Pediatrics and Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | | | - Benjamin M Neale
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | | - Jennelle C Hodge
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Dennis Lal
- Cologne Center for Genomics, University of Cologne, 51149 Cologne, Germany; Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Douglas M Ruderfer
- Division of Genetic Medicine, Department of Medicine, and Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN 37232, USA; Center for Precision Medicine, Department of Biomedical Informatics, and Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | | | - Reedik Mägi
- Estonian Genome Centre, Institute of Genomics, University of Tartu, 51010 Tartu, Estonia
| | - Tõnu Esko
- Estonian Genome Centre, Institute of Genomics, University of Tartu, 51010 Tartu, Estonia
| | - Alexandre Reymond
- Center for Integrative Genomics, University of Lausanne, 1015 Lausanne, Switzerland
| | - Zoltán Kutalik
- Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland; Center for Primary Care and Public Health, University of Lausanne, 1015 Lausanne, Switzerland; Department of Computational Biology, University of Lausanne, 1015 Lausanne, Switzerland
| | - Hakon Hakonarson
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Pediatrics, Division of Human Genetics, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Shamil Sunyaev
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA; Division of Medical Sciences and Department of Medicine, Harvard Medical School, Boston, MA 02115, USA; Division of Genetics, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Harrison Brand
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA; Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, MA 02114, USA.
| | - Michael E Talkowski
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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30
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Najm I, Lal D, Alonso Vanegas M, Cendes F, Lopes-Cendes I, Palmini A, Paglioli E, Sarnat HB, Walsh CA, Wiebe S, Aronica E, Baulac S, Coras R, Kobow K, Cross JH, Garbelli R, Holthausen H, Rössler K, Thom M, El-Osta A, Lee JH, Miyata H, Guerrini R, Piao YS, Zhou D, Blümcke I. The ILAE consensus classification of focal cortical dysplasia: An update proposed by an ad hoc task force of the ILAE diagnostic methods commission. Epilepsia 2022; 63:1899-1919. [PMID: 35706131 PMCID: PMC9545778 DOI: 10.1111/epi.17301] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/24/2022] [Accepted: 05/13/2022] [Indexed: 02/05/2023]
Abstract
Ongoing challenges in diagnosing focal cortical dysplasia (FCD) mandate continuous research and consensus agreement to improve disease definition and classification. An International League Against Epilepsy (ILAE) Task Force (TF) reviewed the FCD classification of 2011 to identify existing gaps and provide a timely update. The following methodology was applied to achieve this goal: a survey of published literature indexed with ((Focal Cortical Dysplasia) AND (epilepsy)) between 01/01/2012 and 06/30/2021 (n = 1349) in PubMed identified the knowledge gained since 2012 and new developments in the field. An online survey consulted the ILAE community about the current use of the FCD classification scheme with 367 people answering. The TF performed an iterative clinico-pathological and genetic agreement study to objectively measure the diagnostic gap in blood/brain samples from 22 patients suspicious for FCD and submitted to epilepsy surgery. The literature confirmed new molecular-genetic characterizations involving the mechanistic Target Of Rapamycin (mTOR) pathway in FCD type II (FCDII), and SLC35A2 in mild malformations of cortical development (mMCDs) with oligodendroglial hyperplasia (MOGHE). The electro-clinical-imaging phenotypes and surgical outcomes were better defined and validated for FCDII. Little new information was acquired on clinical, histopathological, or genetic characteristics of FCD type I (FCDI) and FCD type III (FCDIII). The survey identified mMCDs, FCDI, and genetic characterization as fields for improvement in an updated classification. Our iterative clinico-pathological and genetic agreement study confirmed the importance of immunohistochemical staining, neuroimaging, and genetic tests to improve the diagnostic yield. The TF proposes to include mMCDs, MOGHE, and "no definite FCD on histopathology" as new categories in the updated FCD classification. The histopathological classification can be further augmented by advanced neuroimaging and genetic studies to comprehensively diagnose FCD subtypes; these different levels should then be integrated into a multi-layered diagnostic scheme. This update may help to foster multidisciplinary efforts toward a better understanding of FCD and the development of novel targeted treatment options.
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Affiliation(s)
- Imad Najm
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland, Ohio, USA
| | - Dennis Lal
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland, Ohio, USA.,Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Fernando Cendes
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas - UNICAMP, Campinas, Sao Paulo, Brazil.,Department of Neurology, University of Campinas - UNICAMP, Campinas, Sao Paulo, Brazil
| | - Iscia Lopes-Cendes
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas - UNICAMP, Campinas, Sao Paulo, Brazil.,Department of Translational Medicine, University of Campinas - UNICAMP, Campinas, Sao Paulo, Brazil
| | - Andre Palmini
- Department of Clinical Neurosciences, School of Medicine, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,Porto Alegre Epilepsy Surgery Program, Hospital São Lucas PUCRS, Porto Alegre, Brazil
| | - Eliseu Paglioli
- Department of Surgery, School of Medicine, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Harvey B Sarnat
- Department of Paediatrics, Department of Pathology (Neuropathology) and Department of Clinical Neurosciences, University of Calgary Faculty of Medicine, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Christopher A Walsh
- Division of Genetics and Genomics and Howard Hughes Medical Institute, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Departments of Pediatrics and Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eleonora Aronica
- Department of (Neuro) Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Stéphanie Baulac
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Roland Coras
- Department of Neuropathology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Katja Kobow
- Developmental Neurosciences Programme, UCL NIHR BRC Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - J Helen Cross
- Developmental Neurosciences Programme, UCL NIHR BRC Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rita Garbelli
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Hans Holthausen
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen-Clinic, Vogtareuth, Germany
| | - Karl Rössler
- Department of Neurosurgery, Allgemeines Krankenhaus Wien, Vienna Medical University, Wien, Austria
| | - Maria Thom
- Department of Neuropathology, Institute of Neurology, University College London, UK
| | - Assam El-Osta
- Epigenetics in Human Health and Disease Laboratory, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jeong Ho Lee
- Graduate School of Medical Science and Engineering, KAIST and SoVarGen, Daejeon, South Korea
| | - Hajime Miyata
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Renzo Guerrini
- Neuroscience Department, Children's Hospital Anna Meyer- University of Florence, Florence, Italy
| | - Yue-Shan Piao
- National Center for Neurological Disorders, Department of Pathology, Xuanwu Hospital, Capital Medical University, and Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ingmar Blümcke
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland, Ohio, USA.,Department of Neuropathology, Universitätsklinikum Erlangen, Erlangen, Germany
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31
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Campbell C, Leu C, Feng YCA, Wolking S, Moreau C, Ellis C, Ganesan S, Martins H, Oliver K, Boothman I, Benson K, Molloy A, Brody L, Michaud JL, Hamdan FF, Minassian BA, Lerche H, Scheffer IE, Sisodiya S, Girard S, Cosette P, Delanty N, Lal D, Cavalleri GL. The role of common genetic variation in presumed monogenic epilepsies. EBioMedicine 2022; 81:104098. [PMID: 35679801 PMCID: PMC9188960 DOI: 10.1016/j.ebiom.2022.104098] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/11/2022] [Accepted: 05/20/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The developmental and epileptic encephalopathies (DEEs) are the most severe group of epilepsies which co-present with developmental delay and intellectual disability (ID). DEEs usually occur in people without a family history of epilepsy and have emerged as primarily monogenic, with damaging rare mutations found in 50% of patients. Little is known about the genetic architecture of patients with DEEs in whom no pathogenic variant is identified. Polygenic risk scoring (PRS) is a method that measures a person's common genetic burden for a trait or condition. Here, we used PRS to test whether genetic burden for epilepsy is relevant in individuals with DEEs, and other forms of epilepsy with ID. METHODS Genetic data on 2,759 cases with DEEs, or epilepsy with ID presumed to have a monogenic basis, and 447,760 population-matched controls were analysed. We compared PRS for 'all epilepsy', 'focal epilepsy', and 'genetic generalised epilepsy' (GGE) between cases and controls. We performed pairwise comparisons between cases stratified for identifiable rare deleterious genetic variants and controls. FINDINGS Cases of presumed monogenic severe epilepsy had an increased PRS for 'all epilepsy' (p<0.0001), 'focal epilepsy' (p<0.0001), and 'GGE' (p=0.0002) relative to controls, which explain between 0.08% and 3.3% of phenotypic variance. PRS was increased in cases both with and without an identified deleterious variant of major effect, and there was no significant difference in PRS between the two groups. INTERPRETATION We provide evidence that common genetic variation contributes to the aetiology of DEEs and other forms of epilepsy with ID, even when there is a known pathogenic variant of major effect. These results provide insight into the genetic underpinnings of the severe epilepsies and warrant a shift in our understanding of the aetiology of the DEEs as complex, rather than monogenic, disorders. FUNDING Science foundation Ireland, Human Genome Research Institute; National Heart, Lung, and Blood Institute; German Research Foundation.
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Affiliation(s)
- Ciarán Campbell
- The SFI FutureNeuro Research Centre, RCSI Dublin, Republic of Ireland; The School of Pharmacy and Biomolecular Sciences, RCSI Dublin, Republic of Ireland
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America; UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Bucks, United Kingdom; Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, United States of America
| | - Yen-Chen Anne Feng
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, United States of America; Division of Biostatistics, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Stefan Wolking
- Department of Neurology & Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; Department of Epileptology and Neurology, University of Aachen, Aachen, Germany; Axe Neurosciences, Centre de recherche de l'Université de Montréal, Université de Montréal, Montréal, Canada
| | - Claudia Moreau
- Centre Intersectoriel en Santé Durable, Université du Québec à Chicoutimi, Saguenay, Canada
| | - Colin Ellis
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Shiva Ganesan
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA 19146, USA; The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Helena Martins
- UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Bucks, United Kingdom
| | - Karen Oliver
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Isabelle Boothman
- The SFI FutureNeuro Research Centre, RCSI Dublin, Republic of Ireland; The School of Pharmacy and Biomolecular Sciences, RCSI Dublin, Republic of Ireland
| | - Katherine Benson
- The SFI FutureNeuro Research Centre, RCSI Dublin, Republic of Ireland; The School of Pharmacy and Biomolecular Sciences, RCSI Dublin, Republic of Ireland
| | - Anne Molloy
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Republic of Ireland
| | - Lawrence Brody
- Division of Intramural Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Fadi F Hamdan
- CHU Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Berge A Minassian
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Holger Lerche
- Department of Neurology & Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Ingrid E Scheffer
- University of Melbourne, Austin and Royal Children's Hospitals, Melbourne, Australia; Florey Institute and Murdoch Children's Research Institute, Melbourne, Australia
| | - Sanjay Sisodiya
- UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Bucks, United Kingdom
| | - Simon Girard
- Centre Intersectoriel en Santé Durable, Université du Québec à Chicoutimi, Saguenay, Canada
| | - Patrick Cosette
- Department of Medicine, Neurology Division, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Norman Delanty
- The School of Pharmacy and Biomolecular Sciences, RCSI Dublin, Republic of Ireland; Department of Neurology, Beaumont Hospital, Dublin, Republic of Ireland
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States of America; Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, United States of America; Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Gianpiero L Cavalleri
- The SFI FutureNeuro Research Centre, RCSI Dublin, Republic of Ireland; The School of Pharmacy and Biomolecular Sciences, RCSI Dublin, Republic of Ireland.
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32
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Baez-Nieto D, Allen A, Akers-Campbell S, Yang L, Budnik N, Pupo A, Shin YC, Genovese G, Liao M, Pérez-Palma E, Heyne H, Lal D, Lipscombe D, Pan JQ. Analysing an allelic series of rare missense variants of CACNA1I in a Swedish schizophrenia cohort. Brain 2022; 145:1839-1853. [PMID: 34919654 PMCID: PMC9166571 DOI: 10.1093/brain/awab443] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/23/2021] [Accepted: 11/11/2021] [Indexed: 11/14/2022] Open
Abstract
CACNA1I is implicated in the susceptibility to schizophrenia by large-scale genetic association studies of single nucleotide polymorphisms. However, the channelopathy of CACNA1I in schizophrenia is unknown. CACNA1I encodes CaV3.3, a neuronal voltage-gated calcium channel that underlies a subtype of T-type current that is important for neuronal excitability in the thalamic reticular nucleus and other regions of the brain. Here, we present an extensive functional characterization of 57 naturally occurring rare and common missense variants of CACNA1I derived from a Swedish schizophrenia cohort of more than 10 000 individuals. Our analysis of this allelic series of coding CACNA1I variants revealed that reduced CaV3.3 channel current density was the dominant phenotype associated with rare CACNA1I coding alleles derived from control subjects, whereas rare CACNA1I alleles from schizophrenia patients encoded CaV3.3 channels with altered responses to voltages. CACNA1I variants associated with altered current density primarily impact the ionic channel pore and those associated with altered responses to voltage impact the voltage-sensing domain. CaV3.3 variants associated with altered voltage dependence of the CaV3.3 channel and those associated with peak current density deficits were significantly segregated across affected and unaffected groups (Fisher's exact test, P = 0.034). Our results, together with recent data from the SCHEMA (Schizophrenia Exome Sequencing Meta-Analysis) cohort, suggest that reduced CaV3.3 function may protect against schizophrenia risk in rare cases. We subsequently modelled the effect of the biophysical properties of CaV3.3 channel variants on thalamic reticular nucleus excitability and found that compared with common variants, ultrarare CaV3.3-coding variants derived from control subjects significantly decreased thalamic reticular nucleus excitability (P = 0.011). When all rare variants were analysed, there was a non-significant trend between variants that reduced thalamic reticular nucleus excitability and variants that either had no effect or increased thalamic reticular nucleus excitability across disease status. Taken together, the results of our functional analysis of an allelic series of >50 CACNA1I variants in a schizophrenia cohort reveal that loss of function of CaV3.3 is a molecular phenotype associated with reduced disease risk burden, and our approach may serve as a template strategy for channelopathies in polygenic disorders.
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Affiliation(s)
- David Baez-Nieto
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Andrew Allen
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Seth Akers-Campbell
- Carney Institute for Brain Science & Department of Neuroscience, Brown University, Providence, RI 02912, USA
| | - Lingling Yang
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Nikita Budnik
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Amaury Pupo
- Department of Biology, West Virginia University, Morgantown, West Virginia 26506, USA
| | - Young-Cheul Shin
- Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA
| | - Giulio Genovese
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Maofu Liao
- Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA
| | - Eduardo Pérez-Palma
- Genomic Medicine Institute, Lerner Research institute, Cleveland Clinic, OH 44195, USA
- Centro de Genética y Genómica, Universidad del Desarrollo, Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana, Chile
| | - Henrike Heyne
- Genomic Medicine, Hasso Plattner Institute, Potsdam, 14482, Germany
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research institute, Cleveland Clinic, OH 44195, USA
- Cologne Center for Genomics, University of Cologne, Cologne 50931, Germany
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Diane Lipscombe
- Carney Institute for Brain Science & Department of Neuroscience, Brown University, Providence, RI 02912, USA
| | - Jen Q. Pan
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
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Schwarz N, Seiffert S, Pendziwiat M, Rademacher AV, Brünger T, Hedrich UBS, Augustijn PB, Baier H, Bayat A, Bisulli F, Buono RJ, Bruria BZ, Doyle MG, Guerrini R, Heimer G, Iacomino M, Kearney H, Klein KM, Kousiappa I, Kunz WS, Lerche H, Licchetta L, Lohmann E, Minardi R, McDonald M, Montgomery S, Mulahasanovic L, Oegema R, Ortal B, Papacostas SS, Ragona F, Granata T, Reif PS, Rosenow F, Rothschild A, Scudieri P, Striano P, Tinuper P, Tanteles GA, Vetro A, Zahnert F, Goldberg EM, Zara F, Lal D, May P, Muhle H, Helbig I, Weber Y. Spectrum of Phenotypic, Genetic, and Functional Characteristics in Patients With Epilepsy With KCNC2 Pathogenic Variants. Neurology 2022; 98:e2046-e2059. [PMID: 35314505 PMCID: PMC9162046 DOI: 10.1212/wnl.0000000000200660] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 02/01/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES KCNC2 encodes Kv3.2, a member of the Shaw-related (Kv3) voltage-gated potassium channel subfamily, which is important for sustained high-frequency firing and optimized energy efficiency of action potentials in the brain. The objective of this study was to analyze the clinical phenotype, genetic background, and biophysical function of disease-associated Kv3.2 variants. METHODS Individuals with KCNC2 variants detected by exome sequencing were selected for clinical, further genetic, and functional analysis. Cases were referred through clinical and research collaborations. Selected de novo variants were examined electrophysiologically in Xenopus laevis oocytes. RESULTS We identified novel KCNC2 variants in 18 patients with various forms of epilepsy, including genetic generalized epilepsy (GGE), developmental and epileptic encephalopathy (DEE) including early-onset absence epilepsy, focal epilepsy, and myoclonic-atonic epilepsy. Of the 18 variants, 10 were de novo and 8 were classified as modifying variants. Eight drug-responsive patients became seizure-free using valproic acid as monotherapy or in combination, including severe DEE cases. Functional analysis of 4 variants demonstrated gain of function in 3 severely affected DEE cases and loss of function in 1 case with a milder phenotype (GGE) as the underlying pathomechanisms. DISCUSSION These findings implicate KCNC2 as a novel causative gene for epilepsy and emphasize the critical role of KV3.2 in the regulation of brain excitability.
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Affiliation(s)
- Niklas Schwarz
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Simone Seiffert
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Manuela Pendziwiat
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Annika Verena Rademacher
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Tobias Brünger
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Ulrike B S Hedrich
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Paul B Augustijn
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Hartmut Baier
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Allan Bayat
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Francesca Bisulli
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Russell J Buono
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Ben Zeev Bruria
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Michael G Doyle
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Renzo Guerrini
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Gali Heimer
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Michele Iacomino
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Hugh Kearney
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Karl Martin Klein
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Ioanna Kousiappa
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Wolfram S Kunz
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Holger Lerche
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Laura Licchetta
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Ebba Lohmann
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Raffaella Minardi
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Marie McDonald
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Sarah Montgomery
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Lejla Mulahasanovic
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Renske Oegema
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Barel Ortal
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Savvas S Papacostas
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Francesca Ragona
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Tiziana Granata
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Phillip S Reif
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Felix Rosenow
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Annick Rothschild
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Paolo Scudieri
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Pasquale Striano
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Paolo Tinuper
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - George A Tanteles
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Annalisa Vetro
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Felix Zahnert
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Ethan M Goldberg
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Federico Zara
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Dennis Lal
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Patrick May
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Hiltrud Muhle
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Ingo Helbig
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
| | - Yvonne Weber
- From the Departments of Neurology and Epileptology (N.S., S.S., U.B.S.H., H.L., Y.W.) and Neurodegenerative Diseases (E.L.), Hertie-Institute for Clinical Brain Research, University of Tübingen; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel; Departments of Neuropediatrics (M.P., A.V.R., H.M., I.H.) and Pediatrics I (A.V.R.), University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel; Cologne Center for Genomics (T.B., D.L.), University of Cologne, Germany; Epilepsy Center SEIN (P.B.A.), Heemstede, the Netherlands; Epilepsiezentrum Bodensee (H.B.), Weissenau, Germany; Department of Genetics and Precision Medicine (A.B.), Danish Epilepsy Centre, Dianalund, Denmark; IRCCS Istituti delle Scienze Neurologiche di Bologna (F.B., L.L., R.M., P.T.); Department of Biomedical and Neuromotor Sciences (F.B., L.L., P.T.), University of Bologna, Italy; Department of Biomedical Sciences (R.J.B.), Cooper Medical School of Rowan University, Camden, NJ; Pediatric Neurology Unit (B.Z.B., G.H.), Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Ramat Gan; Sackler School of Medicine (B.Z.B., G.H.), Tel Aviv University, Israel; FutureNeuro SFI Research Centre (M.G.D., H.K.) and Department of Neurology, Beaumont Hospital (M.G.D., H.K.), Royal College of Surgeons in Ireland; StAR MD Programme (M.G.D.), Royal College of Surgeons in Ireland in collaboration with Blackrock Clinic, Dublin, Ireland; Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, and Department of Neuroscience (R.G., A.V.), A. Meyer Children's Hospital, University of Florence; IRCCS Istituto Giannina Gaslini (M.I., P. Striano), Genova, Italy; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology (K.M.K., P.S.R., F. Rosenow), University Hospital Frankfurt; LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (K.M.K., P.S.R., F. Rosenow), Goethe-University Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics, and Community Health Sciences (K.M.K.), Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada; Department of Neurobiology and Epilepsy Center (I.K., S.S.P.), The Cyprus Institute of Neurology and Genetics, Nicosia; Institute of Experimental Epileptology and Cognition Research and Department of Epileptology (W.S.K.), University of Bonn, Germany; Division of Medical Genetics, Department of Pediatrics (M.M., S.M.), Duke University, Durham, NC; CeGaT GmbH and Praxis für Humangenetik Tübingen (L.M.), Germany; Division Biomedical Genetics (R.O.), University Medical Center Utrecht, the Netherlands; The Genomic Unit, Sheba Cancer Research Center (B.O.), Cancer Research Center, Wohl Institute for Translational Medicine (B.O.), and The Institute for Rare Diseases, The Edmond and Lily Safra Children's Hospital (A.R.), Sheba Medical Center, Tel Hashomer, Israel; Medical School (S.S.P.), University of Nicosia, Cyprus; Department of Pediatric Neuroscience (F. Ragona, T.G.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Member of the ERN EpiCARE, Milan, Italy; Sheba Medical Center, Tel-Hashomer; Sackler Faculty of Medicine (A.R.), Tel Aviv University, Israel; Departments of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (P. Scudieri, P. Striano, F. Zara), University of Genova, Italy; Clinical Genetics and Genomics Department (G.A.T.), The Cyprus Institute of Neurology and Genetics, Nicosia; Department of Neurology (F. Zahnert), Epilepsy Center Hessen, Philipps-University Marburg, Germany; Division of Neurology (E.M.G., I.H.), The Epilepsy NeuroGenetics Initiative (ENGIN) (E.M.G., I.H.), and Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center, Neurological Institute (D.L.), and Genomic Medicine Institute, Lerner Research Institute (D.L.), Cleveland Clinic, OH; Stanley Center for Psychiatric Research (D.L.), The Broad Institute of Harvard and MIT, Cambridge, MA; Analytic and Translational Genetics Unit (D.L.), Massachusetts General Hospital, Boston; Luxembourg Centre for Systems Biomedicine (P.M.), University Luxembourg; Department of Neurology (I.H.), Perelman School of Medicine, University of Pennsylvania, PA; and Department of Epileptology and Neurology (Y.W.), University of Aachen, Germany
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Montanucci L, Capriotti E, Birolo G, Benevenuta S, Pancotti C, Lal D, Fariselli P. DDGun: an untrained predictor of protein stability changes upon amino acid variants. Nucleic Acids Res 2022; 50:W222-W227. [PMID: 35524565 PMCID: PMC9252764 DOI: 10.1093/nar/gkac325] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/15/2022] [Accepted: 05/04/2022] [Indexed: 01/22/2023] Open
Abstract
Estimating the functional effect of single amino acid variants in proteins is fundamental for predicting the change in the thermodynamic stability, measured as the difference in the Gibbs free energy of unfolding, between the wild-type and the variant protein (ΔΔG). Here, we present the web-server of the DDGun method, which was previously developed for the ΔΔG prediction upon amino acid variants. DDGun is an untrained method based on basic features derived from evolutionary information. It is antisymmetric, as it predicts opposite ΔΔG values for direct (A → B) and reverse (B → A) single and multiple site variants. DDGun is available in two versions, one based on only sequence information and the other one based on sequence and structure information. Despite being untrained, DDGun reaches prediction performances comparable to those of trained methods. Here we make DDGun available as a web server. For the web server version, we updated the protein sequence database used for the computation of the evolutionary features, and we compiled two new data sets of protein variants to do a blind test of its performances. On these blind data sets of single and multiple site variants, DDGun confirms its prediction performance, reaching an average correlation coefficient between experimental and predicted ΔΔG of 0.45 and 0.49 for the sequence-based and structure-based versions, respectively. Besides being used for the prediction of ΔΔG, we suggest that DDGun should be adopted as a benchmark method to assess the predictive capabilities of newly developed methods. Releasing DDGun as a web-server, stand-alone program and docker image will facilitate the necessary process of method comparison to improve ΔΔG prediction.
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Affiliation(s)
- Ludovica Montanucci
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Emidio Capriotti
- BioFolD Unit, Department of Pharmacy and Biotechnology (FaBiT), University of Bologna, Via F. Selmi 3, 40126 Bologna, Italy
| | - Giovanni Birolo
- Department of Medical Sciences, University of Torino, Via Santena 19, 10126, Torino, Italy
| | - Silvia Benevenuta
- Department of Medical Sciences, University of Torino, Via Santena 19, 10126, Torino, Italy
| | - Corrado Pancotti
- Department of Medical Sciences, University of Torino, Via Santena 19, 10126, Torino, Italy
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Piero Fariselli
- Department of Medical Sciences, University of Torino, Via Santena 19, 10126, Torino, Italy
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Brunklaus A, Pérez-Palma E, Ghanty I, Xinge J, Brilstra E, Ceulemans B, Chemaly N, de Lange I, Depienne C, Guerrini R, Mei D, Møller RS, Nabbout R, Regan BM, Schneider AL, Scheffer IE, Schoonjans AS, Symonds JD, Weckhuysen S, Kattan MW, Zuberi SM, Lal D. Development and Validation of a Prediction Model for Early Diagnosis of SCN1A-Related Epilepsies. Neurology 2022; 98:e1163-e1174. [PMID: 35074891 PMCID: PMC8935441 DOI: 10.1212/wnl.0000000000200028] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pathogenic variants in the neuronal sodium channel α1 subunit gene (SCN1A) are the most frequent monogenic cause of epilepsy. Phenotypes comprise a wide clinical spectrum, including severe childhood epilepsy; Dravet syndrome, characterized by drug-resistant seizures, intellectual disability, and high mortality; and the milder genetic epilepsy with febrile seizures plus (GEFS+), characterized by normal cognition. Early recognition of a child's risk for developing Dravet syndrome vs GEFS+ is key for implementing disease-modifying therapies when available before cognitive impairment emerges. Our objective was to develop and validate a prediction model using clinical and genetic biomarkers for early diagnosis of SCN1A-related epilepsies. METHODS We performed a retrospective multicenter cohort study comprising data from patients with SCN1A-positive Dravet syndrome and patients with GEFS+ consecutively referred for genetic testing (March 2001-June 2020) including age at seizure onset and a newly developed SCN1A genetic score. A training cohort was used to develop multiple prediction models that were validated using 2 independent blinded cohorts. Primary outcome was the discriminative accuracy of the model predicting Dravet syndrome vs other GEFS+ phenotypes. RESULTS A total of 1,018 participants were included. The frequency of Dravet syndrome was 616/743 (83%) in the training cohort, 147/203 (72%) in validation cohort 1, and 60/72 (83%) in validation cohort 2. A high SCN1A genetic score (133.4 [SD 78.5] vs 52.0 [SD 57.5]; p < 0.001) and young age at onset (6.0 [SD 3.0] vs 14.8 [SD 11.8] months; p < 0.001) were each associated with Dravet syndrome vs GEFS+. A combined SCN1A genetic score and seizure onset model separated Dravet syndrome from GEFS+ more effectively (area under the curve [AUC] 0.89 [95% CI 0.86-0.92]) and outperformed all other models (AUC 0.79-0.85; p < 0.001). Model performance was replicated in both validation cohorts 1 (AUC 0.94 [95% CI 0.91-0.97]) and 2 (AUC 0.92 [95% CI 0.82-1.00]). DISCUSSION The prediction model allows objective estimation at disease onset whether a child will develop Dravet syndrome vs GEFS+, assisting clinicians with prognostic counseling and decisions on early institution of precision therapies (http://scn1a-prediction-model.broadinstitute.org/). CLASSIFICATION OF EVIDENCE This study provides Class II evidence that a combined SCN1A genetic score and seizure onset model distinguishes Dravet syndrome from other GEFS+ phenotypes.
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Affiliation(s)
- Andreas Brunklaus
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA.
| | - Eduardo Pérez-Palma
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Ismael Ghanty
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Ji Xinge
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Eva Brilstra
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Berten Ceulemans
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Nicole Chemaly
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Iris de Lange
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Christel Depienne
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Renzo Guerrini
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Davide Mei
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Rikke S Møller
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Rima Nabbout
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Brigid M Regan
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Amy L Schneider
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Ingrid E Scheffer
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - An-Sofie Schoonjans
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Joseph D Symonds
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Sarah Weckhuysen
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Michael W Kattan
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Sameer M Zuberi
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
| | - Dennis Lal
- From the Pediatric Neurosciences Research Group (A.B., I.G., J.D.S., S.M.Z.), Royal Hospital for Children, Glasgow; Institute of Health and Wellbeing (A.B., I.G., J.D.S., S.M.Z.), University of Glasgow, UK; Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana (E.P.-P.), Universidad del Desarrollo, Santiago, Chile; Genomic Medicine Institute, Lerner Research Institute (E.P.-P., D.L.), Department of Quantitative Health Sciences (J.X., M.W.K.), and Epilepsy Center, Neurological Institute (D.L.), Cleveland Clinic, OH; Department of Genetics (E.B., I.d.L.), University Medical Centre, Utrecht, the Netherlands; Department of Child Neurology (B.C., A.-S.S.), University Hospital Antwerp, Belgium; Reference Centre for Rare Epilepsies, Department of Pediatric Neurology (N.C., R.N.), Hôpital Necker-Enfants Malades, Université de Paris, France; Institute of Human Genetics (C.D.), University Hospital Essen, University of Duisburg-Essen, Germany; Neuroscience Department (R.G., D.M.), Children's Hospital A. Meyer-University of Florence, Italy; The Danish Epilepsy Centre (R.S.M.), Dianalund, Denmark; Institute for Regional Health Services (R.S.M.), University of Southern Denmark, Odense; Department of Medicine, Epilepsy Research Centre, Austin Health (B.M.R., A.L.S., I.E.S.), and Florey and Murdoch Children's Research Institutes, Royal Children's Hospital (I.E.S.), University of Melbourne, Australia; Applied and Translational Neurogenomics Group (S.W.), VIB-Center for Molecular Neurology, VIB, Antwerp; Neurology Department (S.W.), University Hospital Antwerp; Institute Born-Bunge (S.W.), University of Antwerp, Belgium; Cologne Center for Genomics (D.L.), University of Cologne, Germany; and Stanley Center for Psychiatric Genetics (D.L.), Broad Institute of MIT and Harvard, Cambridge, MA
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Johannesen KM, Iqbal S, Guazzi M, Mohammadi NA, Pérez-Palma E, Schaefer E, De Saint Martin A, Abiwarde MT, McTague A, Pons R, Piton A, Kurian MA, Ambegaonkar G, Firth H, Sanchis-Juan A, Deprez M, Jansen K, De Waele L, Briltra EH, Verbeek NE, van Kempen M, Fazeli W, Striano P, Zara F, Visser G, Braakman HMH, Haeusler M, Elbracht M, Vaher U, Smol T, Lemke JR, Platzer K, Kennedy J, Klein KM, Au PYB, Smyth K, Kaplan J, Thomas M, Dewenter MK, Dinopoulos A, Campbell AJ, Lal D, Lederer D, Liao VWY, Ahring PK, Møller RS, Gardella E. Structural mapping of GABRB3 variants reveals genotype-phenotype correlations. Genet Med 2022; 24:681-693. [PMID: 34906499 DOI: 10.1016/j.gim.2021.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 09/30/2021] [Accepted: 11/05/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Pathogenic variants in GABRB3 have been associated with a spectrum of phenotypes from severe developmental disorders and epileptic encephalopathies to milder epilepsy syndromes and mild intellectual disability (ID). In this study, we analyzed a large cohort of individuals with GABRB3 variants to deepen the phenotypic understanding and investigate genotype-phenotype correlations. METHODS Through an international collaboration, we analyzed electro-clinical data of unpublished individuals with variants in GABRB3, and we reviewed previously published cases. All missense variants were mapped onto the 3-dimensional structure of the GABRB3 subunit, and clinical phenotypes associated with the different key structural domains were investigated. RESULTS We characterized 71 individuals with GABRB3 variants, including 22 novel subjects, expressing a wide spectrum of phenotypes. Interestingly, phenotypes correlated with structural locations of the variants. Generalized epilepsy, with a median age at onset of 12 months, and mild-to-moderate ID were associated with variants in the extracellular domain. Focal epilepsy with earlier onset (median: age 4 months) and severe ID were associated with variants in both the pore-lining helical transmembrane domain and the extracellular domain. CONCLUSION These genotype-phenotype correlations will aid the genetic counseling and treatment of individuals affected by GABRB3-related disorders. Future studies may reveal whether functional differences underlie the phenotypic differences.
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Affiliation(s)
- Katrine M Johannesen
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Centre "Filadelfia", Dianalund, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Sumaiya Iqbal
- The Center for the Development of Therapeutics (CDOT), Broad Institute of MIT and Harvard, Cambridge, MA; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA; Analytic & Translational Genetics Unit (ATGU), Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Milena Guazzi
- Department of Medicine, University of Genoa, Genoa, Italy; Department of Clinical Neurophysiology, The Danish Epilepsy Centre "Filadelfia", Dianalund, Denmark
| | - Nazanin A Mohammadi
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Centre "Filadelfia", Dianalund, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Eduardo Pérez-Palma
- Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Elise Schaefer
- Service de Génétique Médicale, Institut de Génétique Médicale d'Alsace, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Anne De Saint Martin
- Department of Pediatric Neurology, Strasbourg University Hospital, Strasbourg, France
| | | | - Amy McTague
- Molecular Neurosciences, Developmental Neurosciences Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Neurology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Roser Pons
- First Department of Pediatrics, "I Agia Sofia" Children Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Amelie Piton
- Laboratoire de diagnostic génétique, Hôpital Civil, CHRU de Strasburg, Strasbourg, France
| | - Manju A Kurian
- Molecular Neurosciences, Developmental Neurosciences Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Neurology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Gautam Ambegaonkar
- Department of Paediatric Neurology, Child Development Centre, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Helen Firth
- Department of Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Alba Sanchis-Juan
- NIHR BioResource, Department of Haematology, University of Cambridge, United Kingdom
| | - Marie Deprez
- CNRS, IPMC, Université Côte d'Azur, Sophia-Antipolis, France
| | - Katrien Jansen
- Department of Pediatric Neurology, University Hospitals KU Leuven, Leuven, Belgium
| | - Liesbeth De Waele
- Department of Pediatric Neurology, University Hospitals KU Leuven, Leuven, Belgium; Department of Development and Regeneration, Kulak Kortrijk Campus, Kortrijk, Belgium
| | - Eva H Briltra
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nienke E Verbeek
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marjan van Kempen
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Walid Fazeli
- Department of Pediatric Neurology, University Hospital Bonn, Bonn, Germany
| | - Pasquale Striano
- IRCCS Giannina Gaslini Institute, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Federico Zara
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy; Laboratory of Neurogenetics and Neuroscience, IRCCS Giannina Gaslini Institute, Genova, Italy
| | - Gerhard Visser
- Stichting Epilepsie Instellingen Nederland (SEIN), Hoofddorp, The Netherlands
| | - Hilde M H Braakman
- Department of Pediatric Neurology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Neurology, Academic Center for Epileptology Kempenhaeghe & Maastricht University Medical Center, Heeze, The Netherlands
| | - Martin Haeusler
- Division of Neuropediatrics and Social Pediatrics, Department of Pediatrics, University Hospital RWTH Aachen, Aachen, Germany
| | - Miriam Elbracht
- Institute of Human Genetics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Ulvi Vaher
- Children's Clinic of Tartu University Hospital, Tartu, Estonia; ERN EpiCARE, Tartu, Estonia
| | - Thomas Smol
- Institut de Genetique Medicale, CHU Lille, Universite de Lille, Lille, France
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Joanna Kennedy
- Clinical Genetics Service, University Hospitals Bristol NHS Foundation Trust, St Michael's Hospital, Bristol, United Kingdom
| | - Karl Martin Klein
- Department of Clinical Neurosciences, Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medical Genetics, Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Center of Neurology and Neurosurgery, University Hospital, Goethe-University Frankfurt, Frankfurt, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe University Frankfurt, Frankfurt, Germany
| | - Ping Yee Billie Au
- Department of Medical Genetics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kimberly Smyth
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Julie Kaplan
- Division of Medical Genetics, Nemours A.I. duPont Hospital for Children, Wilmington, DE
| | - Morgan Thomas
- Precision Medicine/Genetic Testing Stewardship Program, Nemours A.I. duPont Hospital for Children, Wilmington, DE
| | - Malin K Dewenter
- Institute of Human Genetics, Universitätsmedizin, Johannes Gutenberg-University, Mainz Institut für Humangenetik, Mainz, Germany
| | - Argirios Dinopoulos
- Third Department of Pediatrics, Attiko University Hospital, University of Athens, Haidari, Greece
| | - Arthur J Campbell
- The Center for the Development of Therapeutics (CDOT), Broad Institute of MIT and Harvard, Cambridge, MA; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Dennis Lal
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA; Genomic Medicine Institute, Cleveland Clinic Lerner Research Institute, Cleveland, OH; Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH; Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany
| | - Damien Lederer
- Centre de Génétique Humaine, Institut de Pathologie et de Génétique, Charleroi, Belgium
| | - Vivian W Y Liao
- Brain and Mind Centre, Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Philip K Ahring
- Brain and Mind Centre, Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rikke S Møller
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Centre "Filadelfia", Dianalund, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Elena Gardella
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Centre "Filadelfia", Dianalund, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Medicine, University of Genoa, Genoa, Italy; Department of Clinical Neurophysiology, The Danish Epilepsy Centre "Filadelfia", Dianalund, Denmark.
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Iqbal S, Brünger T, Pérez-Palma E, Hoksza D, Campbell AJ, Daly MJ, May P, Lal D. Genomic analysis of AlphaFold2-predicted structures identifies maps of 3D essential sites in 243 neurodevelopmental disorder-associated proteins. Biophys J 2022. [DOI: 10.1016/j.bpj.2021.11.1909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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López-Rivera JA, Smuk V, Leu C, Nasr G, Vegh D, Stefanski A, Pérez-Palma E, Busch R, Jehi L, Najm I, Blümcke I, Lal D. Incidence and prevalence of major epilepsy-associated brain lesions. Epilepsy Behav Rep 2022; 18:100527. [PMID: 35243289 PMCID: PMC8885987 DOI: 10.1016/j.ebr.2022.100527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/31/2022] [Accepted: 02/05/2022] [Indexed: 10/28/2022] Open
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Stefanski A, Pérez-Palma E, Mrdjen M, McHugh M, Leu C, Lal D. Identification and quantification of oligogenic loss-of-function disorders. Genet Med 2021; 24:729-735. [PMID: 34906500 DOI: 10.1016/j.gim.2021.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Monogenic disorders can present clinically heterogeneous symptoms. We hypothesized that in patients with a monogenic disorder caused by a large deletion, frequently additional loss-of-function (LOF)-intolerant genes are affected, potentially contributing to the phenotype. METHODS We investigated the LOF-intolerant gene distribution across the genome and its association with benign population and pathogenic classified deletions from individuals with presumably monogenic disorders. For people with presumably monogenic epilepsy, we compared Human Phenotype Ontology terms in people with large and small deletions. RESULTS We identified LOF-intolerant gene dense regions that were enriched for ClinVar and depleted for population copy number variants. Analysis of data from >143,000 individuals with a suspected monogenic disorder showed that 2.5% of haploinsufficiency disorder-associated deletions can affect at least 1 other LOF-intolerant gene. Focusing on epilepsy, we observed that 13.1% of pathogenic and likely pathogenic ClinVar deletions <3 megabase pair, covering the diagnostically most relevant genes, affected at least 1 additional LOF-intolerant gene. Those patients have potentially more complex phenotypes with increasing deletion size. CONCLUSION We could systematically show that large deletions frequently affected admditional LOF-intolerant genes in addition to the established disease gene. Further research is needed to understand how additional potential disease-relevant genes influence monogenic disorders to improve clinical care and the efficacy of targeted therapies.
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Affiliation(s)
- Arthur Stefanski
- Genomic Medicine Institute, Cleveland Clinic Lerner Research Institute, Cleveland, OH; Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Eduardo Pérez-Palma
- Genomic Medicine Institute, Cleveland Clinic Lerner Research Institute, Cleveland, OH; Universidad del Desarrollo, Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana, Santiago, Chile
| | - Marko Mrdjen
- Genomic Medicine Institute, Cleveland Clinic Lerner Research Institute, Cleveland, OH
| | - Megan McHugh
- Genomic Medicine Institute, Cleveland Clinic Lerner Research Institute, Cleveland, OH
| | - Costin Leu
- Genomic Medicine Institute, Cleveland Clinic Lerner Research Institute, Cleveland, OH; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Dennis Lal
- Genomic Medicine Institute, Cleveland Clinic Lerner Research Institute, Cleveland, OH; Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA; Cologne Center for Genomics (CCG), University of Cologne, Cologne, Germany.
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Motelow JE, Povysil G, Dhindsa RS, Stanley KE, Allen AS, Feng YCA, Howrigan DP, Abbott LE, Tashman K, Cerrato F, Cusick C, Singh T, Heyne H, Byrnes AE, Churchhouse C, Watts N, Solomonson M, Lal D, Gupta N, Neale BM, Cavalleri GL, Cossette P, Cotsapas C, De Jonghe P, Dixon-Salazar T, Guerrini R, Hakonarson H, Heinzen EL, Helbig I, Kwan P, Marson AG, Petrovski S, Kamalakaran S, Sisodiya SM, Stewart R, Weckhuysen S, Depondt C, Dlugos DJ, Scheffer IE, Striano P, Freyer C, Krause R, May P, McKenna K, Regan BM, Bennett CA, Leu C, Leech SL, O’Brien TJ, Todaro M, Stamberger H, Andrade DM, Ali QZ, Sadoway TR, Krestel H, Schaller A, Papacostas SS, Kousiappa I, Tanteles GA, Christou Y, Štěrbová K, Vlčková M, Sedláčková L, Laššuthová P, Klein KM, Rosenow F, Reif PS, Knake S, Neubauer BA, Zimprich F, Feucht M, Reinthaler EM, Kunz WS, Zsurka G, Surges R, Baumgartner T, von Wrede R, Pendziwiat M, Muhle H, Rademacher A, van Baalen A, von Spiczak S, Stephani U, Afawi Z, Korczyn AD, Kanaan M, Canavati C, Kurlemann G, Müller-Schlüter K, Kluger G, Häusler M, Blatt I, Lemke JR, Krey I, Weber YG, Wolking S, Becker F, Lauxmann S, Boßelmann C, Kegele J, Hengsbach C, Rau S, Steinhoff BJ, Schulze-Bonhage A, Borggräfe I, Schankin CJ, Schubert-Bast S, Schreiber H, Mayer T, Korinthenberg R, Brockmann K, Wolff M, Dennig D, Madeleyn R, Kälviäinen R, Saarela A, Timonen O, Linnankivi T, Lehesjoki AE, Rheims S, Lesca G, Ryvlin P, Maillard L, Valton L, Derambure P, Bartolomei F, Hirsch E, Michel V, Chassoux F, Rees MI, Chung SK, Pickrell WO, Powell R, Baker MD, Fonferko-Shadrach B, Lawthom C, Anderson J, Schneider N, Balestrini S, Zagaglia S, Braatz V, Johnson MR, Auce P, Sills GJ, Baum LW, Sham PC, Cherny SS, Lui CH, Delanty N, Doherty CP, Shukralla A, El-Naggar H, Widdess-Walsh P, Barišić N, Canafoglia L, Franceschetti S, Castellotti B, Granata T, Ragona F, Zara F, Iacomino M, Riva A, Madia F, Vari MS, Salpietro V, Scala M, Mancardi MM, Nobili L, Amadori E, Giacomini T, Bisulli F, Pippucci T, Licchetta L, Minardi R, Tinuper P, Muccioli L, Mostacci B, Gambardella A, Labate A, Annesi G, Manna L, Gagliardi M, Parrini E, Mei D, Vetro A, Bianchini C, Montomoli M, Doccini V, Barba C, Hirose S, Ishii A, Suzuki T, Inoue Y, Yamakawa K, Beydoun A, Nasreddine W, Khoueiry Zgheib N, Tumiene B, Utkus A, Sadleir LG, King C, Caglayan SH, Arslan M, Yapıcı Z, Topaloglu P, Kara B, Yis U, Turkdogan D, Gundogdu-Eken A, Bebek N, Uğur-İşeri S, Baykan B, Salman B, Haryanyan G, Yücesan E, Kesim Y, Özkara Ç, Tsai MH, Ho CJ, Lin CH, Lin KL, Chou IJ, Poduri A, Shiedley BR, Shain C, Noebels JL, Goldman A, Busch RM, Jehi L, Najm IM, Ferguson L, Khoury J, Glauser TA, Clark PO, Buono RJ, Ferraro TN, Sperling MR, Lo W, Privitera M, French JA, Schachter S, Kuzniecky RI, Devinsky O, Hegde M, Greenberg DA, Ellis CA, Goldberg E, Helbig KL, Cosico M, Vaidiswaran P, Fitch E, Berkovic SF, Lerche H, Lowenstein DH, Goldstein DB. Sub-genic intolerance, ClinVar, and the epilepsies: A whole-exome sequencing study of 29,165 individuals. Am J Hum Genet 2021; 108:2024. [PMID: 34626584 DOI: 10.1016/j.ajhg.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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O'Brien K, Petra V, Lal D, Kwai K, McDonald M, Jeanmonod R. 224 Gender Coding in Job Advertisements for Academic, Non-Academic, and Leadership Positions in Emergency Medicine. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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O'Brien K, Petra V, Lal D, Kwai K, McDonald M, Jeanmonod R. 227 Gender Coding in Physician Job Advertisements and Sex Disparities in Medical and Surgical Fields. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mermer F, Poliquin S, Rigsby K, Rastogi A, Shen W, Romero-Morales A, Nwosu G, McGrath P, Demerast S, Aoto J, Bilousova G, Lal D, Gama V, Kang JQ. Common molecular mechanisms of SLC6A1 variant-mediated neurodevelopmental disorders in astrocytes and neurons. Brain 2021; 144:2499-2512. [PMID: 34028503 PMCID: PMC8418336 DOI: 10.1093/brain/awab207] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Solute carrier family 6 member 1 (SLC6A1) is abundantly expressed in the developing brain even before the CNS is formed. Its encoded GABA transporter 1 (GAT-1) is responsible for the reuptake of GABA into presynaptic neurons and glia, thereby modulating neurotransmission. GAT-1 is expressed globally in the brain, in both astrocytes and neurons. The GABA uptake function of GAT-1 in neurons cannot be compensated for by other GABA transporters, while the function in glia can be partially replaced by GABA transporter 3. Recently, many variants in SLC6A1 have been associated with a spectrum of epilepsy syndromes and neurodevelopmental disorders, including myoclonic atonic epilepsy, childhood absence epilepsy, autism, and intellectual disability, but the pathomechanisms associated with these phenotypes remain unclear. The presence of GAT-1 in both neurons and astrocytes further obscures the role of abnormal GAT-1 in the heterogeneous disease phenotype manifestations. Here we examine the impact on transporter trafficking and function of 22 SLC6A1 variants identified in patients with a broad spectrum of phenotypes. We also evaluate changes in protein expression and subcellular localization of the variant GAT-1 in various cell types, including neurons and astrocytes derived from human patient induced pluripotent stem cells. We found that a partial or complete loss-of-function represents a common disease mechanism, although the extent of GABA uptake reduction is variable. The reduced GABA uptake appears to be due to reduced cell surface expression of the variant transporter caused by variant protein misfolding, endoplasmic reticulum retention, and subsequent degradation. Although the extent of reduction of the total protein, surface protein, and the GABA uptake level of the variant transporters is variable, the loss of GABA uptake function and endoplasmic reticulum retention is consistent across induced pluripotent stem cell-derived cell types, including astrocytes and neurons, for the surveyed variants. Interestingly, we did not find a clear correlation of GABA uptake function and the disease phenotypes, such as myoclonic atonic epilepsy versus developmental delay, in this study. Together, our study suggests that impaired transporter protein trafficking and surface expression are the major disease-associated mechanisms associated with pathogenic SLC6A1 variants. Our results resemble findings from pathogenic variants in other genes affecting the GABA pathway, such as GABAA receptors. This study provides critical insight into therapeutic developments for SLC6A1 variant-mediated disorders and implicates that boosting transporter function by either genetic or pharmacological approaches would be beneficial.
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Affiliation(s)
- Felicia Mermer
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Sarah Poliquin
- Neuroscience Graduate Program, Vanderbilt University, Nashville, TN 37232, USA
- Vanderbilt Brain Institute, Nashville, TN 37232, USA
| | | | - Anuj Rastogi
- Department of Cell and Developmental Biology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Wangzhen Shen
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Alejandra Romero-Morales
- Department of Cell and Developmental Biology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Vanderbilt Center for Stem Cell Biology, Nashville, TN 37232, USA
| | - Gerald Nwosu
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Vanderbilt-Meharry Alliance Vanderbilt University, Nashville, TN 37232, USA
| | - Patrick McGrath
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Scott Demerast
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jason Aoto
- Department of Pharmacology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Ganna Bilousova
- Department of Dermatology, Charles C. Gates Center for Regenerative Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Dennis Lal
- Cleveland Clinic Genomic Medicine Institute and Neurological Institute, Cleveland, OH 44195, USA
| | - Vivian Gama
- Neuroscience Graduate Program, Vanderbilt University, Nashville, TN 37232, USA
- Vanderbilt Brain Institute, Nashville, TN 37232, USA
- Department of Cell and Developmental Biology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Vanderbilt Center for Stem Cell Biology, Nashville, TN 37232, USA
| | - Jing-Qiong Kang
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Neuroscience Graduate Program, Vanderbilt University, Nashville, TN 37232, USA
- Vanderbilt Brain Institute, Nashville, TN 37232, USA
- Department of Pharmacology, Vanderbilt University, Nashville, TN 37232, USA
- Vanderbilt Kennedy Center of Human Development, Nashville, TN 37232, USA
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Khoshkhoo S, Lal D, Walsh CA. Application of single cell genomics to focal epilepsies: A call to action. Brain Pathol 2021; 31:e12958. [PMID: 34196990 PMCID: PMC8412079 DOI: 10.1111/bpa.12958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/17/2021] [Indexed: 12/24/2022] Open
Abstract
Focal epilepsies are the largest epilepsy subtype and associated with significant morbidity. Somatic variation is a newly recognized genetic mechanism underlying a subset of focal epilepsies, but little is known about the processes through which somatic mosaicism causes seizures, the cell types carrying the pathogenic variants, or their developmental origin. Meanwhile, the inception of single cell biology has completely revolutionized the study of neurological diseases and has the potential to answer some of these key questions. Focusing on single cell genomics, transcriptomics, and epigenomics in focal epilepsy research, circumvents the averaging artifact associated with studying bulk brain tissue and offers the kind of granularity that is needed for investigating the consequences of somatic mosaicism. Here we have provided a brief overview of some of the most developed single cell techniques and the major considerations around applying them to focal epilepsy research.
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Affiliation(s)
- Sattar Khoshkhoo
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA.,Howard Hughes Medical Institute, Boston Children's Hospital, Boston, MA, USA.,Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Dennis Lal
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Cologne Center for Genomics, University of Cologne, Cologne, Germany.,Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher A Walsh
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA.,Howard Hughes Medical Institute, Boston Children's Hospital, Boston, MA, USA.,Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Macnee M, Pérez-Palma E, Schumacher-Bass S, Dalton J, Leu C, Blankenberg D, Lal D. SimText: A text mining framework for interactive analysis and visualization of similarities among biomedical entities. Bioinformatics 2021; 37:4285-4287. [PMID: 34037702 PMCID: PMC9502138 DOI: 10.1093/bioinformatics/btab365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/07/2021] [Accepted: 05/24/2021] [Indexed: 11/23/2022] Open
Abstract
Summary Literature exploration in PubMed on a large number of biomedical entities (e.g. genes, diseases or experiments) can be time-consuming and challenging, especially when assessing associations between entities. Here, we describe SimText, a user-friendly toolset that provides customizable and systematic workflows for the analysis of similarities among a set of entities based on text. SimText can be used for (i) text collection from PubMed and extraction of words with different text mining approaches, and (ii) interactive analysis and visualization of data using unsupervised learning techniques in an interactive app. Availability and implementation We developed SimText as an open-source R software and integrated it into Galaxy (https://usegalaxy.eu), an online data analysis platform with supporting self-learning training material available at https://training.galaxyproject.org. A command-line version of the toolset is available for download from GitHub (https://github.com/dlal-group/simtext) or as Docker image (https://hub.docker.com/r/dlalgroup/simtext/tags.). Supplementary information Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Marie Macnee
- Cologne Center for Genomics (CCG), Medical Faculty of the University of Cologne, University Hospital of Cologne, Cologne, 50931, Germany
| | - Eduardo Pérez-Palma
- Universidad del Desarrollo, Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana, Santiago, Chile
| | | | - Jarrod Dalton
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, 44195, USA
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Daniel Blankenberg
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Dennis Lal
- Cologne Center for Genomics (CCG), Medical Faculty of the University of Cologne, University Hospital of Cologne, Cologne, 50931, Germany.,Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA.,Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
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46
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Stevelink R, Luykx JJ, Lin BD, Leu C, Lal D, Smith AW, Schijven D, Carpay JA, Rademaker K, Rodrigues Baldez RA, Devinsky O, Braun KPJ, Jansen FE, Smit DJA, Koeleman BPC. Shared genetic basis between genetic generalized epilepsy and background electroencephalographic oscillations. Epilepsia 2021; 62:1518-1527. [PMID: 34002374 PMCID: PMC8672363 DOI: 10.1111/epi.16922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Indexed: 11/29/2022]
Abstract
Objective Paroxysmal epileptiform abnormalities on electroencephalography (EEG) are the hallmark of epilepsies, but it is uncertain to what extent epilepsy and background EEG oscillations share neurobiological underpinnings. Here, we aimed to assess the genetic correlation between epilepsy and background EEG oscillations. Methods Confounding factors, including the heterogeneous etiology of epilepsies and medication effects, hamper studies on background brain activity in people with epilepsy. To overcome this limitation, we compared genetic data from a genome‐wide association study (GWAS) on epilepsy (n = 12 803 people with epilepsy and 24 218 controls) with that from a GWAS on background EEG (n = 8425 subjects without epilepsy), in which background EEG oscillation power was quantified in four different frequency bands: alpha, beta, delta, and theta. We replicated our findings in an independent epilepsy replication dataset (n = 4851 people with epilepsy and 20 428 controls). To assess the genetic overlap between these phenotypes, we performed genetic correlation analyses using linkage disequilibrium score regression, polygenic risk scores, and Mendelian randomization analyses. Results Our analyses show strong genetic correlations of genetic generalized epilepsy (GGE) with background EEG oscillations, primarily in the beta frequency band. Furthermore, we show that subjects with higher beta and theta polygenic risk scores have a significantly higher risk of having generalized epilepsy. Mendelian randomization analyses suggest a causal effect of GGE genetic liability on beta oscillations. Significance Our results point to shared biological mechanisms underlying background EEG oscillations and the susceptibility for GGE, opening avenues to investigate the clinical utility of background EEG oscillations in the diagnostic workup of epilepsy.
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Affiliation(s)
- Remi Stevelink
- Department of Genetics, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jurjen J Luykx
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,GGNet Mental Health, Apeldoorn, the Netherlands
| | - Bochao D Lin
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Costin Leu
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachussets, USA
| | - Dennis Lal
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachussets, USA
| | - Alexander W Smith
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachussets, USA
| | - Dick Schijven
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Translational Neuroscience, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Johannes A Carpay
- Department of Neurology, Tergooi Hospital, Hilversum, the Netherlands
| | - Koen Rademaker
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Roiza A Rodrigues Baldez
- Clinical Research Laboratory on Neuroinfectious Diseases, Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, New York University School of Medicine, New York, New York, USA
| | - Kees P J Braun
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Floor E Jansen
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Dirk J A Smit
- Psychiatry Department, Amsterdam Neuroscience, Amsterdam Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Bobby P C Koeleman
- Department of Genetics, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Blümcke I, Coras R, Busch RM, Morita-Sherman M, Lal D, Prayson R, Cendes F, Lopes-Cendes I, Rogerio F, Almeida VS, Rocha CS, Sim NS, Lee JH, Kim SH, Baulac S, Baldassari S, Adle-Biassette H, Walsh CA, Bizzotto S, Doan RN, Morillo KS, Aronica E, Mühlebner A, Becker A, Cienfuegos J, Garbelli R, Giannini C, Honavar M, Jacques TS, Thom M, Mahadevan A, Miyata H, Niehusmann P, Sarnat HB, Söylemezoglu F, Najm I. Toward a better definition of focal cortical dysplasia: An iterative histopathological and genetic agreement trial. Epilepsia 2021; 62:1416-1428. [PMID: 33949696 DOI: 10.1111/epi.16899] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Focal cortical dysplasia (FCD) is a major cause of difficult-to-treat epilepsy in children and young adults, and the diagnosis is currently based on microscopic review of surgical brain tissue using the International League Against Epilepsy classification scheme of 2011. We developed an iterative histopathological agreement trial with genetic testing to identify areas of diagnostic challenges in this widely used classification scheme. METHODS Four web-based digital pathology trials were completed by 20 neuropathologists from 15 countries using a consecutive series of 196 surgical tissue blocks obtained from 22 epilepsy patients at a single center. Five independent genetic laboratories performed screening or validation sequencing of FCD-relevant genes in paired brain and blood samples from the same 22 epilepsy patients. RESULTS Histopathology agreement based solely on hematoxylin and eosin stainings was low in Round 1, and gradually increased by adding a panel of immunostainings in Round 2 and the Delphi consensus method in Round 3. Interobserver agreement was good in Round 4 (kappa = .65), when the results of genetic tests were disclosed, namely, MTOR, AKT3, and SLC35A2 brain somatic mutations in five cases and germline mutations in DEPDC5 and NPRL3 in two cases. SIGNIFICANCE The diagnoses of FCD 1 and 3 subtypes remained most challenging and were often difficult to differentiate from a normal homotypic or heterotypic cortical architecture. Immunohistochemistry was helpful, however, to confirm the diagnosis of FCD or no lesion. We observed a genotype-phenotype association for brain somatic mutations in SLC35A2 in two cases with mild malformation of cortical development with oligodendroglial hyperplasia in epilepsy. Our results suggest that the current FCD classification should recognize a panel of immunohistochemical stainings for a better histopathological workup and definition of FCD subtypes. We also propose adding the level of genetic findings to obtain a comprehensive, reliable, and integrative genotype-phenotype diagnosis in the near future.
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Affiliation(s)
- Ingmar Blümcke
- Department of Neuropathology, University Hospital, Erlangen, Germany.,Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Roland Coras
- Department of Neuropathology, University Hospital, Erlangen, Germany
| | - Robyn M Busch
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.,Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Dennis Lal
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA.,Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Richard Prayson
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Fernando Cendes
- Department of Neurology, University of Campinas, Sao Paulo, Brazil.,Brazilian Institute of Neuroscience and Neurotechnology, Sao Paulo, Brazil
| | - Iscia Lopes-Cendes
- Brazilian Institute of Neuroscience and Neurotechnology, Sao Paulo, Brazil.,Department of Medical Genetics and Genomic Medicine, University of Campinas, Sao Paulo, Brazil
| | - Fabio Rogerio
- Brazilian Institute of Neuroscience and Neurotechnology, Sao Paulo, Brazil.,Department of Pathology, University of Campinas, Sao Paulo, Brazil
| | - Vanessa S Almeida
- Brazilian Institute of Neuroscience and Neurotechnology, Sao Paulo, Brazil.,Department of Medical Genetics and Genomic Medicine, University of Campinas, Sao Paulo, Brazil
| | - Cristiane S Rocha
- Brazilian Institute of Neuroscience and Neurotechnology, Sao Paulo, Brazil.,Department of Medical Genetics and Genomic Medicine, University of Campinas, Sao Paulo, Brazil
| | - Nam Suk Sim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jeong Ho Lee
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea.,SoVarGen, Inc., Daejeon, Korea
| | - Se Hoon Kim
- Department of Pathology, College of Medicine, Yonsei University, Seoul, South Korea
| | - Stephanie Baulac
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Sara Baldassari
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Homa Adle-Biassette
- Pathological Anatomy Service, Public Hospital Network of Paris, Paris, France.,NeuroDiderot, Inserm U1141, University of Paris, Paris, France
| | - Christopher A Walsh
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Department of Pediatrics, and Howard Hughes Medical Institute, Boston Children's Hospital, Boston, MA, USA.,Departments of Pediatrics and Neurology, Harvard Medical School, Boston, MA, USA
| | - Sara Bizzotto
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Department of Pediatrics, and Howard Hughes Medical Institute, Boston Children's Hospital, Boston, MA, USA.,Departments of Pediatrics and Neurology, Harvard Medical School, Boston, MA, USA
| | - Ryan N Doan
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Department of Pediatrics, and Howard Hughes Medical Institute, Boston Children's Hospital, Boston, MA, USA.,Departments of Pediatrics and Neurology, Harvard Medical School, Boston, MA, USA
| | - Katherine S Morillo
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Department of Pediatrics, and Howard Hughes Medical Institute, Boston Children's Hospital, Boston, MA, USA.,Departments of Pediatrics and Neurology, Harvard Medical School, Boston, MA, USA
| | - Eleonora Aronica
- Department of (Neuro)Pathology, Amsterdam UMC, location Academic Medical Center, Amsterdam, the Netherlands.,Epilepsy Institutes of the Netherlands Foundation, Heemstede, the Netherlands
| | - Angelika Mühlebner
- Department of (Neuro)Pathology, Amsterdam UMC, location Academic Medical Center, Amsterdam, the Netherlands.,Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Albert Becker
- Department of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Jesus Cienfuegos
- Department of Anatomic Pathology, International Center for Epilepsy Surgery, Humanitas Medical Group Hospital, Mexico City, Mexico.,Department of Anatomic Pathology, Angels Mexico Hospital, Mexico City, Mexico
| | - Rita Garbelli
- Epilepsy Unit, Carlo Besta Neurological Institute, Scientific Institute for Research and Health Care Foundation, Milan, Italy
| | - Caterina Giannini
- Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biomedical and Neuromotor Science,, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Mrinalini Honavar
- Department of Anatomic Pathology, Pedro Hispano Hospital, Matosinhos, Portugal
| | - Thomas S Jacques
- Developmental Biology and Cancer Research and Teaching Programme, University College London Great Ormond Street Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, UK
| | - Maria Thom
- Department of Neuropathology, Institute of Neurology, University College London, London, UK
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Hajime Miyata
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Pitt Niehusmann
- Department of Neuro-/Pathology, Translational Neurodegeneration Research and Neuropathology Lab, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Harvey B Sarnat
- Department of Paediatrics, University of Calgary Faculty of Medicine, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Pathology (Neuropathology),, University of Calgary Faculty of Medicine, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Clinical Neurosciences, University of Calgary Faculty of Medicine, Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Figen Söylemezoglu
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Imad Najm
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
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48
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Salles PA, Mata IF, Brünger T, Lal D, Fernandez HH. ATP1A3-Related Disorders: An Ever-Expanding Clinical Spectrum. Front Neurol 2021; 12:637890. [PMID: 33868146 PMCID: PMC8047318 DOI: 10.3389/fneur.2021.637890] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/09/2021] [Indexed: 01/29/2023] Open
Abstract
The Na+/K+ ATPases are Sodium-Potassium exchanging pumps, with a heteromeric α-β-γ protein complex. The α3 isoform is required as a rescue pump, after repeated action potentials, with a distribution predominantly in neurons of the central nervous system. This isoform is encoded by the ATP1A3 gene. Pathogenic variants in this gene have been implicated in several phenotypes in the last decades. Carriers of pathogenic variants in this gene manifest neurological and non-neurological features in many combinations, usually with an acute onset and paroxysmal episodes triggered by fever or other factors. The first three syndromes described were: (1) rapid-onset dystonia parkinsonism; (2) alternating hemiplegia of childhood; and, (3) cerebellar ataxia, pes cavus, optic atrophy, and sensorineural hearing loss (CAPOS syndrome). Since their original description, an expanding number of cases presenting with atypical and overlapping features have been reported. Because of this, ATP1A3-disorders are now beginning to be viewed as a phenotypic continuum representing discrete expressions along a broadly heterogeneous clinical spectrum.
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Affiliation(s)
- Philippe A Salles
- Department of Neurology and Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.,Centro de Trastornos del Movimiento, Centro de Trastornos del Movimiento (CETRAM), Santiago, Chile
| | - Ignacio F Mata
- Cleveland Clinic Foundation, Genomic Medicine, Lerner Research Institute, Cleveland, OH, United States
| | - Tobias Brünger
- Cologne Center for Genomics, University Cologne, Cologne, Germany
| | - Dennis Lal
- Cleveland Clinic Foundation, Genomic Medicine, Lerner Research Institute, Cleveland, OH, United States
| | - Hubert H Fernandez
- Department of Neurology and Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
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49
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Sarihan EI, Pérez-Palma E, Niestroj LM, Loesch D, Inca-Martinez M, Horimoto AR, Cornejo-Olivas M, Torres L, Mazzetti P, Cosentino C, Sarapura-Castro E, Rivera-Valdivia A, Dieguez E, Raggio V, Lescano A, Tumas V, Borges V, Ferraz HB, Rieder CR, Schumacher-Schuh AF, Santos-Lobato BL, Velez-Pardo C, Jimenez-Del-Rio M, Lopera F, Moreno S, Chana-Cuevas P, Fernandez W, Arboleda G, Arboleda H, Arboleda-Bustos CE, Yearout D, Zabetian CP, Thornton TA, O’Connor TD, Lal D, Mata IF. Genome-Wide Analysis of Copy Number Variation in Latin American Parkinson's Disease Patients. Mov Disord 2021; 36:434-441. [PMID: 33150996 PMCID: PMC8059262 DOI: 10.1002/mds.28353] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Parkinson's disease is the second most common neurodegenerative disorder and affects people from all ethnic backgrounds, yet little is known about the genetics of Parkinson's disease in non-European populations. In addition, the overall identification of copy number variants at a genome-wide level has been understudied in Parkinson's patients. The objective of this study was to understand the genome-wide burden of copy number variants in Latinos and its association with Parkinson's disease. METHODS We used genome-wide genotyping data from 747 Parkinson's disease patients and 632 controls from the Latin American Research Consortium on the Genetics of Parkinson's disease. RESULTS Genome-wide copy number burden analysis showed that patients were significantly enriched for copy number variants overlapping known Parkinson's disease genes compared with controls (odds ratio, 3.97; 95%CI, 1.69-10.5; P = 0.018). PRKN showed the strongest copy number burden, with 20 copy number variant carriers. These patients presented an earlier age of disease onset compared with patients with other copy number variants (median age at onset, 31 vs 57 years, respectively; P = 7.46 × 10-7 ). CONCLUSIONS We found that although overall genome-wide copy number variant burden was not significantly different, Parkinson's disease patients were significantly enriched with copy number variants affecting known Parkinson's disease genes. We also identified that of 250 patients with early-onset disease, 5.6% carried a copy number variant on PRKN in our cohort. Our study is the first to analyze genome-wide copy number variant association in Latino Parkinson's disease patients and provides insights about this complex disease in this understudied population. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Elif Irem Sarihan
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eduardo Pérez-Palma
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Douglas Loesch
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Program in Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Miguel Inca-Martinez
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Andrea R.V.R. Horimoto
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Mario Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis Torres
- Movement Disorders Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Pilar Mazzetti
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Carlos Cosentino
- Movement Disorders Unit, Instituto Nacional de Ciencias Neurologicas, Lima, Peru
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | | | - Elena Dieguez
- Neurology Institute, Universidad de la República, Montevideo, Uruguay
| | - Victor Raggio
- Department of Genetics, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Andres Lescano
- Neurology Institute, Universidad de la República, Montevideo, Uruguay
| | - Vitor Tumas
- Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Vanderci Borges
- Movement Disorders Unit, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Henrique B. Ferraz
- Movement Disorders Unit, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Carlos R. Rieder
- Departamento de Neurologia, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Artur F. Schumacher-Schuh
- Serviço de Neurologia, Hospital de Clínicas de Porto Alegre and Departamento de Farmacologia Universidade Federal do Rio Grande do Su, Porto Alegre, Brazil
| | | | - Carlos Velez-Pardo
- Neuroscience Research Group, Medical Research Institute, Faculty of Medicine, Universidad de Antioquia (UdeA), Medellín, Colombia
| | - Marlene Jimenez-Del-Rio
- Neuroscience Research Group, Medical Research Institute, Faculty of Medicine, Universidad de Antioquia (UdeA), Medellín, Colombia
| | - Francisco Lopera
- Neuroscience Research Group, Medical Research Institute, Faculty of Medicine, Universidad de Antioquia (UdeA), Medellín, Colombia
| | - Sonia Moreno
- Neuroscience Research Group, Medical Research Institute, Faculty of Medicine, Universidad de Antioquia (UdeA), Medellín, Colombia
| | - Pedro Chana-Cuevas
- CETRAM, Facultad de Ciencias Medicas, Universidad de Santiago de Chile, Santiago de Chile, Chile
| | - William Fernandez
- Neuroscience and Cell Death Research Groups, Medical School and Genetic Institute, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Gonzalo Arboleda
- Neuroscience and Cell Death Research Groups, Medical School and Genetic Institute, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Humberto Arboleda
- Neuroscience and Cell Death Research Groups, Medical School and Genetic Institute, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Carlos E. Arboleda-Bustos
- Neuroscience and Cell Death Research Groups, Medical School and Genetic Institute, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Dora Yearout
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Cyrus P. Zabetian
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Timothy A. Thornton
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Timothy D. O’Connor
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Program in Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Dennis Lal
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
- Stanley Center for Psychiatric Research, Broad Institute of MIT & Harvard, Cambridge, Massachusetts, USA
- Epilepsy Center & Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ignacio F. Mata
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Neurology, University of Washington, Seattle, Washington, USA
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50
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Niestroj LM, Perez-Palma E, Howrigan DP, Zhou Y, Cheng F, Saarentaus E, Nürnberg P, Stevelink R, Daly MJ, Palotie A, Lal D. Epilepsy subtype-specific copy number burden observed in a genome-wide study of 17 458 subjects. Brain 2020; 143:2106-2118. [PMID: 32568404 DOI: 10.1093/brain/awaa171] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/17/2020] [Accepted: 04/06/2020] [Indexed: 11/14/2022] Open
Abstract
Cytogenic testing is routinely applied in most neurological centres for severe paediatric epilepsies. However, which characteristics of copy number variants (CNVs) confer most epilepsy risk and which epilepsy subtypes carry the most CNV burden, have not been explored on a genome-wide scale. Here, we present the largest CNV investigation in epilepsy to date with 10 712 European epilepsy cases and 6746 ancestry-matched controls. Patients with genetic generalized epilepsy, lesional focal epilepsy, non-acquired focal epilepsy, and developmental and epileptic encephalopathy were included. All samples were processed with the same technology and analysis pipeline. All investigated epilepsy types, including lesional focal epilepsy patients, showed an increase in CNV burden in at least one tested category compared to controls. However, we observed striking differences in CNV burden across epilepsy types and investigated CNV categories. Genetic generalized epilepsy patients have the highest CNV burden in all categories tested, followed by developmental and epileptic encephalopathy patients. Both epilepsy types also show association for deletions covering genes intolerant for truncating variants. Genome-wide CNV breakpoint association showed not only significant loci for genetic generalized and developmental and epileptic encephalopathy patients but also for lesional focal epilepsy patients. With a 34-fold risk for developing genetic generalized epilepsy, we show for the first time that the established epilepsy-associated 15q13.3 deletion represents the strongest risk CNV for genetic generalized epilepsy across the whole genome. Using the human interactome, we examined the largest connected component of the genes overlapped by CNVs in the four epilepsy types. We observed that genetic generalized epilepsy and non-acquired focal epilepsy formed disease modules. In summary, we show that in all common epilepsy types, 1.5-3% of patients carry epilepsy-associated CNVs. The characteristics of risk CNVs vary tremendously across and within epilepsy types. Thus, we advocate genome-wide genomic testing to identify all disease-associated types of CNVs.
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Affiliation(s)
- Lisa-Marie Niestroj
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, 50931, Germany
| | - Eduardo Perez-Palma
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | | | - Yadi Zhou
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Feixiong Cheng
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.,Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44195, USA.,Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Elmo Saarentaus
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, FI-00014, Finland
| | - Peter Nürnberg
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, 50931, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, 50931, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, 50931, Germany
| | - Remi Stevelink
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mark J Daly
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, FI-00014, Finland.,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Aarno Palotie
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, FI-00014, Finland.,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Dennis Lal
- Cologne Center for Genomics (CCG), University of Cologne, Cologne, 50931, Germany.,Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.,Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA.,Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195 USA
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