1
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Layo-Carris DE, Lubin EE, Sangree AK, Clark KJ, Durham EL, Gonzalez EM, Smith S, Angireddy R, Wang XM, Weiss E, Mendoza-Londono R, Dupuis L, Damseh N, Velasco D, Valenzuela I, Codina-Solà M, Ziats C, Have J, Clarkson K, Steel D, Kurian M, Barwick K, Carrasco D, Dagli AI, Nowaczyk MJM, Hančárová M, Bendová Š, Prchalova D, Sedláček Z, Baxová A, Nowak CB, Douglas J, Chung WK, Longo N, Platzer K, Klöckner C, Averdunk L, Wieczorek D, Krey I, Zweier C, Reis A, Balci T, Simon M, Kroes HY, Wiesener A, Vasileiou G, Marinakis NM, Veltra D, Sofocleous C, Kosma K, Traeger Synodinos J, Voudris KA, Vuillaume ML, Gueguen P, Derive N, Colin E, Battault C, Au B, Delatycki M, Wallis M, Gallacher L, Majdoub F, Smal N, Weckhuysen S, Schoonjans AS, Kooy RF, Meuwissen M, Cocanougher BT, Taylor K, Pizoli CE, McDonald MT, James P, Roeder ER, Littlejohn R, Borja NA, Thorson W, King K, Stoeva R, Suerink M, Nibbeling E, Baskin S, L E Guyader G, Kaplan J, Muss C, Carere DA, Bhoj EJK, Bryant LM. Expanded phenotypic spectrum of neurodevelopmental and neurodegenerative disorder Bryant-Li-Bhoj syndrome with 38 additional individuals. Eur J Hum Genet 2024:10.1038/s41431-024-01610-1. [PMID: 38678163 DOI: 10.1038/s41431-024-01610-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 04/29/2024] Open
Abstract
Bryant-Li-Bhoj syndrome (BLBS), which became OMIM-classified in 2022 (OMIM: 619720, 619721), is caused by germline variants in the two genes that encode histone H3.3 (H3-3A/H3F3A and H3-3B/H3F3B) [1-4]. This syndrome is characterized by developmental delay/intellectual disability, craniofacial anomalies, hyper/hypotonia, and abnormal neuroimaging [1, 5]. BLBS was initially categorized as a progressive neurodegenerative syndrome caused by de novo heterozygous variants in either H3-3A or H3-3B [1-4]. Here, we analyze the data of the 58 previously published individuals along 38 unpublished, unrelated individuals. In this larger cohort of 96 people, we identify causative missense, synonymous, and stop-loss variants. We also expand upon the phenotypic characterization by elaborating on the neurodevelopmental component of BLBS. Notably, phenotypic heterogeneity was present even amongst individuals harboring the same variant. To explore the complex phenotypic variation in this expanded cohort, the relationships between syndromic phenotypes with three variables of interest were interrogated: sex, gene containing the causative variant, and variant location in the H3.3 protein. While specific genotype-phenotype correlations have not been conclusively delineated, the results presented here suggest that the location of the variants within the H3.3 protein and the affected gene (H3-3A or H3-3B) contribute more to the severity of distinct phenotypes than sex. Since these variables do not account for all BLBS phenotypic variability, these findings suggest that additional factors may play a role in modifying the phenotypes of affected individuals. Histones are poised at the interface of genetics and epigenetics, highlighting the potential role for gene-environment interactions and the importance of future research.
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Affiliation(s)
- Dana E Layo-Carris
- Department of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Emily E Lubin
- Department of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Annabel K Sangree
- Department of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly J Clark
- Department of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily L Durham
- Department of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth M Gonzalez
- Department of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarina Smith
- Department of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rajesh Angireddy
- Department of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Xiao Min Wang
- Department of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erin Weiss
- Department of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Roberto Mendoza-Londono
- Division of Clinical and Metabolic Genetics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Lucie Dupuis
- Division of Clinical and Metabolic Genetics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Nadirah Damseh
- Division of Clinical and Metabolic Genetics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Danita Velasco
- Children's Nebraska, University of Nebraska Medical Center, Omaha, NE, USA
| | - Irene Valenzuela
- Department of Clinical and Molecular Genetics and Rare Disease Unit Hospital Vall d'Hebron, Barcelona, Spain
- Medicine Genetics Group, Vall Hebron Research Institute, Barcelona, Spain
| | - Marta Codina-Solà
- Department of Clinical and Molecular Genetics and Rare Disease Unit Hospital Vall d'Hebron, Barcelona, Spain
- Medicine Genetics Group, Vall Hebron Research Institute, Barcelona, Spain
| | | | - Jaclyn Have
- Shodair Children's Hospital, Helena, MT, USA
| | | | - Dora Steel
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Manju Kurian
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Katy Barwick
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Diana Carrasco
- Department of Clinical Genetics, Cook Children's Hospital, Fort Worth, TX, USA
| | - Aditi I Dagli
- Orlando Health, Arnold Palmer Hospital For Children, Orlando, FL, USA
| | - M J M Nowaczyk
- McMaster University Medical Centre, Hamilton, ON, Canada
| | - Miroslava Hančárová
- Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Šárka Bendová
- Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Darina Prchalova
- Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Zdeněk Sedláček
- Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Alica Baxová
- Charles University First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Catherine Bearce Nowak
- Division of Genetics and Metabolism, Massachusetts General Hospital for Children, Boston, MA, USA
| | | | - Wendy K Chung
- Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | | | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Chiara Klöckner
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Luisa Averdunk
- Institute of Human Genetics, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Dagmar Wieczorek
- Institute of Human Genetics, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Ilona Krey
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Christiane Zweier
- Institute of Human Genetics, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
- Department of Human Genetics, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Andre Reis
- Institute of Human Genetics, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Tugce Balci
- University of Western Ontario, London, ON, Canada
| | - Marleen Simon
- Department of Genetics, University Medical Center, Utrecht, Netherlands
| | - Hester Y Kroes
- Department of Genetics, University Medical Center, Utrecht, Netherlands
| | - Antje Wiesener
- Department of Genetics, University Medical Center, Utrecht, Netherlands
| | - Georgia Vasileiou
- Department of Genetics, University Medical Center, Utrecht, Netherlands
| | - Nikolaos M Marinakis
- Laboratory of Medical Genetics, St. Sophia's Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Danai Veltra
- Laboratory of Medical Genetics, St. Sophia's Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christalena Sofocleous
- Laboratory of Medical Genetics, St. Sophia's Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Kosma
- Laboratory of Medical Genetics, St. Sophia's Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Joanne Traeger Synodinos
- Laboratory of Medical Genetics, St. Sophia's Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos A Voudris
- Second Department of Paediatrics, University of Athens, 'P & A Kyriakou' Children's Hospital, Athens, Greece
| | - Marie-Laure Vuillaume
- Service de Génétique, CHU de Tours, Tours, France
- UMR1253, iBrain, Inserm, University of Tours, Tours, France
- Laboratoire de Biologie Médicale Multi-Sites SeqOIA, Paris, France
| | - Paul Gueguen
- Service de Génétique, CHU de Tours, Tours, France
- UMR1253, iBrain, Inserm, University of Tours, Tours, France
- Laboratoire de Biologie Médicale Multi-Sites SeqOIA, Paris, France
| | - Nicolas Derive
- Laboratoire de Biologie Médicale Multi-Sites SeqOIA, Paris, France
| | - Estelle Colin
- Service de Génétique Médicale, CHU d'Angers, Angers, France
| | | | - Billie Au
- University of Calgary, Calgary, AB, Canada
| | - Martin Delatycki
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Mathew Wallis
- Tasmanian Clinical Genetics Service, Tasmanian Health Service, Hobart, TAS, Australia
- School of Medicine and Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Lyndon Gallacher
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Fatma Majdoub
- Applied and Translational Neurogenomics Group, VIB Center for Molecular Neurology, Antwerp, Belgium
- Applied and Translational Neurogenomics Group, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
- Medical Genetics Department, University Hedi Chaker Hospital of Sfax, Sfax, Tunisia
| | - Noor Smal
- Applied and Translational Neurogenomics Group, VIB Center for Molecular Neurology, Antwerp, Belgium
- Applied and Translational Neurogenomics Group, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Sarah Weckhuysen
- Applied and Translational Neurogenomics Group, VIB Center for Molecular Neurology, Antwerp, Belgium
- Applied and Translational Neurogenomics Group, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
- Department of Pediatric Neurology, University Hospital Antwerp, Antwerp, Belgium
- Translational Neurosciences, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
- NEURO Research Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - An-Sofie Schoonjans
- Department of Pediatric Neurology, University Hospital Antwerp, Antwerp, Belgium
- Department of Pediatrics, Duke University Hospital, Durham, NC, USA
| | - R Frank Kooy
- Center of Medical Genetics, Antwerp University Hospital/University of Antwerp, Edegem, Belgium
| | - Marije Meuwissen
- Department of Pediatrics, Duke University Hospital, Durham, NC, USA
- Center of Medical Genetics, Antwerp University Hospital/University of Antwerp, Edegem, Belgium
| | | | - Kathryn Taylor
- Division of Pediatric Neurology, Duke University Hospital, Durham, NC, USA
| | - Carolyn E Pizoli
- Division of Pediatric Neurology, Duke University Hospital, Durham, NC, USA
| | - Marie T McDonald
- Division of Medical Genetics, Duke University Hospital, Durham, NC, USA
| | - Philip James
- DMG Children's Rehabilitative Services, Phoenix, AZ, USA
| | - Elizabeth R Roeder
- Department of Pediatrics, Baylor College of Medicine, San Antonio, TX, USA
| | - Rebecca Littlejohn
- Department of Pediatrics, Baylor College of Medicine, San Antonio, TX, USA
| | - Nicholas A Borja
- John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Willa Thorson
- John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kristine King
- Genetics Department, Mary Bridge Children's Hospital, Multicare Health System, Tacoma, WA, USA
| | - Radka Stoeva
- Medical genetics department, Centre Hospitalier, Le Mans, France
| | - Manon Suerink
- Department of Clinical Genetics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Esther Nibbeling
- Department of Clinical Genetics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Stephanie Baskin
- Department of Pediatrics, Baylor College of Medicine, San Antonio, TX, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Gwenaël L E Guyader
- Service de Génétique médicale, Centre Labellisé Anomalies du Développement-Ouest Site, Poitiers, France
| | | | | | | | - Elizabeth J K Bhoj
- Department of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Laura M Bryant
- Department of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
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Pan X, Tao AM, Lu S, Ma M, Hannan SB, Slaugh R, Drewes Williams S, O'Grady L, Kanca O, Person R, Carter MT, Platzer K, Schnabel F, Abou Jamra R, Roberts AE, Newburger JW, Revah-Politi A, Granadillo JL, Stegmann APA, Sinnema M, Accogli A, Salpietro V, Capra V, Ghaloul-Gonzalez L, Brueckner M, Simon MEH, Sweetser DA, Glinton KE, Kirk SE, Wangler MF, Yamamoto S, Chung WK, Bellen HJ. De novo variants in FRYL are associated with developmental delay, intellectual disability, and dysmorphic features. Am J Hum Genet 2024; 111:742-760. [PMID: 38479391 PMCID: PMC11023917 DOI: 10.1016/j.ajhg.2024.02.007] [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: 08/23/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 04/07/2024] Open
Abstract
FRY-like transcription coactivator (FRYL) belongs to a Furry protein family that is evolutionarily conserved from yeast to humans. The functions of FRYL in mammals are largely unknown, and variants in FRYL have not previously been associated with a Mendelian disease. Here, we report fourteen individuals with heterozygous variants in FRYL who present with developmental delay, intellectual disability, dysmorphic features, and other congenital anomalies in multiple systems. The variants are confirmed de novo in all individuals except one. Human genetic data suggest that FRYL is intolerant to loss of function (LoF). We find that the fly FRYL ortholog, furry (fry), is expressed in multiple tissues, including the central nervous system where it is present in neurons but not in glia. Homozygous fry LoF mutation is lethal at various developmental stages, and loss of fry in mutant clones causes defects in wings and compound eyes. We next modeled four out of the five missense variants found in affected individuals using fry knockin alleles. One variant behaves as a severe LoF variant, whereas two others behave as partial LoF variants. One variant does not cause any observable defect in flies, and the corresponding human variant is not confirmed to be de novo, suggesting that this is a variant of uncertain significance. In summary, our findings support that fry is required for proper development in flies and that the LoF variants in FRYL cause a dominant disorder with developmental and neurological symptoms due to haploinsufficiency.
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Affiliation(s)
- Xueyang Pan
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Jan & Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Alice M Tao
- Vagelos School of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Shenzhao Lu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Jan & Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Mengqi Ma
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Jan & Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Shabab B Hannan
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Jan & Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Rachel Slaugh
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Sarah Drewes Williams
- Division of Genetic and Genomic Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren O'Grady
- Division of Medical Genetics & Metabolism, Massachusetts General for Children, Boston, MA, USA; MGH Institute of Health Professions, Charlestown, MA, USA
| | - Oguz Kanca
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Jan & Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | | | - Melissa T Carter
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Franziska Schnabel
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Amy E Roberts
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Medicine, Division of Genetics, Boston Children's Hospital, Boston, MA, USA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Anya Revah-Politi
- Institute for Genomic Medicine and Precision Genomics Laboratory, Columbia University Irving Medical Center, New York, NY, USA
| | - Jorge L Granadillo
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Alexander P A Stegmann
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Margje Sinnema
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Andrea Accogli
- Division of Medical Genetics, Department of Medicine, McGill University Health Center, Montreal, QC, Canada; Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Vincenzo Salpietro
- Department of Neuromuscular Disorders, University College London Institute of Neurology, Queen Square, London, UK
| | - Valeria Capra
- Unit of Medical Genetics and Genomics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Lina Ghaloul-Gonzalez
- Division of Genetic and Genomic Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA; Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Martina Brueckner
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA; Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
| | - Marleen E H Simon
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - David A Sweetser
- Division of Medical Genetics & Metabolism, Massachusetts General for Children, Boston, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin E Glinton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Department of Genetics, Texas Children's Hospital, Houston, TX, USA
| | - Susan E Kirk
- Section of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Cancer and Hematology Center, Houston, TX, USA
| | - Michael F Wangler
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Jan & Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Shinya Yamamoto
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Jan & Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA; Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Wendy K Chung
- Departments of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Hugo J Bellen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA.
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3
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Kassabian B, Levy AM, Gardella E, Aledo-Serrano A, Ananth AL, Brea-Fernández AJ, Caumes R, Chatron N, Dainelli A, De Wachter M, Denommé-Pichon AS, Dye TJ, Fazzi E, Felt R, Fernández-Jaén A, Fernández-Prieto M, Gantz E, Gasperowicz P, Gil-Nagel A, Gómez-Andrés D, Greiner HM, Guerrini R, Haanpää MK, Helin M, Hoyer J, Hurst ACE, Kallish S, Karkare SN, Khan A, Kleinendorst L, Koch J, Kothare SV, Koudijs SM, Lagae L, Lakeman P, Leppig KA, Lesca G, Lopergolo D, Lusk L, Mackenzie A, Mei D, Møller RS, Pereira EM, Platzer K, Quelin C, Revah-Politi A, Rheims S, Rodríguez-Palmero A, Rossi A, Santorelli F, Seinfeld S, Sell E, Stephenson D, Szczaluba K, Trinka E, Umair M, Van Esch H, van Haelst MM, Veenma DCM, Weber S, Weckhuysen S, Zacher P, Tümer Z, Rubboli G. Developmental epileptic encephalopathy in DLG4-related synaptopathy. Epilepsia 2024; 65:1029-1045. [PMID: 38135915 DOI: 10.1111/epi.17876] [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: 10/13/2023] [Revised: 12/05/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE The postsynaptic density protein of excitatory neurons PSD-95 is encoded by discs large MAGUK scaffold protein 4 (DLG4), de novo pathogenic variants of which lead to DLG4-related synaptopathy. The major clinical features are developmental delay, intellectual disability (ID), hypotonia, sleep disturbances, movement disorders, and epilepsy. Even though epilepsy is present in 50% of the individuals, it has not been investigated in detail. We describe here the phenotypic spectrum of epilepsy and associated comorbidities in patients with DLG4-related synaptopathy. METHODS We included 35 individuals with a DLG4 variant and epilepsy as part of a multicenter study. The DLG4 variants were detected by the referring laboratories. The degree of ID, hypotonia, developmental delay, and motor disturbances were evaluated by the referring clinician. Data on awake and sleep electroencephalography (EEG) and/or video-polygraphy and brain magnetic resonance imaging were collected. Antiseizure medication response was retrospectively assessed by the referring clinician. RESULTS A large variety of seizure types was reported, although focal seizures were the most common. Encephalopathy related to status epilepticus during slow-wave sleep (ESES)/developmental epileptic encephalopathy with spike-wave activation during sleep (DEE-SWAS) was diagnosed in >25% of the individuals. All but one individual presented with neurodevelopmental delay. Regression in verbal and/or motor domains was observed in all individuals who suffered from ESES/DEE-SWAS, as well as some who did not. We could not identify a clear genotype-phenotype relationship even between individuals with the same DLG4 variants. SIGNIFICANCE Our study shows that a subgroup of individuals with DLG4-related synaptopathy have DEE, and approximately one fourth of them have ESES/DEE-SWAS. Our study confirms DEE as part of the DLG4-related phenotypic spectrum. Occurrence of ESES/DEE-SWAS in DLG4-related synaptopathy requires proper investigation with sleep EEG.
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Affiliation(s)
- Benedetta Kassabian
- Department of Epilepsy Genetics and Precision Medicine, Danish Epilepsy Center Filadelfia, member of the European Reference Network EpiCARE, Dianalund, Denmark
- Neurology Unit, Department of Neurosciences, University of Padua, Padua, Italy
| | - Amanda M Levy
- Department of Clinical Genetics, Kennedy Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Elena Gardella
- Department of Epilepsy Genetics and Precision Medicine, Danish Epilepsy Center Filadelfia, member of the European Reference Network EpiCARE, Dianalund, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Angel Aledo-Serrano
- Epilepsy and Neurogenetics Unit, Vithas la Milagrosa University Hospital, Vithas Hospital Group, Madrid, Spain
| | - Amitha L Ananth
- Division of Pediatric Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Alejandro J Brea-Fernández
- Grupo de Genómica y Bioinformática, Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas (CiMUS), Centro de Investigación Biomédica en Red de Enfermedades Raras del Instituto de Salud Carlos III (CIBERER-ISCIII), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Grupo de Genética, Fundación Pública Galega de Medicina Xenómica, Instituto de Investigación Biomédica de Santiago (IDIS), Santiago de Compostela, Spain
| | | | - Nicolas Chatron
- Service de Genetique, Hospices Civils de Lyon, Bron, France
- Institute NeuroMyoGène, Laboratoire Physiopathologie et Génétique du Neurone et du Muscle, Centre National de la recherche scientifique (CNRS) Unité mixte de recherche (UMR) 5261- L'Institut national de la santé et de la recherche médicale (INSERM) U1315, Université de Lyon-Université Claude Bernard Lyon 1, Lyon, France
| | - Alice Dainelli
- Neuroscience Department, Meyer Children's Hospital IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), member of the European Reference Network EpiCARE, Florence, Italy
| | - Matthias De Wachter
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Anne-Sophie Denommé-Pichon
- Functional Unit for Diagnostic Innovation in Rare Diseases, Fédération Hospitalo-Universitaire Médecine TRANSLationnelle et Anomalies du Développement (FHU-TRANSLAD), Dijon Bourgogne University Hospital, Dijon, France
- L'Institut national de la santé et de la recherche médicale (INSERM) Unité mixte de recherche (UMR) 1231, Génétique des Anomalies du Développement (GAD), Fédération Hospitalo-Universitaire Médecine TRANSLationnelle et Anomalies du Développement (FHU-TRANSLAD), University of Burgundy, Dijon, France
| | - Thomas J Dye
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Elisa Fazzi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Child Neurology and Psychiatry, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili of Brescia, Brescia, Italy
| | - Roxanne Felt
- Department of Neurology, Kaiser Permanente Bellevue Medical Center, Bellevue, Washington, USA
| | - Alberto Fernández-Jaén
- Department of Pediatric Neurology, Neurogenetics Section, Hospital Universitario Quirónsalud, Madrid, Spain
- Facultad de Medicina, Universidad Europea, Madrid, Spain
| | - Montse Fernández-Prieto
- Grupo de Genómica y Bioinformática, Centro Singular de Investigación en Medicina Molecular y Enfermedades Crónicas (CiMUS), Centro de Investigación Biomédica en Red de Enfermedades Raras del Instituto de Salud Carlos III (CIBERER-ISCIII), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Grupo de Genética, Fundación Pública Galega de Medicina Xenómica, Instituto de Investigación Biomédica de Santiago (IDIS), Santiago de Compostela, Spain
| | - Emily Gantz
- Division of Pediatric Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Piotr Gasperowicz
- Department of Medical Genetics, Medical University of Warsaw, Warsaw, Poland
| | - Antonio Gil-Nagel
- Neurology Department, Epilepsy Program, Ruber Internacional Hospital, Madrid, Spain
| | - David Gómez-Andrés
- Child Neurology Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Hansel M Greiner
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Renzo Guerrini
- Neuroscience Department, Meyer Children's Hospital IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), member of the European Reference Network EpiCARE, Florence, Italy
| | - Maria K Haanpää
- Department of Genomics, Turku University Hospital, Turku, Finland
| | - Minttu Helin
- Department of Pediatric Neurology, Turku University Hospital, Turku, Finland
| | - Juliane Hoyer
- Friedrich-Alexander-Universität Erlangen Nürnberg, Institute of Human Genetics, Erlangen, Germany
| | - Anna C E Hurst
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Staci Kallish
- Division of Translational Medicine and Human Genetics, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shefali N Karkare
- Division of Pediatric Neurology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York, USA
| | - Amjad Khan
- Department of Zoology, Faculty of Biological Sciences, University of Lakki Marwat, Lakki Marwat, Pakistan
- Institute for Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Lotte Kleinendorst
- Department of Human Genetics, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, the Netherlands
- Emma Center for Personalized Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Johannes Koch
- University Children's Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Sanjeev V Kothare
- Division of Pediatric Neurology, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York, USA
| | - Suzanna M Koudijs
- Department of Neurology, Erasmus Medical Center (MC) Sophia Children's Hospital, Rotterdam, the Netherlands
- Erfelijke Neuro-Cognitieve Ontwikkelingsstoornissen, Rotterdam, Erasmus Medical Center (ENCORE)-GRIN Expertise Center, Rotterdam, the Netherlands
| | - Lieven Lagae
- Department of Development and Regeneration, Section Paediatric Neurology, member of the European Reference Network EpiCARE, University Hospitals Leuven, Leuven, Belgium
| | - Phillis Lakeman
- Department of Human Genetics, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Kathleen A Leppig
- Genetic Services, Kaiser Permanente of Washington, Seattle, Washington, USA
| | - Gaetan Lesca
- Service de Genetique, Hospices Civils de Lyon, Bron, France
- Institute NeuroMyoGène, Laboratoire Physiopathologie et Génétique du Neurone et du Muscle, Centre National de la recherche scientifique (CNRS) Unité mixte de recherche (UMR) 5261- L'Institut national de la santé et de la recherche médicale (INSERM) U1315, Université de Lyon-Université Claude Bernard Lyon 1, Lyon, France
| | - Diego Lopergolo
- Department of Medicine, Surgery, and Neurosciences, University of Siena, Siena, Italy
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Stella Maris Foundation, Pisa, Italy
| | - Laina Lusk
- Division of Neurology, Epilepsy Neurogenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alex Mackenzie
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Davide Mei
- Neuroscience Department, Meyer Children's Hospital IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), member of the European Reference Network EpiCARE, Florence, Italy
| | - Rikke S Møller
- Department of Epilepsy Genetics and Precision Medicine, Danish Epilepsy Center Filadelfia, member of the European Reference Network EpiCARE, Dianalund, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Elaine M Pereira
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Chloe Quelin
- Department of Medical Genetics, CHU de Rennes, Rennes, France
| | - Anya Revah-Politi
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, member of the European Reference Network EpiCARE, Hospices Civils de Lyon and Lyon 1 University, Lyon, France
| | - Agustí Rodríguez-Palmero
- Paediatric Neurology Unit, Department of Pediatrics, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
- Grupo de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| | - Andrea Rossi
- Unit of Child Neurology and Psychiatry, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili of Brescia, Brescia, Italy
| | - Filippo Santorelli
- Molecular Medicine for Neurodegenerative and Neuromuscular Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Stella Maris Foundation, Pisa, Italy
| | - Syndi Seinfeld
- Department of Pediatric Neurology, Neuroscience Center, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Erick Sell
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Donna Stephenson
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Krzysztof Szczaluba
- Department of Medical Genetics, Medical University of Warsaw, Warsaw, Poland
- Center of Excellence for Rare and Undiagnosed Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Eugen Trinka
- Department of Neurology, Neurointensive Care and Neurorehabilitation, Christian Doppler University Hospital, member of the European Reference Network EpiCARE, Paracelsus Medical University, Center for Cognitive Neuroscience, Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, member of the European Reference Network EpiCARE, Paracelsus Medical University, Center for Cognitive Neuroscience, Salzburg, Austria
| | - Muhammad Umair
- Medical Genomics Research Department, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Life Sciences, School of Science, University of Management and Technology, Lahore, Pakistan
| | - Hilde Van Esch
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Mieke M van Haelst
- Department of Human Genetics, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, the Netherlands
- Emma Center for Personalized Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Danielle C M Veenma
- Erfelijke Neuro-Cognitieve Ontwikkelingsstoornissen, Rotterdam, Erasmus Medical Center (ENCORE)-GRIN Expertise Center, Rotterdam, the Netherlands
- Department of Pediatrics, Erasmus Medical Center (MC)-Sophia Hospital, Rotterdam, the Netherlands
| | - Sacha Weber
- Service de Génétique, Centre Hospitalier Universitaire (CHU) de Caen-Normandie, Caen, France
- Service de Neurologie, Centre Hospitalier Universitaire (CHU) de Caen-Normandie, Caen, France
| | - Sarah Weckhuysen
- Applied and Translational Neurogenomics Group, Vlaams Instituut voor Biotechnologie (VIB) Center for Molecular Neurology, Antwerp, Belgium
- Department of Neurology, Antwerp University Hospital, Antwerp, Belgium
| | - Pia Zacher
- Center for Adults with Disability (MZEB), Epilepsy Center Kleinwachau, Radeberg, Germany
| | - Zeynep Tümer
- Department of Clinical Genetics, Kennedy Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Guido Rubboli
- Department of Epilepsy Genetics and Precision Medicine, Danish Epilepsy Center Filadelfia, member of the European Reference Network EpiCARE, Dianalund, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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4
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Lesmann H, Hustinx A, Moosa S, Marchi E, Caro P, Abdelrazek IM, Pantel JT, Klinkhammer H, Hagen MT, Kamphans T, Meiswinkel W, Li JM, Javanmardi B, Knaus A, Uwineza A, Knopp C, Tkemaladze T, Elbracht M, Mattern L, Jamra RA, Velmans C, Strehlow V, Goel H, Nunes BC, Vilella T, Pinheiro IF, Kim CA, Melaragno MI, Barakat TS, Nabil A, Suh J, Averdunk L, Ekure E, Graziano C, Phowthongkum P, Güzel N, Haack TB, Brunet T, Rudnik-Schöneborn S, Platzer K, Borovikov A, Schnabel F, Heuft L, Herrmann V, Martinez-Monseny AF, Höller M, Alaaeldin K, Jezela-Stanek A, Mohamed A, Lasa-Aranzasti A, Sayer JA, Hu P, Ledgister Hanchard SE, Elmakkawy G, Safwat S, Ebstein F, Krüger E, Küry S, Arlt A, Marbach F, Netzer C, Kaptain S, Weiland H, Li D, Dupuis L, Mendoza-Londono R, Houge SD, Weis D, Chung BHY, Mak CCY, Devriendt K, Gripp KW, Mücke M, Verloes A, Schaaf CP, Nellåker C, Solomon BD, Waikel RL, Nöthen MM, Abdalla E, Lyon GJ, Krawitz PM, Hsieh TC. GestaltMatcher Database - A global reference for the facial phenotypic variability of rare human diseases. medRxiv 2024:2023.06.06.23290887. [PMID: 37503210 PMCID: PMC10371103 DOI: 10.1101/2023.06.06.23290887] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Dysmorphologists sometimes encounter challenges in recognizing disorders due to phenotypic variability influenced by factors such as age and ethnicity. Moreover, the performance of Next Generation Phenotyping Tools such as GestaltMatcher is dependent on the diversity of the training set. Therefore, we developed GestaltMatcher Database (GMDB) - a global reference for the phenotypic variability of rare diseases that complies with the FAIR-principles. We curated dysmorphic patient images and metadata from 2,224 publications, transforming GMDB into an online dynamic case report journal. To encourage clinicians worldwide to contribute, each case can receive a Digital Object Identifier (DOI), making it a citable micro-publication. This resulted in a collection of 2,312 unpublished images, partly with longitudinal data. We have compiled a collection of 10,189 frontal images from 7,695 patients representing 683 disorders. The web interface enables gene- and phenotype-centered queries for registered users (https://db.gestaltmatcher.org/). Despite the predominant European ancestry of most patients (59%), our global collaborations have facilitated the inclusion of data from frequently underrepresented ethnicities, with 17% Asian, 4% African, and 6% with other ethnic backgrounds. The analysis has revealed a significant enhancement in GestaltMatcher performance across all ethnic groups, incorporating non-European ethnicities, showcasing a remarkable increase in Top-1-Accuracy by 31.56% and Top-5-Accuracy by 12.64%. Importantly, this improvement was achieved without altering the performance metrics for European patients. GMDB addresses dysmorphology challenges by representing phenotypic variability and including underrepresented groups, enhancing global diagnostic rates and serving as a vital clinician reference database.
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Affiliation(s)
- Hellen Lesmann
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Alexander Hustinx
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Shahida Moosa
- Division of Molecular Biology and Human Genetics, Stellenbosch University and Medical Genetics, Tygerberg Hospital, Stellenbosch, South Africa
| | - Elaine Marchi
- New York State Institute for Basic Research in Developmental Disabilities, New York State, Albany, USA
| | - Pilar Caro
- Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - Ibrahim M Abdelrazek
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Jean Tori Pantel
- Institute for Digitalization and General Medicine, University Hospital RWTH Aachen, Aachen, Germany
- Centre for Rare Diseases Aachen (ZSEA), University Hospital RWTH Aachen, Aachen, Germany
| | - Hannah Klinkhammer
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Merle Ten Hagen
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | | | | | - Jing-Mei Li
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Behnam Javanmardi
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Alexej Knaus
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Annette Uwineza
- College of Medicine and Health Sciences, University of Rwanda, and University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Cordula Knopp
- Institute for Human Genetics and Genomic Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Tinatin Tkemaladze
- Department of Molecular and Medical Genetics, Tbilisi State Medical University, Tbilisi, Georgia
- Givi Zhvania Pediatric Academic Clinic, Tbilisi State Medical University, Georgia
| | - Miriam Elbracht
- Institute for Human Genetics and Genomic Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Larissa Mattern
- Institute for Human Genetics and Genomic Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Clara Velmans
- Institute of Human Genetics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Vincent Strehlow
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Himanshu Goel
- School of Medicine and Public Health, University of Newcastle, Callaghan NSW, Australia
| | - Beatriz Carvalho Nunes
- Genetics Division, Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Thainá Vilella
- Genetics Division, Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Chong Ae Kim
- Genetics Unit, Instituto da Criança, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Isabel Melaragno
- Genetics Division, Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Tahsin Stefan Barakat
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Amira Nabil
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Julia Suh
- Institute for Human Genetics and Genomic Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Luisa Averdunk
- Department of Pediatrics, Universtiy Hospital Düsseldorf, Düsseldorf, Germany
| | - Ekanem Ekure
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Prasit Phowthongkum
- Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
- Division of Medical Genetics and Genomics, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nergis Güzel
- Institut für Humangenetik und Genommedizin, Uniklinik RWTH Aachen, Aachen, Germany
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Theresa Brunet
- Institut für Humangenetik, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | | | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | | | - Franziska Schnabel
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Lara Heuft
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Vera Herrmann
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Antonio F Martinez-Monseny
- Department of Clinical Genetics, SJD Barcelona Children's Hospital, Esplugues del Llobregat (Barcelona), Spain
| | - Matthias Höller
- Institute for Human Genetics, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Khoshoua Alaaeldin
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Aleksandra Jezela-Stanek
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Amal Mohamed
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Amaia Lasa-Aranzasti
- Medicine Genetics Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Department of Clinical and Molecular Genetics, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - John A Sayer
- Biosciences Institute, Newcastle University, Central Parkway, Newcastle upon Tyne, UK
- Renal Services, The Newcastle Upon Tyne NHS Hospitals Foundation Trust, Freeman Road, Newcastle Upon Tyne, UK
| | - Ping Hu
- Division of Cancer prevention, National Cancer Institute, Bethesda, USA
| | | | - Gehad Elmakkawy
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Sylvia Safwat
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Frédéric Ebstein
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
- Nantes Université, CHU Nantes, Service de Génétique Médicale, F-44000 Nantes, France
| | - Elke Krüger
- Insitute for Medical Biochemistry and Molecular Biology, University of Greifswald, Greifswald, Greifswald, Germany
| | - Sébastien Küry
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
- Nantes Université, CHU Nantes, Service de Génétique Médicale, F-44000 Nantes, France
| | - Annabelle Arlt
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Felix Marbach
- Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - Christian Netzer
- Institute of Human Genetics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Sophia Kaptain
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Hannah Weiland
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Dong Li
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Lucie Dupuis
- Department to Paediatrics, Division of Clinical and Metabolic Genetics, The Hospital of Sick Children, Toronto, Canada
| | - Roberto Mendoza-Londono
- Department to Paediatrics, Division of Clinical and Metabolic Genetics, The Hospital of Sick Children, Toronto, Canada
| | - Sofia Douzgou Houge
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Denisa Weis
- Institue for Medical Genetics, Kepler University Hospital, Linz, Austria
| | - Brian Hon-Yin Chung
- Hong Kong Genome Institute, Hong Kong, China
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Christopher C Y Mak
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Karen W Gripp
- Division of Medical Genetics, A.I. du Pont Hospital for Children/Nemours, USA, Wilmington, USA
| | - Martin Mücke
- Institute for Digitalization and General Medicine, University Hospital RWTH Aachen, Aachen, Germany
- Centre for Rare Diseases Aachen (ZSEA), University Hospital RWTH Aachen, Aachen, Germany
| | - Alain Verloes
- Department of Clinical Genetics, Robert-Debré Hospital, Paris, France
| | | | - Christoffer Nellåker
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Benjamin D Solomon
- Medical Genomics Unit, Medical Genetics Branch, National Human Genome Research Institute, Bethesda, USA
| | - Rebekah L Waikel
- Medical Genomics Unit, Medical Genetics Branch, National Human Genome Research Institute, Bethesda, USA
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Ebtesam Abdalla
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Gholson J Lyon
- Department of Human Genetics, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York, United States of America
- George A. Jervis Clinic, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York, United States of America
- Biology PhD Program, The Graduate Center, The City University of New York, New York, United States of America
| | - Peter M Krawitz
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
| | - Tzung-Chien Hsieh
- Institute for Genomic Statistics and Bioinformatics, University of Bonn, Bonn, Germany
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5
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Gokce-Samar Z, Vetro A, De Bellescize J, Pisano T, Monteiro L, Penaud N, Korff CM, Fluss J, Marini C, Cesaroni E, Alvarez BM, Sanlaville D, Chatron N, Arzimanoglou AA, Labalme A, Cuddapah VA, Ruggiero SM, Lecoquierre F, Nicolas G, Marie GA, Lebas A, Testard HO, Helbig KL, Ruiz A, Ngoh A, Kurian MA, Reid K, Spaull R, Joset P, Ramantani G, Steindl K, Krenn M, Gerstl L, Vieker S, Craiu D, Pendziwiat M, Haldeman-Englert C, Kanivets I, Romanova I, Rajan DS, Rosenfeld JA, Au M, Grand K, Graham J, Isapof A, Villeneuve N, Smol T, Caumes R, Zacher P, Neuser S, Tinschert S, Platzer K, Bartolomaeus T, Mohnke I, Radtke M, Jamra RA, Helbig I, Jansen FE, Koop K, Rudolf G, Küry S, Courchet J, Guerrini R, Lesca G. Molecular and Phenotypic Characterization of the RORB-Related Disorder. Neurology 2024; 102:e207945. [PMID: 38165337 DOI: 10.1212/wnl.0000000000207945] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/18/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Heterozygous variants in RAR-related orphan receptor B (RORB) have recently been associated with susceptibility to idiopathic generalized epilepsy. However, few reports have been published so far describing pathogenic variants of this gene in patients with epilepsy and intellectual disability (ID). In this study, we aimed to delineate the epilepsy phenotype associated with RORB pathogenic variants and to provide arguments in favor of the pathogenicity of variants. METHODS Through an international collaboration, we analyzed seizure characteristics, EEG data, and genotypes of a cohort of patients with heterozygous variants in RORB. To gain insight into disease mechanisms, we performed ex vivo cortical electroporation in mouse embryos of 5 selected variants, 2 truncating and 3 missense, and evaluated on expression and quantified changes in axonal morphology. RESULTS We identified 35 patients (17 male, median age 10 years, range 2.5-23 years) carrying 32 different heterozygous variants in RORB, including 28 single-nucleotide variants or small insertions/deletions (12 missense, 12 frameshift or nonsense, 2 splice-site variants, and 2 in-frame deletions), and 4 microdeletions; de novo in 18 patients and inherited in 10. Seizures were reported in 31/35 (89%) patients, with a median age at onset of 3 years (range 4 months-12 years). Absence seizures occurred in 25 patients with epilepsy (81%). Nineteen patients experienced a single seizure type: absences, myoclonic absences, or absences with eyelid myoclonia and focal seizures. Nine patients had absence seizures combined with other generalized seizure types. One patient had presented with absences associated with photosensitive occipital seizures. Three other patients had generalized tonic-clonic seizures without absences. ID of variable degree was observed in 85% of the patients. Expression studies in cultured neurons showed shorter axons for the 5 tested variants, both truncating and missense variants, supporting an impaired protein function. DISCUSSION In most patients, the phenotype of the RORB-related disorder associates absence seizures with mild-to-moderate ID. In silico and in vitro evaluation of the variants in our cohort, including axonal morphogenetic experiments in cultured neurons, supports their pathogenicity, showing a hypomorphic effect.
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Affiliation(s)
- Zeynep Gokce-Samar
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Annalisa Vetro
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Julitta De Bellescize
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Tiziana Pisano
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Laloe Monteiro
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Noémie Penaud
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Christian M Korff
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Joel Fluss
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Carla Marini
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Elisabetta Cesaroni
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Blanca Mercedes Alvarez
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Damien Sanlaville
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Nicolas Chatron
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Alexis A Arzimanoglou
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Audrey Labalme
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Vishnu A Cuddapah
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Sarah M Ruggiero
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Francois Lecoquierre
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Gael Nicolas
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Guerrot Anne Marie
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Axel Lebas
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Herve O Testard
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Katherine L Helbig
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Anna Ruiz
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Adeline Ngoh
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Manju A Kurian
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Kimberley Reid
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Robert Spaull
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Pascal Joset
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Georgia Ramantani
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Katharina Steindl
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Martin Krenn
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Lucia Gerstl
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Silvia Vieker
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Dana Craiu
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Manuela Pendziwiat
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Chad Haldeman-Englert
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Ilya Kanivets
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Irina Romanova
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Deepa S Rajan
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Jill A Rosenfeld
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Margaret Au
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Katheryn Grand
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - John Graham
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Arnaud Isapof
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Nathalie Villeneuve
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Thomas Smol
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Roseline Caumes
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Pia Zacher
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Sonja Neuser
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Sigrid Tinschert
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Konrad Platzer
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Tobias Bartolomaeus
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Ines Mohnke
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Maximilian Radtke
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Rami Abou Jamra
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Ingo Helbig
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Floortje E Jansen
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Klaas Koop
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Gabrielle Rudolf
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Sebastien Küry
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Julien Courchet
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Renzo Guerrini
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
| | - Gaetan Lesca
- From the Department of Pediatric Clinical Epileptology (Z.G.-S., J.D.B., A.A.A.), Sleep Disorders and Functional Neurology, University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Neuroscience Department (A.V., T.P., R.G.) IRCCS, Children's Hospital Meyer, Member of ERN Epicare, and University of Florence, Italy; Univ Lyon (L.M., N.P., D.S., N.C., J.C., G.L.), Univ Lyon 1, CNRS, INSERM, Physiopathologie et Génétique du Neurone et du Muscle, UMR5261, U1315, Institut NeuroMyoGène, France; Pediatric Neurology Unit (C.M.K., J.F.), University Hospitals of Geneva, Switzerland; Child Neurology and Psychiatric Unit (C.M., E.C.), Children's Hospital G. Salesi, Azienda Universitaria Ospedaliera delle Marche, Ancona, Italy; Department of Neurology (B.M.A.), University Hospitals of Montpellier; Department of Genetics (D.S., N.C., A. Labalme, G.L.), University Hospitals of Lyon, HCL, Member of ERN Epicare, France; Paediatric Epilepsy Research (A.A.A.), Child Neurology Department, Member of the ERN EpiCARE, San Juan de Dios Children's Hospital, Barcelona, Spain; Division of Neurology (V.A.C., S.M.R., I.H.), and The Epilepsy NeuroGenetics Initiative (ENGIN) (V.A.C., S.M.R., K.L.H., I.H.), Children's Hospital of Philadelphia, PA; Department of Neurology (V.A.C., S.M.R., I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Univ Rouen Normandie (F.L., G.N.), Inserm U1245 and CHU Rouen, Department of Genetics and Reference Center for Developmental Disorders; Department of Pediatric Neurology (G.A.M., A. Lebas), University Hospitals of Rouen; Department of Pediatric Neurology (H.O.T.), Hospital of Alpes Léman, Annemasse, France; Department of Pediatric Neurology (A.R.), Barcelona Children's Hospital, University of Barcelona, Spain; Developmental Neurosciences (A.N., M.A.K., K.R., R.S.), Zayed Centre for Research, University College of London, Great Ormond Street Hospital, Institute of Child Health, United Kingdom; Institute of Medical Genetics (P.J.), University of Zürich; Department of Neuropediatrics (G. Ramantani, K.S.), University Children's Hospital and University of Zürich, Switzerland; Department of Neurology (M.K.), Medical University of Vienna, Austria; Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics (L.G.), Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Institute of Human Genetics (S.V.), Medical University of Innsbruck, Innsbruck, Austria; Werner-Forßmann-Krankenhaus (S.V., S.T.), Eberswalde, Germany; Pediatric Neurology Discipline (D.C.), Neurosciences Department, Carol Davila University of Medicine Bucharest; Pediatric Neurology Clinic (D.C.), Al Obregia Hospital, Center of Expertise for Pediatric Neurology Rare Disorders, Member of ERN EpiCARE, Bucharest, Romania; Institute of Clinical Molecular Biology (M.P., I.H.), Christian-Albrechts-University of Kiel, Germany; Mission Fullerton Genetics Center (C.H.-E.), Asheville, NC; Department of Neurology (I.K.), Svt. Luka's Institute of Child Neurology and Epilepsy, Moscow; Department of Medical Genetics (I.R.), Kazan State University, Russia; Division of Child Neurology (D.S.R.), Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, PA; Department of Molecular and Human Genetics (J.A.R.), Baylor College of Medicine, Houston, TX; Division of Clinical Genetics and Dysmorphology (M.A., K.G., J.M.G.), Cedars-Sinai Medical Center, Los Angeles, CA; Department of Neurology (A.I.), University Hospitals of Armand Trousseau, AP-HP, Paris; Department of Pediatric Neurology (N.V.), University Hospitals of Marseille, AP-HM; Univ. Lille (T.S.), CHU Lille, ULR7364, RADEME, Institute of Medical Genetics; Department of Clinical Genetics (R.C.), CHU Lille, France; Institute of Human Genetics (P.Z., S.N., K.P., T.B., I.M., M.R., R.A.J.), University of Leipzig Medical Center, Germany; Institute of Human Genetics (S.T.), Medical University of Innsbruck, Austria; Department of Biomedical and Health Informatics (DBHi) (I.H.), Children's Hospital of Philadelphia, PA; Department of Pediatric Neurology (F.E.J., K.K.), Brain Center UMC Utrecht, Member of ERN Epicare, Utrecht, the Netherlands; Department of Neurology (G. Rudolf), Strasbourg University Hospital; and Nantes Université (S.K.), CHU Nantes, Service de Génétique Médicale, and CNRS, INSERM, l'institut du thorax, France
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Bosch E, Popp B, Güse E, Skinner C, van der Sluijs PJ, Maystadt I, Pinto AM, Renieri A, Bruno LP, Granata S, Marcelis C, Baysal Ö, Hartwich D, Holthöfer L, Isidor B, Cogne B, Wieczorek D, Capra V, Scala M, De Marco P, Ognibene M, Jamra RA, Platzer K, Carter LB, Kuismin O, van Haeringen A, Maroofian R, Valenzuela I, Cuscó I, Martinez-Agosto JA, Rabani AM, Mefford HC, Pereira EM, Close C, Anyane-Yeboa K, Wagner M, Hannibal MC, Zacher P, Thiffault I, Beunders G, Umair M, Bhola PT, McGinnis E, Millichap J, van de Kamp JM, Prijoles EJ, Dobson A, Shillington A, Graham BH, Garcia EJ, Galindo MK, Ropers FG, Nibbeling EAR, Hubbard G, Karimov C, Goj G, Bend R, Rath J, Morrow MM, Millan F, Salpietro V, Torella A, Nigro V, Kurki M, Stevenson RE, Santen GWE, Zweier M, Campeau PM, Severino M, Reis A, Accogli A, Vasileiou G. Elucidating the clinical and molecular spectrum of SMARCC2-associated NDD in a cohort of 65 affected individuals. Genet Med 2023; 25:100950. [PMID: 37551667 DOI: 10.1016/j.gim.2023.100950] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/28/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023] Open
Abstract
PURPOSE Coffin-Siris and Nicolaides-Baraitser syndromes are recognizable neurodevelopmental disorders caused by germline variants in BAF complex subunits. The SMARCC2 BAFopathy was recently reported. Herein, we present clinical and molecular data on a large cohort. METHODS Clinical symptoms for 41 novel and 24 previously published affected individuals were analyzed using the Human Phenotype Ontology. For genotype-phenotype correlations, molecular data were standardized and grouped into non-truncating and likely gene-disrupting (LGD) variants. Missense variant protein expression and BAF-subunit interactions were examined using 3D protein modeling, co-immunoprecipitation, and proximity-ligation assays. RESULTS Neurodevelopmental delay with intellectual disability, muscular hypotonia, and behavioral disorders were the major manifestations. Clinical hallmarks of BAFopathies were rare. Clinical presentation differed significantly, with LGD variants being predominantly inherited and associated with mildly reduced or normal cognitive development, whereas non-truncating variants were mostly de novo and presented with severe developmental delay. These distinct manifestations and non-truncating variant clustering in functional domains suggest different pathomechanisms. In vitro testing showed decreased protein expression for N-terminal missense variants similar to LGD. CONCLUSION This study improved SMARCC2 variant classification and identified discernible SMARCC2-associated phenotypes for LGD and non-truncating variants, which were distinct from other BAFopathies. The pathomechanism of most non-truncating variants has yet to be investigated.
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Affiliation(s)
- Elisabeth Bosch
- Institute of Human Genetics, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Bernt Popp
- Berlin Institute of Health at Charitè, Universitätsklinikum Berlin, Centre of Functional Genomics, Berlin, Germany; Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Esther Güse
- Institute of Human Genetics, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | | | - Isabelle Maystadt
- Center for Human Genetics, Institute of Pathology and Genetics, Gosselies, Belgium
| | - Anna Maria Pinto
- Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alessandra Renieri
- Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy; Medical Genetics Unit, University of Siena, Siena, Italy
| | - Lucia Pia Bruno
- Telethon Institute of Genetics and Medicine (TIGEM), Naples, Italy
| | - Stefania Granata
- Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy; Medical Genetics Unit, University of Siena, Siena, Italy
| | - Carlo Marcelis
- Human Genetics department, Radboud university medical center, Nijmegen, The Netherlands
| | - Özlem Baysal
- Human Genetics department, Radboud university medical center, Nijmegen, The Netherlands
| | - Dewi Hartwich
- Institute of Human Genetics - University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Laura Holthöfer
- Institute of Human Genetics - University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Bertrand Isidor
- Nantes Université, CHU de Nantes, Service de Génétique médicale, Nantes, France; Nantes Université, CHU de Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Benjamin Cogne
- Nantes Université, CHU de Nantes, Service de Génétique médicale, Nantes, France; Nantes Université, CHU de Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Dagmar Wieczorek
- Institute of Human Genetics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Valeria Capra
- Genomics and Clinical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marcello Scala
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy; Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Patrizia De Marco
- Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marzia Ognibene
- Medical Genetics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Lauren B Carter
- Department of Pediatrics, Division of Medical Genetics, Levine Children's Hospital, Atrium Health, Charlotte, NC
| | - Outi Kuismin
- Department of Clinical Genetics, Research Unit of Clinical Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Arie van Haeringen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Reza Maroofian
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Irene Valenzuela
- Department of Clinical and Molecular Genetics, University Hospital Vall d'Hebron, Barcelona, Spain; Medicine Genetics Group, Valle Hebron Research Institute, Barcelona, Spain
| | - Ivon Cuscó
- Department of Clinical and Molecular Genetics, University Hospital Vall d'Hebron, Barcelona, Spain; Medicine Genetics Group, Valle Hebron Research Institute, Barcelona, Spain
| | - Julian A Martinez-Agosto
- Departments of Human Genetics, Pediatrics, and Psychiatry, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Ahna M Rabani
- Department of Pediatrics & Institute for Precision Health, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Heather C Mefford
- Center for Pediatric Neurological Disease Research, St. Jude Children's Research Hospital, Memphis, TN
| | - Elaine M Pereira
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Charlotte Close
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Kwame Anyane-Yeboa
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Mallory Wagner
- Division of Pediatric Genetics, Metabolism, and Genomic Medicine, Department of Pediatrics, University of Michigan Health System, University of Michigan, Ann Arbor, MI
| | - Mark C Hannibal
- Division of Pediatric Genetics, Metabolism, and Genomic Medicine, Department of Pediatrics, University of Michigan Health System, University of Michigan, Ann Arbor, MI
| | - Pia Zacher
- Epilepsy Center Kleinwachau, Radeberg, Germany
| | - Isabelle Thiffault
- Department of Pediatrics and Pathology, Genomic Medicine Center, Children's Mercy Kansas City and Children's Mercy Research Institute, Kansas City, MO
| | - Gea Beunders
- Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Muhammad Umair
- Medical Genomics Research Department, King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, MNGHA, Riyadh, Saudi Arabia; Department of Life Sciences, School of Science, University of Management and Technology (UMT), Lahore, Pakistan
| | - Priya T Bhola
- Department of Genetics, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Canada
| | - Erin McGinnis
- Division of Neurology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - John Millichap
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jiddeke M van de Kamp
- Department of Human Genetics, Amsterdam UMC, location VU Medical Center, Amsterdam, The Netherlands
| | | | | | - Amelle Shillington
- Department of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Brett H Graham
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Evan-Jacob Garcia
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | | | - Fabienne G Ropers
- Willem-Alexander Children's Hospital, Department of Pediatrics, Leiden University Medical Center, The Netherlands
| | - Esther A R Nibbeling
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Gail Hubbard
- Department of Medical Genetics, Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Catherine Karimov
- Department of Medical Genetics, Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Guido Goj
- Vestische Kinder- und Jugendklinik, Datteln, Germany
| | - Renee Bend
- PreventionGenetics, Part of Exact Sciences, Marshfield, WI
| | - Julie Rath
- PreventionGenetics, Part of Exact Sciences, Marshfield, WI
| | | | | | - Vincenzo Salpietro
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, United Kingdom; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Annalaura Torella
- Telethon Institute of Genetics and Medicine (TIGEM), Naples, Italy; Department of Precision Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Vincenzo Nigro
- Telethon Institute of Genetics and Medicine (TIGEM), Naples, Italy; Department of Precision Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Mitja Kurki
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA
| | | | - Gijs W E Santen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Markus Zweier
- Institute of Medical Genetics, University of Zürich, Schlieren-Zurich, Switzerland
| | - Philippe M Campeau
- Department of Pediatrics, CHU Sainte-Justine and University of Montreal, Montreal, QC, Canada
| | | | - André Reis
- Institute of Human Genetics, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Centre for Rare Diseases Erlangen (ZSEER), Erlangen, Germany
| | - Andrea Accogli
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre; Department of Human Genetics, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Georgia Vasileiou
- Institute of Human Genetics, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Centre for Rare Diseases Erlangen (ZSEER), Erlangen, Germany.
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7
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Oppermann H, Marcos-Grañeda E, Weiss LA, Gurnett CA, Jelsig AM, Vineke SH, Isidor B, Mercier S, Magnussen K, Zacher P, Hashim M, Pagnamenta AT, Race S, Srivastava S, Frazier Z, Maiwald R, Pergande M, Milani D, Rinelli M, Levy J, Krey I, Fontana P, Lonardo F, Riley S, Kretzer J, Rankin J, Reis LM, Semina EV, Reuter MS, Scherer SW, Iascone M, Weis D, Fagerberg CR, Brasch-Andersen C, Hansen LK, Kuechler A, Noble N, Gardham A, Tenney J, Rathore G, Beck-Woedl S, Haack TB, Pavlidou DC, Atallah I, Vodopiutz J, Janecke AR, Hsieh TC, Lesmann H, Klinkhammer H, Krawitz PM, Lemke JR, Jamra RA, Nieto M, Tümer Z, Platzer K. CUX1-related neurodevelopmental disorder: deep insights into phenotype-genotype spectrum and underlying pathology. Eur J Hum Genet 2023; 31:1251-1260. [PMID: 37644171 PMCID: PMC10620399 DOI: 10.1038/s41431-023-01445-2] [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: 12/21/2022] [Revised: 06/26/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
Heterozygous, pathogenic CUX1 variants are associated with global developmental delay or intellectual disability. This study delineates the clinical presentation in an extended cohort and investigates the molecular mechanism underlying the disorder in a Cux1+/- mouse model. Through international collaboration, we assembled the phenotypic and molecular information for 34 individuals (23 unpublished individuals). We analyze brain CUX1 expression and susceptibility to epilepsy in Cux1+/- mice. We describe 34 individuals, from which 30 were unrelated, with 26 different null and four missense variants. The leading symptoms were mild to moderate delayed speech and motor development and borderline to moderate intellectual disability. Additional symptoms were muscular hypotonia, seizures, joint laxity, and abnormalities of the forehead. In Cux1+/- mice, we found delayed growth, histologically normal brains, and increased susceptibility to seizures. In Cux1+/- brains, the expression of Cux1 transcripts was half of WT animals. Expression of CUX1 proteins was reduced, although in early postnatal animals significantly more than in adults. In summary, disease-causing CUX1 variants result in a non-syndromic phenotype of developmental delay and intellectual disability. In some individuals, this phenotype ameliorates with age, resulting in a clinical catch-up and normal IQ in adulthood. The post-transcriptional balance of CUX1 expression in the heterozygous brain at late developmental stages appears important for this favorable clinical course.
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Affiliation(s)
- Henry Oppermann
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany.
| | - Elia Marcos-Grañeda
- Department of Cellular and Molecular Biology, Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Científicas (CNB-CSIC), Campus de Cantoblanco, Madrid, Spain
| | - Linnea A Weiss
- Department of Cellular and Molecular Biology, Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Científicas (CNB-CSIC), Campus de Cantoblanco, Madrid, Spain
| | - Christina A Gurnett
- Department of Neurology, Washington University in St Louis, St Louis, MO, USA
| | - Anne Marie Jelsig
- Dpt. of Clinical Genetics, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Susanne H Vineke
- Dpt. of Clinical Genetics, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Bertrand Isidor
- Service de Génétique Médicale, CHU de Nantes, Nantes, France
| | - Sandra Mercier
- Service de Génétique Médicale, CHU de Nantes, Nantes, France
- L'institut du thorax, Inserm, Cnrs, Univ Nantes, Nantes, France
| | - Kari Magnussen
- Randall Children's Hospital at Legacy Emanuel, Portland, OR, USA
| | - Pia Zacher
- Epilepsy Center Kleinwachau, Radeberg, Germany
| | - Mona Hashim
- NIHR Oxford Biomedical Research Centre, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Alistair T Pagnamenta
- NIHR Oxford Biomedical Research Centre, Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Simone Race
- BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Zoë Frazier
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Robert Maiwald
- MVZ for Coagulation Diagnostics and Medical Genetics Cologne, ÜBAG Zotz/Klimas, Cologne, Germany
| | | | - Donatella Milani
- Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Rinelli
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Departmental Unit of Molecular and Genomic Diagnostics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jonathan Levy
- Genetics Department, CHU Robert-Debré, AP-HP, Paris, France
| | - Ilona Krey
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Paolo Fontana
- Medical Genetics Unit, A.O.R.N. San Pio, Benevento, Italy
| | | | - Stephanie Riley
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jasmine Kretzer
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Julia Rankin
- Department of Clinical Genetics, Royal Devon University Healthcare NHS Trust, Exeter, UK
| | - Linda M Reis
- Department of Pediatrics and Children's Research Institute, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Elena V Semina
- Department of Pediatrics and Children's Research Institute, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Miriam S Reuter
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Stephen W Scherer
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Maria Iascone
- Laboratory of Medical Genetics, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Denisa Weis
- Department of Medical Genetics, Kepler University Hospital Med Campus IV, Johannes Kepler University, Linz, Austria
| | | | | | | | - Alma Kuechler
- Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Nathan Noble
- Blank Children's Developmental Center, Unity Point Health, Des Moines, IA, USA
| | - Alice Gardham
- North West Thames Regional Genetic Service, North West London Hospitals, London, UK
| | - Jessica Tenney
- Division of Medical Genetics, University of California, San Francisco, CA, USA
| | - Geetanjali Rathore
- Dvision of Pediatric Neurology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Stefanie Beck-Woedl
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Despoina C Pavlidou
- Division of Genetic Medicine, Lausanne Universitary Hospital and University of Lausanne, Lausanne, Switzerland
| | - Isis Atallah
- Division of Genetic Medicine, Lausanne Universitary Hospital and University of Lausanne, Lausanne, Switzerland
| | - Julia Vodopiutz
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
- Vienna Bone and Growth Center, Vienna, Austria
| | - Andreas R Janecke
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
| | - Tzung-Chien Hsieh
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Hellen Lesmann
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
- Institut für Humangenetik, Universitätsklinikum Bonn, Universität Bonn, Bonn, Germany
| | - Hannah Klinkhammer
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Peter M Krawitz
- Institute for Genomic Statistics and Bioinformatics, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, 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
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Marta Nieto
- Department of Cellular and Molecular Biology, Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Científicas (CNB-CSIC), Campus de Cantoblanco, Madrid, Spain.
| | - Zeynep Tümer
- Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicin, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
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8
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Thalwitzer KM, Driedger JH, Xian J, Saffari A, Zacher P, Bölsterli BK, Ruggiero SM, Sullivan KR, Datta AN, Kellinghaus C, Althaus J, Wiemer-Kruel A, van Baalen A, Pampel A, Alber M, Braakman HMH, Debus OM, Denecke J, Hobbiebrunken E, Breitweg I, Diehl D, Eitel H, Gburek-Augustat J, Preisel M, Schlump JU, Laufs M, Mammadova D, Wurst C, Prager C, Löhr-Nilles C, Martin P, Garbade SF, Platzer K, Benkel-Herrenbrueck I, Egler K, Fazeli W, Lemke JR, Runkel E, Klein B, Linden T, Schröter J, Steffeck H, Thies B, von Deimling F, Illsinger S, Borggraefe I, Classen G, Wieczorek D, Ramantani G, Koelker S, Hoffmann GF, Ries M, Helbig I, Syrbe S. Natural History and Developmental Trajectories of Individuals With Disease-Causing Variants in STXBP1. Neurology 2023; 101:e879-e891. [PMID: 37407264 PMCID: PMC10501093 DOI: 10.1212/wnl.0000000000207550] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/08/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Pathogenic variants in STXBP1 are among the major genetic causes of neurodevelopmental disorders. Despite the increasing number of individuals diagnosed without a history of epilepsy, little is known about the natural history and developmental trajectories in this subgroup and endpoints for future therapeutic studies are limited to seizure control. METHODS We performed a cross-sectional retrospective study using standardized questionnaires for clinicians and caregivers of individuals with STXBP1-related disorders capturing medical histories, genetic findings, and developmental outcomes. Motor and language function were assessed using Gross Motor Function Classification System (GMFCS) scores and a speech impairment score and were compared within and across clinically defined subgroups. RESULTS We collected data of 71 individuals with STXBP1-related disorders, including 44 previously unreported individuals. Median age at inclusion was 5.3 years (interquartile range 3.5-9.3) with the oldest individual aged 43.8 years. Epilepsy was absent in 18/71 (25%) of individuals. The range of developmental outcomes was broad, including 2 individuals presenting with close to age-appropriate motor development. Twenty-nine of 61 individuals (48%) were able to walk unassisted, and 24/69 (35%) were able to speak single words. Individuals without epilepsy presented with a similar onset and spectrum of phenotypic features but had lower GMFCS scores (median 3 vs 4, p < 0.01) than individuals with epilepsy. Individuals with epileptic spasms were less likely to walk unassisted than individuals with other seizure types (6% vs 58%, p < 0.01). Individuals with early epilepsy onset had higher speech impairment scores (p = 0.02) than individuals with later epilepsy onset. DISCUSSION We expand the spectrum of STXBP1-related disorders and provide clinical features and developmental trajectories in individuals with and without a history of epilepsy. Individuals with epilepsy, in particular epileptic spasms, and neonatal or early-onset presented with less favorable motor and language functional outcomes compared with individuals without epilepsy. These findings identify children at risk for severe disease and can serve as comparator for future interventional studies in STXBP1-related disorders.
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Affiliation(s)
- Kim M Thalwitzer
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Jan H Driedger
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Julie Xian
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Afshin Saffari
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Pia Zacher
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Bigna K Bölsterli
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sarah McKeown Ruggiero
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Katie Rose Sullivan
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Alexandre N Datta
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Christoph Kellinghaus
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Jürgen Althaus
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Adelheid Wiemer-Kruel
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Andreas van Baalen
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Armin Pampel
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Michael Alber
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Hilde M H Braakman
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Otfried M Debus
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Jonas Denecke
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Elke Hobbiebrunken
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Ina Breitweg
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Danielle Diehl
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Hans Eitel
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Janina Gburek-Augustat
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Martin Preisel
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Jan-Ulrich Schlump
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Mirjam Laufs
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Dilbar Mammadova
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Carsten Wurst
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Christine Prager
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Christa Löhr-Nilles
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Peter Martin
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sven F Garbade
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Konrad Platzer
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Ira Benkel-Herrenbrueck
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Kerstin Egler
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Walid Fazeli
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Johannes R Lemke
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Eva Runkel
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Barbara Klein
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Tobias Linden
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Julian Schröter
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Heike Steffeck
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Bastian Thies
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Florian von Deimling
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sabine Illsinger
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Ingo Borggraefe
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Georg Classen
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Dagmar Wieczorek
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Georgia Ramantani
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Stefan Koelker
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Georg F Hoffmann
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Markus Ries
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Ingo Helbig
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Steffen Syrbe
- From the Division of Pediatric Epileptology (K.M.T., J.H.D., A.S., J.S., S.S.), Pediatric Neurology and Metabolic Medicine (A.S., S.F.G., J.S., S.K., G.F.H., M.R.), Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany; The Epilepsy NeuroGenetics Initiative (ENGIN) (K.M.T., J.X., S.M.R., K.R.S., I.H.), Division of Neurology (J.X., S.M.R., K.R.S., I.H.), and Department of Biomedical and Health Informatics (DBHi) (J.X., I.H.), Children's Hospital of Philadelphia, PA; Epilepsy Center Kleinwachau (P.Z.), Radeberg, Germany; Department of Neuropediatrics and Children's Research Center (B.K.B., G.R.), University Children's Hospital Zurich, University of Zurich; Department of Pediatric Neurology (B.K.B.), Children's Hospital of Eastern Switzerland, Sankt Gallen; Department of Pediatric Neurology and Developmental Medicine (A.N.D.), University Children's Hospital Basel UKBB, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück; Department of Pediatrics (J.A.), Christophorus Hospital Coesfeld; Epilepsy Center Kork (A.W.-K.), Clinic for Children and Adolescents, Kehl-Kork; Department of Neuropediatrics (A.v.B., M.L.), University Medical Center Schleswig-Holstein, Kiel University (CAU); Center for Social Pediatrics (A.P.), Johannes Wesling Klinikum Minden; Department of Pediatric Neurology and Developmental Medicine (M.A.), University Children's Hospital, Tübingen, Germany; Department of Pediatric Neurology (H.M.H.B.), Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatrics (O.M.D.), Clemenshospital Münster; Department of Pediatrics (J.D.), University Medical Center Hamburg-Eppendorf; Division of Pediatric Neurology (E.H.), Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen; Kinderärzte Ammersee (I. Breitweg), Neubruch 1, Inning an Ammersee; Department of Neuropediatrics (D.D.), University Hospital Giessen; Department of Neuropediatrics (H.E.), Klinikum Esslingen; Division of Neuropediatrics (J.G.-A.), Hospital for Children and Adolescents, University Hospital Leipzig, Germany; Department of Neuropediatrics (M.P.), Children University Hospital and Paracelsus Medical University, Salzburg, Austria; Department of Neuropediatrics (J.-U.S.), Gemeinschaftskrankenhaus Herdecke; Department of Pediatrics and Adolescent Medicine (D.M.), and Center for Social Pediatrics (D.M.), University Hospital Erlangen, Friedrich-Alexander-Universität (FAU); Department of Pediatric Neurology (C.W.), SRH Zentralklinikum Suhl; Department of Pediatric Neurology (C.P.), and Center for Chronically Sick Children (C.P.), Charité-Universitätsmedizin Berlin; Department of Pediatric Neurology (C.L.-N.), Klinikum Mutterhaus der Borromäerinnen gGmbH, Trier; Séguin-Clinic for Persons with Severe Intellectual Disability (P.M.), Epilepsy Centre Kork; Medical Faculty (P.M.), University of Freiburg; Institute of Human Genetics (K.P., J.R.L.), University of Leipzig Medical Center; Sana-Krankenhaus Düsseldorf-Gerresheim (I.B.-H.), Academic Teaching Hospital der Heinrich-Heine-University Düsseldorf; Department of Neuropediatrics (K.E.), Sankt Elisabeth, KJF Klinik, Neuburg an der Donau; Department of Neuropediatrics (W.F.), Children's Hospital, University of Bonn; Center of Rare Diseases (J.R.L.), University of Leipzig Medical Center; Klinikum Aschaffenburg-Alzenau (E.R.); Department of Neuropediatrics (B.K.), Klinikum Frankfurt Höchst GmbH; Department of Neuropediatrics (T.L.), University Children's Hospital, Klinikum Oldenburg; Department of Neuropediatrics (H.S.), Klinikum Wolfsburg; Kinderneurologie Thies (B.T.), Lüneburg; Sozialpädiatrisches Zentrum Coburg (F.v.D.); Clinic for Pediatric Kidney-, Liver- and Metabolic Diseases (S.I.), Hannover Medical School; Division of Pediatric Neurology and Developmental Medicine (I. Borggraefe), Department of Pediatrics, University Hospital of the Ludwig-Maximilians-University of Munich; Department of Pediatrics (G.C.), Evangelisches Klinikum Bethel, University Hospital Owl, University Bielefeld; Institute of Human Genetics (D.W.), Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany; and Department of Neurology (I.H.), University of Pennsylvania Perelman School of Medicine, Philadelphia.
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9
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Calame DG, Guo T, Wang C, Garrett L, Jolly A, Dawood M, Kurolap A, Henig NZ, Fatih JM, Herman I, Du H, Mitani T, Becker L, Rathkolb B, Gerlini R, Seisenberger C, Marschall S, Hunter JV, Gerard A, Heidlebaugh A, Challman T, Spillmann RC, Jhangiani SN, Coban-Akdemir Z, Lalani S, Liu L, Revah-Politi A, Iglesias A, Guzman E, Baugh E, Boddaert N, Rondeau S, Ormieres C, Barcia G, Tan QKG, Thiffault I, Pastinen T, Sheikh K, Biliciler S, Mei D, Melani F, Shashi V, Yaron Y, Steele M, Wakeling E, Østergaard E, Nazaryan-Petersen L, Millan F, Santiago-Sim T, Thevenon J, Bruel AL, Thauvin-Robinet C, Popp D, Platzer K, Gawlinski P, Wiszniewski W, Marafi D, Pehlivan D, Posey JE, Gibbs RA, Gailus-Durner V, Guerrini R, Fuchs H, Hrabě de Angelis M, Hölter SM, Cheung HH, Gu S, Lupski JR. Monoallelic variation in DHX9, the gene encoding the DExH-box helicase DHX9, underlies neurodevelopment disorders and Charcot-Marie-Tooth disease. Am J Hum Genet 2023; 110:1394-1413. [PMID: 37467750 PMCID: PMC10432148 DOI: 10.1016/j.ajhg.2023.06.013] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023] Open
Abstract
DExD/H-box RNA helicases (DDX/DHX) are encoded by a large paralogous gene family; in a subset of these human helicase genes, pathogenic variation causes neurodevelopmental disorder (NDD) traits and cancer. DHX9 encodes a BRCA1-interacting nuclear helicase regulating transcription, R-loops, and homologous recombination and exhibits the highest mutational constraint of all DDX/DHX paralogs but remains unassociated with disease traits in OMIM. Using exome sequencing and family-based rare-variant analyses, we identified 20 individuals with de novo, ultra-rare, heterozygous missense or loss-of-function (LoF) DHX9 variant alleles. Phenotypes ranged from NDDs to the distal symmetric polyneuropathy axonal Charcot-Marie-Tooth disease (CMT2). Quantitative Human Phenotype Ontology (HPO) analysis demonstrated genotype-phenotype correlations with LoF variants causing mild NDD phenotypes and nuclear localization signal (NLS) missense variants causing severe NDD. We investigated DHX9 variant-associated cellular phenotypes in human cell lines. Whereas wild-type DHX9 was restricted to the nucleus, NLS missense variants abnormally accumulated in the cytoplasm. Fibroblasts from an individual with an NLS variant also showed abnormal cytoplasmic DHX9 accumulation. CMT2-associated missense variants caused aberrant nucleolar DHX9 accumulation, a phenomenon previously associated with cellular stress. Two NDD-associated variants, p.Gly411Glu and p.Arg761Gln, altered DHX9 ATPase activity. The severe NDD-associated variant p.Arg141Gln did not affect DHX9 localization but instead increased R-loop levels and double-stranded DNA breaks. Dhx9-/- mice exhibited hypoactivity in novel environments, tremor, and sensorineural hearing loss. All together, these results establish DHX9 as a critical regulator of mammalian neurodevelopment and neuronal homeostasis.
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Affiliation(s)
- Daniel G Calame
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Tianyu Guo
- School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chen Wang
- School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lillian Garrett
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute of Developmental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Angad Jolly
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA
| | - Moez Dawood
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Alina Kurolap
- Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Noa Zunz Henig
- Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jawid M Fatih
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Isabella Herman
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Boys Town National Research Hospital, Boys Town, NE, USA
| | - Haowei Du
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Tadahiro Mitani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Lore Becker
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Birgit Rathkolb
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute of Molecular Animal Breeding and Biotechnology, Gene Center, Ludwig-Maximilians University Munich, Munich, Germany; German Center for Diabetes Research (DZD), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Raffaele Gerlini
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Claudia Seisenberger
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Susan Marschall
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Jill V Hunter
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA; E.B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston, TX, USA
| | - Amanda Gerard
- Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | | | - Thomas Challman
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA, USA
| | - Rebecca C Spillmann
- Department of Pediatrics, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Shalini N Jhangiani
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Zeynep Coban-Akdemir
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Seema Lalani
- Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Lingxiao Liu
- School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anya Revah-Politi
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY, USA; Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Alejandro Iglesias
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Edwin Guzman
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Evan Baugh
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Nathalie Boddaert
- Paediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université Paris Cité, Institut Imagine INSERM U1163, 75015 Paris, France
| | - Sophie Rondeau
- Service de Médecine Génomique des Maladies Rares - APHP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| | - Clothide Ormieres
- Service de Médecine Génomique des Maladies Rares - APHP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| | - Giulia Barcia
- Service de Médecine Génomique des Maladies Rares - APHP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| | - Queenie K G Tan
- Department of Pediatrics, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Isabelle Thiffault
- Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO, USA
| | - Tomi Pastinen
- Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO, USA; University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Kazim Sheikh
- Department of Neurology, UT Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Suur Biliciler
- Department of Neurology, UT Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Davide Mei
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Federico Melani
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Vandana Shashi
- Department of Pediatrics, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Yuval Yaron
- Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mary Steele
- Lifetime Neurodevelopmental Care, San Francisco, CA, USA
| | - Emma Wakeling
- North East Thames Regional Genetic Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Elsebet Østergaard
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lusine Nazaryan-Petersen
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Julien Thevenon
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Interrégion Est, Fédération Hospitalo-Universitaire Médecine TRANSLationnelle et Anomalies du Développement, Centre Hospitalier Universitaire Dijon, Equipe Genetics of Developmental Anomalies-INSERM UMR 1231, Dijon, France
| | - Ange-Line Bruel
- Functional Unit for Diagnostic Innovation in Rare Diseases, FHU-TRANSLAD, Dijon Bourgogne University Hospital, Dijon, France; INSERM UMR1231 GAD "Génétique des Anomalies du Développement," FHU-TRANSLAD, University of Burgundy, Dijon, France
| | - Christel Thauvin-Robinet
- INSERM UMR1231 GAD "Génétique des Anomalies du Développement," FHU-TRANSLAD, University of Burgundy, Dijon, France; Department of Genetics and Reference Center for Development Disorders and Intellectual Disabilities, Dijon Bourgogne University Hospital, Dijon, France
| | - Denny Popp
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Pawel Gawlinski
- Institute of Mother and Child, Kasprzaka 17a, 02-211 Warsaw, Poland
| | - Wojciech Wiszniewski
- Oregon Health & Sciences University, 3181 SW Sam Jackson Park Road L103, Portland, OR, USA
| | - Dana Marafi
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Davut Pehlivan
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer E Posey
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Richard A Gibbs
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Valerie Gailus-Durner
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Renzo Guerrini
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, Italy; University of Florence, Florence, Italy
| | - Helmut Fuchs
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Martin Hrabě de Angelis
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; German Center for Diabetes Research (DZD), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; Chair of Experimental Genetics, TUM School of Life Sciences, Technische Universität München, Alte Akademie 8, 85354 Freising, Germany
| | - Sabine M Hölter
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute of Developmental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Technische Universität München, Freising-Weihenstephan, Germany
| | - Hoi-Hung Cheung
- School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shen Gu
- School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China; Key Laboratory for Regenerative Medicine, Ministry of Education, School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China; Kunming Institute of Zoology Chinese Academy of Sciences, the Chinese University of Hong Kong Joint Laboratory of Bioresources and Molecular Research of Common Diseases, Hong Kong SAR, China.
| | - James R Lupski
- Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
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10
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Rossi A, Blok LS, Neuser S, Klöckner C, Platzer K, Faivre LO, Weigand H, Dentici ML, Tartaglia M, Niceta M, Alfieri P, Srivastava S, Coulter D, Smith L, Vinorum K, Cappuccio G, Brunetti-Pierri N, Torun D, Arslan M, Lauridsen MF, Murch O, Irving R, Lynch SA, Mehta SG, Carmichael J, Zonneveld-Huijssoon E, de Vries B, Kleefstra T, Johannesen KM, Westphall IT, Hughes SS, Smithson S, Evans J, Dudding-Byth T, Simon M, van Binsbergen E, Herkert JC, Beunders G, Oppermann H, Bakal M, Møller RS, Rubboli G, Bayat A. POU3F3-related disorder: Defining the phenotype and expanding the molecular spectrum. Clin Genet 2023; 104:186-197. [PMID: 37165752 PMCID: PMC10330344 DOI: 10.1111/cge.14353] [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: 01/23/2023] [Revised: 04/06/2023] [Accepted: 04/24/2023] [Indexed: 05/12/2023]
Abstract
POU3F3 variants cause developmental delay, behavioral problems, hypotonia and dysmorphic features. We investigated the phenotypic and genetic landscape, and genotype-phenotype correlations in individuals with POU3F3-related disorders. We recruited unpublished individuals with POU3F3 variants through international collaborations and obtained updated clinical data on previously published individuals. Trio exome sequencing or single exome sequencing followed by segregation analysis were performed in the novel cohort. Functional effects of missense variants were investigated with 3D protein modeling. We included 28 individuals (5 previously published) from 26 families carrying POU3F3 variants; 23 de novo and one inherited from an affected parent. Median age at study inclusion was 7.4 years. All had developmental delay mainly affecting speech, behavioral difficulties, psychiatric comorbidities and dysmorphisms. Additional features included gastrointestinal comorbidities, hearing loss, ophthalmological anomalies, epilepsy, sleep disturbances and joint hypermobility. Autism, hearing and eye comorbidities, dysmorphisms were more common in individuals with truncating variants, whereas epilepsy was only associated with missense variants. In silico structural modeling predicted that all (likely) pathogenic variants destabilize the DNA-binding region of POU3F3. Our study refined the phenotypic and genetic landscape of POU3F3-related disorders, it reports the functional properties of the identified pathogenic variants, and delineates some genotype-phenotype correlations.
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Affiliation(s)
- Alessandra Rossi
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, member of the ERN-EpiCARE, Dianalund, Denmark
- Pediatric Clinic, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Lot Snijders Blok
- Human Genetics Department, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sonja Neuser
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, 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
| | - Laurence Olivier Faivre
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Centre Hospitalier Universitaire Dijon, Dijon, France
- Genetics of Developmental Disorders Team, INSERM - Bourgogne Franche-Comté University, UMR 1231 GAD, Dijon, France
| | - Heike Weigand
- Department of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Dr. von Hauner’s Children’s Hospital, University of Munich, Munich, Germany
| | - Maria L. Dentici
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
- Medical Genetics Unit, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Marcello Niceta
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Paolo Alfieri
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - David Coulter
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Lacey Smith
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | | | - Gerarda Cappuccio
- Department of Translational Medicine, Federico II University, Naples, Italy
- Telethon Institute of Genetics and Medicine, Pozzuoli, Naples, Italy
| | - Nicola Brunetti-Pierri
- Department of Translational Medicine, Federico II University, Naples, Italy
- Telethon Institute of Genetics and Medicine, Pozzuoli, Naples, Italy
- Scuola Superiore Meridionale, School for Advanced Studies, Naples, Italy
| | - Deniz Torun
- Department of Medical Genetics, Gülhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Mutluay Arslan
- Department of Pediatric Neurology, Gülhane Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | | | - Oliver Murch
- All Wales Medical Genomics Service, University Hospital of Wales, Cardiff, UK
| | - Rachel Irving
- All Wales Medical Genomics Service, University Hospital of Wales, Cardiff, UK
| | - Sally A. Lynch
- Children’s Health Ireland at Crumlin, Dublin 12, Ireland
| | - Sarju G. Mehta
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jenny Carmichael
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Evelien Zonneveld-Huijssoon
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands
| | - Bert de Vries
- Human Genetics Department, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tjitske Kleefstra
- Human Genetics Department, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Katrine M. Johannesen
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, member of the ERN-EpiCARE, Dianalund, Denmark
- Department of Genetics, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Ian T. Westphall
- Department of Paediatrics, Copenhagen University Hospital, Hvidovre, Denmark
| | - Susan S. Hughes
- Division of Genetics, Children’s Mercy Kansas City, Kansas City, MO, USA
| | - Sarah Smithson
- Department of Clinical Genetics, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Julie Evans
- Bristol Genetics Laboratory, North Bristol NHS Trust, Pathology Sciences Building, Southmead Hospital, Bristol, UK
| | - Tracy Dudding-Byth
- NSW Genetics of Learning Disability (GOLD) Service, University of Newcastle, NSW Australia
| | - Marleen Simon
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ellen van Binsbergen
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Johanna C. Herkert
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands
| | - Gea Beunders
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands
| | - Henry Oppermann
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Mert Bakal
- Clinic of Radiology, University of Health Sciences Turkey, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Rikke S. Møller
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, member of the ERN-EpiCARE, Dianalund, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Guido Rubboli
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, member of the ERN-EpiCARE, Dianalund, Denmark
- Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Allan Bayat
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, member of the ERN-EpiCARE, Dianalund, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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11
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Saffari A, Lau T, Tajsharghi H, Karimiani EG, Kariminejad A, Efthymiou S, Zifarelli G, Sultan T, Toosi MB, Sedighzadeh S, Siu VM, Ortigoza-Escobar JD, AlShamsi AM, Ibrahim S, Al-Sannaa NA, Al-Hertani W, Sandra W, Tarnopolsky M, Alavi S, Li C, Day-Salvatore DL, Martínez-González MJ, Levandoski KM, Bedoukian E, Madan-Khetarpal S, Idleburg MJ, Menezes MJ, Siddharth A, Platzer K, Oppermann H, Smitka M, Collins F, Lek M, Shahrooei M, Ghavideldarestani M, Herman I, Rendu J, Faure J, Baker J, Bhambhani V, Calderwood L, Akhondian J, Imannezhad S, Mirzadeh HS, Hashemi N, Doosti M, Safi M, Ahangari N, Torbati PN, Abedini S, Salpietro V, Gulec EY, Eshaghian S, Ghazavi M, Pascher MT, Vogel M, Abicht A, Moutton S, Bruel AL, Rieubland C, Gallati S, Strom TM, Lochmüller H, Mohammadi MH, Alvi JR, Zackai EH, Keena BA, Skraban CM, Berger SI, Andrew EH, Rahimian E, Morrow MM, Wentzensen IM, Millan F, Henderson LB, Dafsari HS, Jungbluth H, Gomez-Ospina N, McRae A, Peter M, Veltra D, Marinakis NM, Sofocleous C, Ashrafzadeh F, Pehlivan D, Lemke JR, Melki J, Benezit A, Bauer P, Weis D, Lupski JR, Senderek J, Christodoulou J, Chung WK, Goodchild R, Offiah AC, Moreno-De-Luca A, Suri M, Ebrahimi-Fakhari D, Houlden H, Maroofian R. The clinical and genetic spectrum of autosomal-recessive TOR1A-related disorders. Brain 2023; 146:3273-3288. [PMID: 36757831 PMCID: PMC10393417 DOI: 10.1093/brain/awad039] [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: 08/26/2022] [Revised: 12/20/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
In the field of rare diseases, progress in molecular diagnostics led to the recognition that variants linked to autosomal-dominant neurodegenerative diseases of later onset can, in the context of biallelic inheritance, cause devastating neurodevelopmental disorders and infantile or childhood-onset neurodegeneration. TOR1A-associated arthrogryposis multiplex congenita 5 (AMC5) is a rare neurodevelopmental disorder arising from biallelic variants in TOR1A, a gene that in the heterozygous state is associated with torsion dystonia-1 (DYT1 or DYT-TOR1A), an early-onset dystonia with reduced penetrance. While 15 individuals with AMC5-TOR1A have been reported (less than 10 in detail), a systematic investigation of the full disease-associated spectrum has not been conducted. Here, we assess the clinical, radiological and molecular characteristics of 57 individuals from 40 families with biallelic variants in TOR1A. Median age at last follow-up was 3 years (0-24 years). Most individuals presented with severe congenital flexion contractures (95%) and variable developmental delay (79%). Motor symptoms were reported in 79% and included lower limb spasticity and pyramidal signs, as well as gait disturbances. Facial dysmorphism was an integral part of the phenotype, with key features being a broad/full nasal tip, narrowing of the forehead and full cheeks. Analysis of disease-associated manifestations delineated a phenotypic spectrum ranging from normal cognition and mild gait disturbance to congenital arthrogryposis, global developmental delay, intellectual disability, absent speech and inability to walk. In a subset, the presentation was consistent with foetal akinesia deformation sequence with severe intrauterine abnormalities. Survival was 71%, with higher mortality in males. Death occurred at a median age of 1.2 months (1 week-9 years), due to respiratory failure, cardiac arrest or sepsis. Analysis of brain MRI studies identified non-specific neuroimaging features, including a hypoplastic corpus callosum (72%), foci of signal abnormality in the subcortical and periventricular white matter (55%), diffuse white matter volume loss (45%), mega cisterna magna (36%) and arachnoid cysts (27%). The molecular spectrum included 22 distinct variants, defining a mutational hotspot in the C-terminal domain of the Torsin-1A protein. Genotype-phenotype analysis revealed an association of missense variants in the 3-helix bundle domain to an attenuated phenotype, while missense variants near the Walker A/B motif as well as biallelic truncating variants were linked to early death. In summary, this systematic cross-sectional analysis of a large cohort of individuals with biallelic TOR1A variants across a wide age-range delineates the clinical and genetic spectrum of TOR1A-related autosomal-recessive disease and highlights potential predictors for disease severity and survival.
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Affiliation(s)
- Afshin Saffari
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Child Neurology and Inherited Metabolic Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Tracy Lau
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, UK
| | - Homa Tajsharghi
- School of Health Sciences, Division of Biomedicine, University of Skovde, Skovde, Sweden
| | - Ehsan Ghayoor Karimiani
- Molecular and Clinical Sciences Institute, St. George's, University of London, Cranmer Terrace, London, UK
- Department of Medical Genetics, Next Generation Genetic Polyclinic, Mashhad, Iran
| | | | - Stephanie Efthymiou
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, UK
| | | | - Tipu Sultan
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, UK
| | - Mehran Beiraghi Toosi
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Neuroscience Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sahar Sedighzadeh
- Department of Biological Sciences, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran
- KaryoGen, Isfahan, Iran
| | - Victoria Mok Siu
- Division of Medical Genetics, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Juan Darío Ortigoza-Escobar
- Movement Disorders Unit, Pediatric Neurology Department, Institut de Recerca, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Aisha M AlShamsi
- Genetic Division, Pediatrics Department, Tawam Hospital, Al Ain, UAE
| | - Shahnaz Ibrahim
- Department of pediatrics and child Health, Aga Khan University, Karachi, Pakistan
| | | | - Walla Al-Hertani
- Harvard Medical School, Boston Children's Hospital, Department of Pediatrics, Division of Genetics and Genomics, Boston, MA, USA
| | - Whalen Sandra
- APHP UF de Génétique Clinique, Centre de Référence des Anomalies du Développement et Syndromes Malformatifs, APHP, Hôpital Armand Trousseau, ERN ITHACA, Sorbonne Université, Paris, France
| | - Mark Tarnopolsky
- Department of Pediatrics (MT – Neuromuscular and Neurometabolics, CL – Medical Genetics), McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Shahryar Alavi
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, UK
| | - Chumei Li
- Department of Pediatrics (MT – Neuromuscular and Neurometabolics, CL – Medical Genetics), McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Debra-Lynn Day-Salvatore
- The Department of Medical Genetics and Genomic Medicine at Saint Peter's University Hospital, New Brunswick, NJ, USA
| | | | - Kristin M Levandoski
- The Department of Medical Genetics and Genomic Medicine at Saint Peter's University Hospital, New Brunswick, NJ, USA
| | - Emma Bedoukian
- Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Suneeta Madan-Khetarpal
- Division of Genetic and Genomic Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michaela J Idleburg
- Division of Genetic and Genomic Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Minal Juliet Menezes
- Department of Anaesthesia, the Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Child and Adolescent Health, and Specialty of Genomic Medicine, Sydney Medical School, Sydney University, Sydney, NSW, Australia
| | - Aishwarya Siddharth
- Harvard Medical School, Boston Children's Hospital, Department of Pediatrics, Division of Genetics and Genomics, Boston, MA, USA
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Henry Oppermann
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Martin Smitka
- Department of Neuropediatrics, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Felicity Collins
- Discipline of Child and Adolescent Health, and Specialty of Genomic Medicine, Sydney Medical School, Sydney University, Sydney, NSW, Australia
- Department of Clinical Genetics, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Monkol Lek
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mohmmad Shahrooei
- Medical Laboratory of Dr. Shahrooei, Tehran, Iran
- Department of Microbiology and Immunology, Clinical and Diagnostic Immunology, KU Leuven, Leuven, Belgium
| | | | - Isabella Herman
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
- Division of Pediatric Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - John Rendu
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Julien Faure
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Janice Baker
- Division of Genetics and Genomic Medicine, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Vikas Bhambhani
- Division of Genetics and Genomic Medicine, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Laurel Calderwood
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
- Department of Pediatrics, Division of Medical Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Javad Akhondian
- Pediatric Neurology Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shima Imannezhad
- Department of Pediatric Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hanieh Sadat Mirzadeh
- Department of Pediatric Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narges Hashemi
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Doosti
- Department of Medical Genetics, Next Generation Genetic Polyclinic, Mashhad, Iran
| | - Mojtaba Safi
- Department of Medical Genetics, Next Generation Genetic Polyclinic, Mashhad, Iran
| | - Najmeh Ahangari
- Innovative medical research centre, Mashhad branch, Islamic Azad University, Mashhad, Iran
| | | | - Soheila Abedini
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, UK
| | - Vincenzo Salpietro
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, UK
| | - Elif Yilmaz Gulec
- Istanbul Medeniyet University Medical School, Department of Medical Genetics, Istanbul, Turkey
| | | | - Mohammadreza Ghazavi
- Department of Pediatric Neurology, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Michael T Pascher
- Friedrich-Baur-Institute at the Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Marina Vogel
- Friedrich-Baur-Institute at the Department of Neurology, University Hospital, LMU Munich, Munich, Germany
- Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Angela Abicht
- Friedrich-Baur-Institute at the Department of Neurology, University Hospital, LMU Munich, Munich, Germany
- Medizinisch Genetisches Zentrum, Munich, German
| | - Sébastien Moutton
- Multidisciplinary Center for Prenatal Diagnosis, Pôle Mère Enfant, Maison de Santé Protestante Bordeaux Bagatelle, Talence, France
| | - Ange-Line Bruel
- Équipe Génétique des Anomalies du Développement (GAD), INSERM UMR1231, Dijon, France
- Unité Fonctionnelle Innovation en Diagnostic génomique des maladies rares, FHU-TRANSLAD, Dijon University Hospital, Dijon, France
| | - Claudine Rieubland
- Division of Human Genetics, Department of Pediatrics, Inselspital, University of Bern, Switzerland
| | - Sabina Gallati
- Division of Human Genetics, Department of Pediatrics, Inselspital, University of Bern, Switzerland
| | - Tim M Strom
- Institute of Human Genetics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Hanns Lochmüller
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
| | | | - Javeria Raza Alvi
- Department of Pediatric Neurology, The Children's Hospital and the University of Child Health Sciences, Lahore, Pakistan
| | - Elaine H Zackai
- Division of Human Genetics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Beth A Keena
- Division of Human Genetics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Cara M Skraban
- Division of Human Genetics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Seth I Berger
- Children's National Research Institute, Washington DC, USA
| | - Erin H Andrew
- Children's National Research Institute, Washington DC, USA
| | | | | | | | | | | | - Hormos Salimi Dafsari
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Max-Planck-Institute for Biology of Ageing and CECAD, Cologne, Germany
- Department of Paediatric Neurology - Neuromuscular Service, Evelina London Children's Hospital, Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Heinz Jungbluth
- Department of Paediatric Neurology - Neuromuscular Service, Evelina London Children's Hospital, Guy's & St Thomas' Hospital NHS Foundation Trust, London, UK
- Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine (FoLSM), King's College London, London, UK
| | | | - Anne McRae
- Division of Genetics, Genomics, and Metabolism, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Merlene Peter
- Division of Genetics, Genomics, and Metabolism, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Danai Veltra
- Laboratory of Medical Genetics, Medical School, National and Kapodistrian University of Athens, St. Sophia's Children's Hospital, Athens, Greece
| | - Nikolaos M Marinakis
- Laboratory of Medical Genetics, Medical School, National and Kapodistrian University of Athens, St. Sophia's Children's Hospital, Athens, Greece
| | - Christalena Sofocleous
- Laboratory of Medical Genetics, Medical School, National and Kapodistrian University of Athens, St. Sophia's Children's Hospital, Athens, Greece
| | - Farah Ashrafzadeh
- Department of Pediatric Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Davut Pehlivan
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | - 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
| | - Judith Melki
- Institut National de la Santé et de la Recherche Médicale (Inserm), UMR-1195, Université Paris Saclay, Le Kremlin Bicêtre, 94276, Paris, France
| | - Audrey Benezit
- Neurologie et réanimation pédiatrique, Hôpital Raymond Poincaré, APHP, Garches, France
| | - Peter Bauer
- CENTOGENE GmbH, Am Strande 7, 18055 Rostock, Germany
| | - Denisa Weis
- Department of Medical Genetics, Kepler University Hospital, Johann Kepler University, Linz, Austria
| | - James R Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jan Senderek
- Friedrich-Baur-Institute at the Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - John Christodoulou
- Discipline of Child and Adolescent Health, and Specialty of Genomic Medicine, Sydney Medical School, Sydney University, Sydney, NSW, Australia
- Murdoch Children's Research Institute, Melbourne and Department of Paediatrics, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Wendy K Chung
- Department of Pediatrics and Medicine, Columbia University New York, NY, USA
| | - Rose Goodchild
- KU Leuven Department of Neurosciences, Leuven Brain Institute, Leuven, Belgium
- VIB-KU Leuven Center for Brain and Disease Research, Laboratory for Dystonia Research, Leuven, Belgium
| | - Amaka C Offiah
- Department of Oncology & Metabolism, University of Sheffield, UK
| | - Andres Moreno-De-Luca
- Autism & Developmental Medicine Institute, Genomic Medicine Institute, Department of Radiology, Diagnostic Medicine Institute, Geisinger, Danville, PA, USA
| | - Mohnish Suri
- Clinical Genetics Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Darius Ebrahimi-Fakhari
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Movement Disorders Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA, USA
- Intellectual and Developmental Disabilities Research Center, Boston Children's Hospital, Boston, MA, USA
| | - Henry Houlden
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, UK
| | - Reza Maroofian
- Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, UK
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12
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Sczakiel HL, Zhao M, Wollert-Wulf B, Danyel M, Ehmke N, Stoltenburg C, Damseh N, Al-Ashhab M, Balci TB, Osmond M, Andrade A, Schallner J, Porrmann J, McDonald K, Liao M, Oppermann H, Platzer K, Dierksen N, Mojarrad M, Eslahi A, Bakaeean B, Calame DG, Lupski JR, Firoozfar Z, Seyedhassani SM, Mohammadi SA, Anwaar N, Rahman F, Seelow D, Janz M, Horn D, Maroofian R, Boschann F. Broadening the phenotypic and molecular spectrum of FINCA syndrome: Biallelic NHLRC2 variants in 15 novel individuals. Eur J Hum Genet 2023; 31:905-917. [PMID: 37188825 PMCID: PMC10400545 DOI: 10.1038/s41431-023-01382-0] [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: 11/09/2022] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/17/2023] Open
Abstract
FINCA syndrome [MIM: 618278] is an autosomal recessive multisystem disorder characterized by fibrosis, neurodegeneration and cerebral angiomatosis. To date, 13 patients from nine families with biallelic NHLRC2 variants have been published. In all of them, the recurrent missense variant p.(Asp148Tyr) was detected on at least one allele. Common manifestations included lung or muscle fibrosis, respiratory distress, developmental delay, neuromuscular symptoms and seizures often followed by early death due to rapid disease progression.Here, we present 15 individuals from 12 families with an overlapping phenotype associated with nine novel NHLRC2 variants identified by exome analysis. All patients described here presented with moderate to severe global developmental delay and variable disease progression. Seizures, truncal hypotonia and movement disorders were frequently observed. Notably, we also present the first eight cases in which the recurrent p.(Asp148Tyr) variant was not detected in either homozygous or compound heterozygous state.We cloned and expressed all novel and most previously published non-truncating variants in HEK293-cells. From the results of these functional studies, we propose a potential genotype-phenotype correlation, with a greater reduction in protein expression being associated with a more severe phenotype.Taken together, our findings broaden the known phenotypic and molecular spectrum and emphasize that NHLRC2-related disease should be considered in patients presenting with intellectual disability, movement disorders, neuroregression and epilepsy with or without pulmonary involvement.
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Affiliation(s)
- Henrike L Sczakiel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institut für Medizinische Genetik und Humangenetik, Augustenburger Platz 1, 13353, Berlin, Germany
- Max Planck Institute for Molecular Genetics, RG Development & Disease, Ihnestr. 63-73, 14195, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Clinician Scientist Program, Charitéplatz 1, 10117, Berlin, Germany
| | - Max Zhao
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institut für Medizinische Genetik und Humangenetik, Augustenburger Platz 1, 13353, Berlin, Germany
- Max Planck Institute for Molecular Genetics, RG Development & Disease, Ihnestr. 63-73, 14195, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Brigitte Wollert-Wulf
- Biology of Malignant Lymphomas, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, 13125, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, 13125, Germany
- Hematology, Oncology and Cancer Immunology, Charité - Universitätsmedizin Berlin, Berlin, 13125, Germany
| | - Magdalena Danyel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institut für Medizinische Genetik und Humangenetik, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Charitéplatz 1, 10117, Berlin, Germany
| | - Nadja Ehmke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institut für Medizinische Genetik und Humangenetik, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Corinna Stoltenburg
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Sozialpädiatrisches Zentrum Neuropädiatrie, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Nadirah Damseh
- Department of Pediatrics and Genetics, Al Makassed Hospital and Al-Quds University, Jerusalem, Palestine
| | - Motee Al-Ashhab
- Department of Pediatrics and Genetics, Al Makassed Hospital and Al-Quds University, Jerusalem, Palestine
| | - Tugce B Balci
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, Western University, London, ON, Canada
| | - Matthew Osmond
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Andrea Andrade
- Division of Pediatric Neurology, London Health Sciences Centre, Western University, London, ON, Canada
| | - Jens Schallner
- Department of Sozialpaediatrisches Zentrum, Klinik fuer Kinder und Jugendmedizin, Universitaetsklinikum Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Joseph Porrmann
- Institute for Clinical Genetics, Universitätsklinikum, Technischen Universität Dresden, Dresden, Germany
| | - Kimberly McDonald
- Pediatric Neurology, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Henry Oppermann
- Institute of Human Genetics, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | | | - Majid Mojarrad
- Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Atieh Eslahi
- Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behnaz Bakaeean
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Daniel G Calame
- Section of Pediatric Neurology and Developmental Neurosciences, Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA
- Texas Children's Hospital, Houston, TX, 77030, USA
| | - James R Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA
- Texas Children's Hospital, Houston, TX, 77030, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, 77030, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
| | | | | | | | - Najwa Anwaar
- Department of Developmental - Behavioral Pediatrics, University of Child Health Sciences and The Children's Hospital, Lahore, Pakistan
| | - Fatima Rahman
- Department of Developmental - Behavioral Pediatrics, University of Child Health Sciences and The Children's Hospital, Lahore, Pakistan
| | - Dominik Seelow
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institut für Medizinische Genetik und Humangenetik, Augustenburger Platz 1, 13353, Berlin, Germany
- Bioinformatics and Translational Genetics, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Janz
- Biology of Malignant Lymphomas, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, 13125, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, 13125, Germany
- Hematology, Oncology and Cancer Immunology, Charité - Universitätsmedizin Berlin, Berlin, 13125, Germany
| | - Denise Horn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institut für Medizinische Genetik und Humangenetik, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Reza Maroofian
- Department of Neuromuscular Diseases, University College London, Queen Square, Institute of Neurology, London, WC1N 3BG, UK
| | - Felix Boschann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institut für Medizinische Genetik und Humangenetik, Augustenburger Platz 1, 13353, Berlin, Germany.
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Charitéplatz 1, 10117, Berlin, Germany.
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13
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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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14
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Schönauer R, Jin W, Findeisen C, Valenzuela I, Devlin LA, Murrell J, Bedoukian EC, Pöschla L, Hantmann E, Riedhammer KM, Hoefele J, Platzer K, Biemann R, Campeau PM, Münch J, Heyne H, Hoffmann A, Ghosh A, Sun W, Dong H, Noé F, Wolfrum C, Woods E, Parker MJ, Neatu R, Le Guyader G, Bruel AL, Perrin L, Spiewak H, Missotte I, Fourgeaud M, Michaud V, Lacombe D, Paolucci SA, Buchan JG, Glissmeyer M, Popp B, Blüher M, Sayer JA, Halbritter J. Monoallelic intragenic POU3F2 variants lead to neurodevelopmental delay and hyperphagic obesity, confirming the gene's candidacy in 6q16.1 deletions. Am J Hum Genet 2023; 110:998-1007. [PMID: 37207645 PMCID: PMC10257002 DOI: 10.1016/j.ajhg.2023.04.010] [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: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023] Open
Abstract
While common obesity accounts for an increasing global health burden, its monogenic forms have taught us underlying mechanisms via more than 20 single-gene disorders. Among these, the most common mechanism is central nervous system dysregulation of food intake and satiety, often accompanied by neurodevelopmental delay (NDD) and autism spectrum disorder. In a family with syndromic obesity, we identified a monoallelic truncating variant in POU3F2 (alias BRN2) encoding a neural transcription factor, which has previously been suggested as a driver of obesity and NDD in individuals with the 6q16.1 deletion. In an international collaboration, we identified ultra-rare truncating and missense variants in another ten individuals sharing autism spectrum disorder, NDD, and adolescent-onset obesity. Affected individuals presented with low-to-normal birth weight and infantile feeding difficulties but developed insulin resistance and hyperphagia during childhood. Except for a variant leading to early truncation of the protein, identified variants showed adequate nuclear translocation but overall disturbed DNA-binding ability and promotor activation. In a cohort with common non-syndromic obesity, we independently observed a negative correlation of POU3F2 gene expression with BMI, suggesting a role beyond monogenic obesity. In summary, we propose deleterious intragenic variants of POU3F2 to cause transcriptional dysregulation associated with hyperphagic obesity of adolescent onset with variable NDD.
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Affiliation(s)
- Ria Schönauer
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany; Division of Nephrology, Endocrinology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Wenjun Jin
- Division of Nephrology, Endocrinology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Christin Findeisen
- Division of Nephrology, Endocrinology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | | | - Laura Alice Devlin
- Translational and Clinical Research Institute, Newcastle University, Central Parkway, NE1 3BZ Newcastle, UK
| | - Jill Murrell
- Division of Genomic Diagnostics at Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Emma C Bedoukian
- Roberts Individualized Medical Genetics Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Linda Pöschla
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Elena Hantmann
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Korbinian M Riedhammer
- Institute of Human Genetics, Klinikum rechts der Isar, Technical University Munich, School of Medicine, Munich, Germany; Department of Nephrology, Klinikum rechts der Isar, Technical University Munich, School of Medicine, Munich, Germany
| | - Julia Hoefele
- Institute of Human Genetics, Klinikum rechts der Isar, Technical University Munich, School of Medicine, Munich, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Ronald Biemann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
| | - Philipp M Campeau
- Department of Pediatrics, University of Montreal, Montreal, QC, Canada
| | - Johannes Münch
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Henrike Heyne
- Hasso-Plattner-Institute, University of Potsdam, Potsdam, Germany; Hasso Plattner Institute for Digital Health at Mount Sinai School of Medicine, New York City, NY, USA; Institute for Molecular Medicine Finland: FIMM, University of Helsinki, Helsinki, Finland
| | - Anne Hoffmann
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Adhideb Ghosh
- Institute of Food, Nutrition and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Wenfei Sun
- Institute of Food, Nutrition and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Hua Dong
- Institute of Food, Nutrition and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Falko Noé
- Institute of Food, Nutrition and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Christian Wolfrum
- Institute of Food, Nutrition and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Emily Woods
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | | | - Ruxandra Neatu
- Translational and Clinical Research Institute, Newcastle University, Central Parkway, NE1 3BZ Newcastle, UK
| | - Gwenael Le Guyader
- Unité neurovasculaire et troubles cognitifs, University of Poitiers, Poitiers, France
| | - Ange-Line Bruel
- Equipe GAD, UMR1231 Inserm, Université de Bourgogne Franche Comté, Dijon, France
| | - Laurence Perrin
- UF de Génétique Clinique Département de Génétique, CHU Paris - Hôpital Robert Debré, Paris, France
| | - Helena Spiewak
- North East and Yorkshire Genomic Laboratory Hub, Central Laboratory, St. James's University Hospital, Leeds, UK
| | - Isabelle Missotte
- Service de Pédiatrie, Centre Hospitalier Territorial, Nouvelle Calédonie, France
| | - Melanie Fourgeaud
- Service de Génétique Médicale, Centre de Référence Anomalies du Développement et Syndrome Malformatifs, CHU de Bordeaux, France
| | - Vincent Michaud
- Service de Génétique Médicale, Centre de Référence Anomalies du Développement et Syndrome Malformatifs, CHU de Bordeaux, France; INSERM U1211, Maladies Rares: Génétique et Métabolisme (MRGM), Université de Bordeaux, Bordeaux, France
| | - Didier Lacombe
- Service de Génétique Médicale, Centre de Référence Anomalies du Développement et Syndrome Malformatifs, CHU de Bordeaux, France; INSERM U1211, Maladies Rares: Génétique et Métabolisme (MRGM), Université de Bordeaux, Bordeaux, France
| | - Sarah A Paolucci
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Jillian G Buchan
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | | | - Bernt Popp
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Center of Functional Genomics, Berlin, Germany
| | - Matthias Blüher
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - John A Sayer
- Translational and Clinical Research Institute, Newcastle University, Central Parkway, NE1 3BZ Newcastle, UK; The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Road, NE7 7DN Newcastle, UK; NIHR Newcastle Biomedical Research Centre, NE4 5PL Newcastle, UK
| | - Jan Halbritter
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany; Division of Nephrology, Endocrinology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany.
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15
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Teunissen MWA, Lewerissa E, van Hugte EJH, Wang S, Ockeloen CW, Koolen DA, Pfundt R, Marcelis CLM, Brilstra E, Howe JL, Scherer SW, Le Guillou X, Bilan F, Primiano M, Roohi J, Piton A, de Saint Martin A, Baer S, Seiffert S, Platzer K, Jamra RA, Syrbe S, Doering JH, Lakhani S, Nangia S, Gilissen C, Vermeulen RJ, Rouhl RPW, Brunner HG, Willemsen MH, Kasri NN. ANK2 loss-of-function variants are associated with epilepsy, and lead to impaired axon initial segment plasticity and hyperactive network activity in hiPSC-derived neuronal networks. Hum Mol Genet 2023:7169123. [PMID: 37195288 DOI: 10.1093/hmg/ddad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/21/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE To characterize a novel neurodevelopmental syndrome due to loss-of-function (LoF) variants in Ankyrin 2 (ANK2), and to explore the effects on neuronal network dynamics and homeostatic plasticity in human induced pluripotent stem cell-derived neurons. METHODS We collected clinical and molecular data of twelve individuals with heterozygous de novo LoF variants in ANK2. We generated a heterozygous LoF allele of ANK2 using CRISPR/Cas9 in human induced pluripotent stem cells (hiPSCs). HiPSCs were differentiated towards excitatory neurons of which we measured spontaneous electrophysiological responses using micro-electrode arrays (MEAs), characterized somatodendritic morphology and axon initial segment (AIS) structure and plasticity. RESULTS We found a broad neurodevelopmental disorder, comprising intellectual disability, autism spectrum disorders, and early onset epilepsy. Using MEAs, we found that hiPSC-derived neurons with heterozygous LoF of ANK2 show a hyperactive and desynchronized neuronal network. ANK2 deficient neurons also showed increased somatodendritic structures and altered AIS structure of which its plasticity is impaired upon activity-dependent modulation. CONCLUSIONS Phenotypic characterization of patients with de novo ANK2 LoF variants define a novel NDD with early onset epilepsy. Our functional in vitro data of ANK2-deficient human neurons show a specific neuronal phenotype in which reduced ANKB expression leads to hyperactive and desynchronized neuronal network activity, increased somatodendritic complexity and AIS structure and impaired activity-dependent plasticity of the AIS.
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Affiliation(s)
- Maria W A Teunissen
- Maastricht University Medical Center, Department of Neurology, 6229 HX Maastricht, The Netherlands
- Academic Center for Epileptology Kempenhaeghe/Maastricht University Medical Center, Heeze, The Netherlands
| | - Elly Lewerissa
- Department of Human Genetics, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, The Netherlands
| | - Eline J H van Hugte
- Department of Human Genetics, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, The Netherlands
| | - Shan Wang
- Department of Human Genetics, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, The Netherlands
| | - Charlotte W Ockeloen
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - David A Koolen
- Department of Human Genetics, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, The Netherlands
| | - Rolph Pfundt
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Carlo L M Marcelis
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Eva Brilstra
- Department of Human Genetics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Jennifer L Howe
- The Centre for Applied Genomics and Genetics and Genome Biology, The Hospital for Sick Children, ON M5G 1X8 Toronto, Canada
| | - Stephen W Scherer
- The Centre for Applied Genomics and Genetics and Genome Biology, The Hospital for Sick Children, ON M5G 1X8 Toronto, Canada
- McLaughlin Centre and Department of Molecular Genetics, University of Toronto, Toronto, ON, ON M5S 3H7, Canada
| | - Xavier Le Guillou
- Department of Medical Genetics, Centre Hospitalier Universitaire de Poitiers, 86000 Poitiers, France
| | - Frédéric Bilan
- Department of Medical Genetics, Centre Hospitalier Universitaire de Poitiers, 86000 Poitiers, France
- Laboratory of Experimental and Clinical Neurosciences University of Poitiers, INSERM U1084, Poitiers, France
| | - Michelle Primiano
- Department of Clinical Genetics, Morgan Stanley Children's Hospital of New York-Presbytarian, 10032 New York, USA
| | - Jasmin Roohi
- Department of Clinical Genetics, Morgan Stanley Children's Hospital of New York-Presbytarian, 10032 New York, USA
- Clinical Genetics, Kaiser Permanente Mid-Atlantic Permanente Medical Group, MD 20852 Rockville, USA
| | - Amelie Piton
- Laboratoire de Diagnostic Génétique, Institut de Génétique Médicale d'Alsace (IGMA), Hôspitaux Universitaire de Strasbourg, BP 426 67091 Strasbourg, France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch 67400, France
| | - Anne de Saint Martin
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch 67400, France
- Department of Pediatric Neurology, Strasbourg University Hospital, Hôspital de Hautepierre, BP 426 67091 Strasbourg, France
| | - Sarah Baer
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch 67400, France
- Department of Pediatric Neurology, Strasbourg University Hospital, Hôspital de Hautepierre, BP 426 67091 Strasbourg, France
| | - Simone Seiffert
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, 72076 Tuebingen, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University Medical Center Leipzig, 04103 Leipzig, Germany
| | - Rami Abou Jamra
- Institute of Human Genetics, University Medical Center Leipzig, 04103 Leipzig, Germany
| | - Steffen Syrbe
- Division of Paediatric Epileptology, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Jan Henje Doering
- Division of Paediatric Epileptology, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Shenela Lakhani
- Department of neurogenetics, Weill Cornell Medicine, Brain and Mind Research Institute, 10065 New York, USA
| | - Srishti Nangia
- Department of Pediatrics, Division of Child Neurology, New York Presbyterian Hospital-Weill Cornell Medical Center, 10032 New York, USA
| | - Christian Gilissen
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - R Jeroen Vermeulen
- Maastricht University Medical Center, Department of Neurology, 6229 HX Maastricht, The Netherlands
| | - Rob P W Rouhl
- Maastricht University Medical Center, Department of Neurology, 6229 HX Maastricht, The Netherlands
- Academic Center for Epileptology Kempenhaeghe/Maastricht University Medical Center, Heeze, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Han G Brunner
- Academic Center for Epileptology Kempenhaeghe/Maastricht University Medical Center, Heeze, The Netherlands
- Department of Human Genetics, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Clinical Genetics and GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, 6299 MD Maastricht, The Netherlands
| | - Marjolein H Willemsen
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Nael Nadif Kasri
- Department of Human Genetics, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, The Netherlands
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16
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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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17
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Priestley JRC, Deshwar AR, Murthy H, D'Agostino MD, Dupuis L, Gangaram B, Gray C, Jobling R, Pannia E, Platzer K, Prescott K, Redman M, Rippert AL, Rosenfeld JA, Scott DA, Wang YW, Schmederer Z, Dalal A, Sarma AS, Skraban C, Dowling JJ, Mendoza-Londono R, Slavotinek A, Bhoj EJ. Monoallelic Loss of Function BMP2 Variants Result in BMP2-Related Skeletal Dysplasia Spectrum. Genet Med 2023:100863. [PMID: 37125634 DOI: 10.1016/j.gim.2023.100863] [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: 11/03/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023] Open
Abstract
PURPOSE Bone morphogenic proteins (BMPs) regulate gene expression related to many critical developmental processes, including osteogenesis for which they are named. BMP2 is widely expressed in cells of mesenchymal origin, including bone, cartilage, skeletal and cardiac muscle, and adipose tissue. It also participates in neurodevelopment by inducing differentiation of neural stem cells. In humans, BMP2 variants result in a multiple congenital anomaly syndrome through a haploinsufficiency mechanism. We sought to expand the phenotypic spectrum and highlight phenotypes of patients harboring monoallelic missense variants in BMP2. METHODS We employed retrospective chart review to examine phenotypes from an international cohort of 18 individuals and compared these to published cases. Patient-derived missense variants were modeled in zebrafish to examine their effect on the ability of bmp2b to promote embryonic ventralization. RESULTS The presented cases recapitulated existing descriptions of BMP2-related disorder including craniofacial, cardiac, and skeletal anomalies and exhibit a wide phenotypic spectrum. We also identified patients with neural tube defects, structural brain anomalies, and endocrinopathies. Missense variants modeled in zebrafish resulted in loss of protein function. CONCLUSIONS We use this expansion of reported phenotypes to suggest multidisciplinary medical monitoring and management of patients with BMP2-related skeletal dysplasia spectrum.
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Affiliation(s)
- Jessica R C Priestley
- Division of Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ashish R Deshwar
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada; Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Harsha Murthy
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maria Daniela D'Agostino
- Division of Medical Genetics, Departments of Specialized Medicine and Human Genetics, McGill University Health Center, Montreal, Quebec, Canada
| | - Lucie Dupuis
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Balram Gangaram
- Division of Medical Genetics, University of California San Francisco, San Francisco, California, USA
| | - Christopher Gray
- Division of Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rebekah Jobling
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada; Genome Diagnostics, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Emanuela Pannia
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Katrina Prescott
- Clinical Genetics, The Leeds Teaching Hospital NHS Trust, Leeds, West Yorkshire, UK
| | - Melody Redman
- Clinical Genetics, The Leeds Teaching Hospital NHS Trust, Leeds, West Yorkshire, UK
| | - Alyssa L Rippert
- Division of Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jill A Rosenfeld
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA; Baylor Genetics Laboratories, Houston, Texas, USA
| | - Daryl A Scott
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA; Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas, USA
| | - Yi Wen Wang
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada; Division of Medical Genetics, Departments of Specialized Medicine and Human Genetics, McGill University Health Center, Montreal, Quebec, Canada
| | - Zelia Schmederer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany; Medizinisch Genetisches Zentrum, Munich, Germany
| | - Ashwin Dalal
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - Asodu Sandeep Sarma
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - Cara Skraban
- Division of Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James J Dowling
- Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Roberto Mendoza-Londono
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Anne Slavotinek
- Division of Medical Genetics, University of California San Francisco, San Francisco, California, USA; Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Elizabeth J Bhoj
- Division of Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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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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Luppe J, Sticht H, Lecoquierre F, Goldenberg A, Gorman KM, Molloy B, Agolini E, Novelli A, Briuglia S, Kuismin O, Marcelis C, Vitobello A, Denommé-Pichon AS, Julia S, Lemke JR, Abou Jamra R, Platzer K. Heterozygous and homozygous variants in STX1A cause a neurodevelopmental disorder with or without epilepsy. Eur J Hum Genet 2023; 31:345-352. [PMID: 36564538 PMCID: PMC9995539 DOI: 10.1038/s41431-022-01269-6] [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: 06/20/2022] [Revised: 11/24/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
The neuronal SNARE complex drives synaptic vesicle exocytosis. Therefore, one of its core proteins syntaxin 1A (STX1A) has long been suspected to play a role in neurodevelopmental disorders. We assembled eight individuals harboring ultra rare variants in STX1A who present with a spectrum of intellectual disability, autism and epilepsy. Causative variants comprise a homozygous splice variant, three de novo missense variants and two inframe deletions of a single amino acid. We observed a phenotype mainly driven by epilepsy in the individuals with missense variants in contrast to intellectual disability and autistic behavior in individuals with single amino acid deletions and the splicing variant. In silico modeling of missense variants and single amino acid deletions show different impaired protein-protein interactions. We hypothesize the two phenotypic courses of affected individuals to be dependent on two different pathogenic mechanisms: (1) a weakened inhibitory STX1A-STXBP1 interaction due to missense variants results in an STX1A-related developmental epileptic encephalopathy and (2) a hampered SNARE complex formation due to inframe deletions causes an STX1A-related intellectual disability and autism phenotype. Our description of a STX1A-related neurodevelopmental disorder with or without epilepsy thus expands the group of rare diseases called SNAREopathies.
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Affiliation(s)
- Johannes Luppe
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Heinrich Sticht
- Institute of Biochemistry, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - François Lecoquierre
- Department of Genetics and Reference Center for Developmental Disorders, Normandie Univ, UNIROUEN, CHU Rouen, Inserm U1245, FHU G4 Génomique, F-76000, Rouen, France
| | - Alice Goldenberg
- Department of Genetics and Reference Center for Developmental Disorders, Normandie Univ, UNIROUEN, CHU Rouen, Inserm U1245, FHU G4 Génomique, F-76000, Rouen, France
| | - Kathleen M Gorman
- Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple Street, Dublin, Ireland
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | | | - Emanuele Agolini
- Laboratory of Medical Genetics, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Silvana Briuglia
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy
| | - Outi Kuismin
- Institute for Molecular Medicine Finland, Helsinki, Finland
| | - Carlo Marcelis
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Antonio Vitobello
- Inserm UMR1231 GAD, University of Burgundy-Franche Comté, Dijon, France
| | | | - Sophie Julia
- Federative Institute of Biology, CHU de Toulouse, Toulouse, France
| | - 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
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany.
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20
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Cali E, Suri M, Scala M, Ferla MP, Alavi S, Faqeih EA, Bijlsma EK, Wigby KM, Baralle D, Mehrjardi MYV, Schwab J, Platzer K, Steindl K, Hashem M, Jones M, Niyazov DM, Jacober J, Littlejohn RO, Weis D, Zadeh N, Rodan L, Goldenberg A, Lecoquierre F, Dutra-Clarke M, Horvath G, Young D, Orenstein N, Bawazeer S, Vulto-van Silfhout AT, Herenger Y, Dehghani M, Seyedhassani SM, Bahreini A, Nasab ME, Ercan-Sencicek AG, Firoozfar Z, Movahedinia M, Efthymiou S, Striano P, Karimiani EG, Salpietro V, Taylor JC, Redman M, Stegmann APA, Laner A, Abdel-Salam G, Li M, Bengala M, Müller AJ, Digilio MC, Rauch A, Gunel M, Titheradge H, Schweitzer DN, Kraus A, Valenzuela I, McLean SD, Phornphutkul C, Salih M, Begtrup A, Schnur RE, Torti E, Haack TB, Prada CE, Alkuraya FS, Houlden H, Maroofian R. Biallelic PRMT7 pathogenic variants are associated with a recognizable syndromic neurodevelopmental disorder with short stature, obesity, and craniofacial and digital abnormalities. Genet Med 2023; 25:135-142. [PMID: 36399134 PMCID: PMC10620944 DOI: 10.1016/j.gim.2022.09.016] [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: 04/10/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Protein arginine methyltransferase 7 (PRMT7) is a member of a family of enzymes that catalyzes the methylation of arginine residues on several protein substrates. Biallelic pathogenic PRMT7 variants have previously been associated with a syndromic neurodevelopmental disorder characterized by short stature, brachydactyly, intellectual developmental disability, and seizures. To our knowledge, no comprehensive study describes the detailed clinical characteristics of this syndrome. Thus, we aim to delineate the phenotypic spectrum of PRMT7-related disorder. METHODS We assembled a cohort of 51 affected individuals from 39 different families, gathering clinical information from 36 newly described affected individuals and reviewing data of 15 individuals from the literature. RESULTS The main clinical characteristics of the PRMT7-related syndrome are short stature, mild to severe developmental delay/intellectual disability, hypotonia, brachydactyly, and distinct facial morphology, including bifrontal narrowing, prominent supraorbital ridges, sparse eyebrows, short nose with full/broad nasal tip, thin upper lip, full and everted lower lip, and a prominent or squared-off jaw. Additional variable findings include seizures, obesity, nonspecific magnetic resonance imaging abnormalities, eye abnormalities (i.e., strabismus or nystagmus), and hearing loss. CONCLUSION This study further delineates and expands the molecular, phenotypic spectrum and natural history of PRMT7-related syndrome characterized by a neurodevelopmental disorder with skeletal, growth, and endocrine abnormalities.
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Affiliation(s)
- Elisa Cali
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Mohnish Suri
- Nottingham Clinical Genetics Service, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, United Kingdom
| | - Marcello Scala
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Matteo P Ferla
- Genomic Medicine theme, Oxford Biomedical Research Centre, NIHR, Oxford, Oxfordshire, United Kingdom; Wellcome Centre for Human Genetics, Oxford University, Oxford, Oxfordshire, United Kingdom
| | - Shahryar Alavi
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Department of Cell and Molecular Biology and Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran; Palindrome, Isfahan, Iran
| | - Eissa Ali Faqeih
- Section of Medical Genetics, Children's Specialist Hospital, King Fahad Medical, City, Riyadh, Saudi Arabia
| | - Emilia K Bijlsma
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Kristen M Wigby
- Division of Medical Genetics, Department of Pediatrics, University of California, and Rady Children's Hospital, San Diego, CA
| | - Diana Baralle
- Wessex Clinical Genetics Service, Princess Anne Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Mohammad Y V Mehrjardi
- Medical Genetics Research Center, Shahid Sadoughi University of Medical Science, Yazd, Iran
| | - Jennifer Schwab
- Division of Human Genetics, Warren Alpert Medical School of Brown University, Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Katharina Steindl
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland
| | - Mais Hashem
- Department of Translational Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Marilyn Jones
- Division of Medical Genetics, Department of Pediatrics, University of California, and Rady Children's Hospital, San Diego, CA
| | - Dmitriy M Niyazov
- Section of Medical Genetics, Department of Pediatrics, Ochsner Health System and University of Queensland, New Orleans, LA
| | - Jennifer Jacober
- Section of Medical Genetics, Department of Pediatrics, Ochsner Health System and University of Queensland, New Orleans, LA
| | | | - Denisa Weis
- Department of Medical Genetics, Kepler University Hospital Med Campus IV, Johannes Kepler University, Linz, Austria
| | - Neda Zadeh
- Children's Hospital of Orange County, Orange, CA; Genetics Center, Orange, California
| | - Lance Rodan
- Department of Neurology, Boston Children's Hospital, Boston, MA; Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA
| | - Alice Goldenberg
- Department of Genetics and Reference Center for Developmental Disorders, Normandie University, UNIROUEN, CHU Rouen, Inserm U1245, FHU G4 Génomique, Rouen, France
| | - François Lecoquierre
- Department of Genetics and Reference Center for Developmental Disorders, Normandie University, UNIROUEN, CHU Rouen, Inserm U1245, FHU G4 Génomique, Rouen, France
| | - Marina Dutra-Clarke
- Division of Genetics, Department of Pediatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Gabriella Horvath
- BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Dana Young
- Adult Metabolic Diseases Clinic, Vancouver General Hospital, Vancouver, Canada
| | - Naama Orenstein
- Pediatric Genetics Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shahad Bawazeer
- Section of Medical Genetics, Children's Specialist Hospital, King Fahad Medical, City, Riyadh, Saudi Arabia
| | | | | | - Mohammadreza Dehghani
- Medical Genetics Research Center, Shahid Sadoughi University of Medical Science, Yazd, Iran
| | | | - Amir Bahreini
- Palindrome, Isfahan, Iran; KaryoGen, Isfahan, Iran; Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, PA
| | | | - A Gulhan Ercan-Sencicek
- Department of Neurosurgery, Program on Neurogenetics, Yale School of Medicine, Yale University, New Haven, CT; Masonic Medical Research Institute, Utica, NY
| | - Zahra Firoozfar
- Department of Cell and Molecular Biology and Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran; Palindrome, Isfahan, Iran
| | - Mojtaba Movahedinia
- Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Stephanie Efthymiou
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Ehsan Ghayoor Karimiani
- Department of Medical Genetics, Next Generation Genetic Polyclinic, Mashhad, Iran; Molecular and Clinical Sciences Institute, St. George's, University of London, London, United Kingdom; Innovative Medical Research Center, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Vincenzo Salpietro
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy; Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Jenny C Taylor
- Genomic Medicine theme, Oxford Biomedical Research Centre, NIHR, Oxford, Oxfordshire, United Kingdom; Wellcome Centre for Human Genetics, Oxford University, Oxford, Oxfordshire, United Kingdom
| | - Melody Redman
- Yorkshire Regional Genetics Service, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Alexander P A Stegmann
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Andreas Laner
- MGZ - Medizinisch Genetisches Zentrum, Munich, Germany
| | - Ghada Abdel-Salam
- Human Genetics and Genome Research Division, Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | | | - Mario Bengala
- Laboratory of Medical Genetics, Tor Vergata Hospital, Rome, Italy
| | - Amelie Johanna Müller
- Autophagy Laboratory, Department of Molecular Biology, Interfaculty Institute of Cell Biology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Maria C Digilio
- Medical Genetics Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anita Rauch
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland
| | - Murat Gunel
- Department of Neurosurgery, Program on Neurogenetics, Yale School of Medicine, Yale University, New Haven, CT
| | - Hannah Titheradge
- West Midlands Regional Genetics Service and Birmingham Health Partners, Birmingham, United Kingdom; Women's and Children's NHS Trust, Birmingham, United Kingdom
| | - Daniela N Schweitzer
- Division of Genetics, Department of Pediatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Alison Kraus
- Yorkshire Regional Genetics Service, Chapel Allerton Hospital, Leeds, United Kingdom; Castle Hill Hospital, Cottingham, Hull, United Kingdom
| | - Irene Valenzuela
- Department of Clinical and Molecular Genetics, University Hospital Vall d'Hebron, Barcelona, Spain; Medicine Genetics Group, Valle Hebron Research Institute, Barcelona, Spain
| | - Scott D McLean
- Department of Pediatrics and Molecular and Human Genetics, Baylor College of Medicine, San Antonio, TX
| | - Chanika Phornphutkul
- Section of Medical Genetics, Department of Pediatrics, Ochsner Health System and University of Queensland, New Orleans, LA
| | - Mustafa Salih
- Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Department of Pediatrics, College of Medicine, AlMughtaribeen University, Khartoum, Sudan
| | | | | | | | - Tobias B Haack
- Institute of Human Genetics and Applied Genomics University of Tübingen, Tübingen, Germany; Centre for Rare Diseases, University of Tübingen, Tübingen, Germany
| | - Carlos E Prada
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH; Division of Genetics, Birth Defects and Metabolism, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics, Feinberg School of Medicine of Northwestern University, Chicago, IL
| | - Fowzan S Alkuraya
- Department of Translational Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Department of Anatomy and Cell Biology College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Reza Maroofian
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
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Lieberwirth JK, Büttner B, Klöckner C, Platzer K, Popp B, Abou Jamra R. AutoCaSc: Prioritizing candidate genes for neurodevelopmental disorders. Hum Mutat 2022; 43:1795-1807. [PMID: 35998261 DOI: 10.1002/humu.24451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/27/2022] [Revised: 07/24/2022] [Accepted: 08/18/2022] [Indexed: 01/24/2023]
Abstract
Routine exome sequencing (ES) in individuals with neurodevelopmental disorders (NDD) remains inconclusive in >50% of the cases. Research analysis of unsolved cases can identify novel candidate genes but is time-consuming, subjective, and hard to compare between labs. The field, therefore, requires automated and standardized assessment methods to prioritize candidates for matchmaking. We developed AutoCaSc (https://autocasc.uni-leipzig.de) based on our candidate scoring scheme. We validated our approach using synthetic trios and real in-house trio ES data. AutoCaSc consistently (94.5% of all cases) scored the relevant variants in valid novel NDD genes in the top three ranks. In 93 real trio exomes, AutoCaSc identified most (97.5%) previously manually scored variants while evaluating additional high-scoring variants missed in manual evaluation. It identified candidate variants in previously undescribed NDD candidate genes (CNTN2, DLGAP1, SMURF1, NRXN3, and PRICKLE1). AutoCaSc enables anybody to quickly screen a variant for its plausibility in NDD. After contributing >40 descriptions of NDD-associated genes, we provide usage recommendations based on our extensive experience. Our implementation is capable of pipeline integration and therefore allows the screening of large cohorts for candidate genes. AutoCaSc empowers even small labs to a standardized matchmaking collaboration and to contribute to the ongoing identification of novel NDD entities.
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Affiliation(s)
| | - Benjamin Büttner
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, 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
| | - Bernt Popp
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany.,Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Center of Functional Genomics, Berlin, Germany
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
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22
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Gburek-Augustat J, Platzer K, Schumann I, Starke S, Hershfield MS, Sorge I, Merkenschlager A. Case Report: Deficiency of Adenosine Deaminase 2 (DADA2) as a Cause of Brainstem Stroke in a 3-Year-Old Girl and the Importance of Early Fast-Track Genetic Diagnostics to Influence Therapy. Neuropediatrics 2022; 53:432-435. [PMID: 35817355 DOI: 10.1055/a-1896-5817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Deficiency of adenosine deaminase 2 (DADA2) is a rare Mendelian, autoinflammatory multiorgan disease. We report the case of a 3.8-year-old female patient who was admitted with an acute brainstem stroke and was diagnosed with DADA2 by early initiation of exome sequencing. We recommend that DADA2 and a genetic workup should be taken into account, when evaluating strokes in children even if no other than neurological symptoms are evident.
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Affiliation(s)
- Janina Gburek-Augustat
- Division of Neuropaediatrics, Hospital for Children and Adolescents, University Hospital Leipzig, Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Isabell Schumann
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Sven Starke
- Department of Paediatric Oncology, Haematology and Haemostaseology, Hospital for Children and Adolescents, University Hospital Leipzig, Leipzig, Germany
| | - Michael Steven Hershfield
- Department of Medicine and Biochemistry, Duke University Medical Center, Durham, North Carolina, United States
| | - Ina Sorge
- Department of Pediatric Radiology, Hospital for Children and Adolescents, University Hospital Leipzig, Leipzig, Germany
| | - Andreas Merkenschlager
- Division of Neuropaediatrics, Hospital for Children and Adolescents, University Hospital Leipzig, Leipzig, Germany
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23
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Woods E, Marson I, Coci E, Spiller M, Kumar A, Brady A, Homfray T, Fisher R, Turnpenny P, Rankin J, Kanani F, Platzer K, Ververi A, Emmanouilidou E, Bourboun N, Giannakoulas G, Balasubramanian M. Expanding the phenotype of TAB2 variants and literature review. Am J Med Genet A 2022; 188:3331-3342. [PMID: 35971781 PMCID: PMC9804770 DOI: 10.1002/ajmg.a.62949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/30/2022] [Revised: 04/18/2022] [Accepted: 06/19/2022] [Indexed: 01/31/2023]
Abstract
TAB2 is a gene located on chromosome 6q25.1 and plays a key role in development of the heart. Existing literature describes congenital heart disease as a common recognized phenotype of TAB2 gene variants, with evidence of a distinct syndromic phenotype also existing beyond this. Here we describe 14 newly identified individuals with nine novel, pathogenic TAB2 variants. The majority of individuals were identified through the Deciphering Developmental Disorders study through trio whole exome sequencing. Eight individuals had de novo variants, the other six individuals were found to have maternally inherited, or likely maternally inherited, variants. Five individuals from the same family were identified following cardiac disease gene panel in the proband and subsequent targeted familial gene sequencing. The clinical features of this cohort were compared to the existing literature. Common clinical features include distinctive facial features, growth abnormalities, joint hypermobility, hypotonia, and developmental delay. Newly identified features included feeding difficulties, sleep problems, visual problems, genitourinary abnormality, and other anatomical variations. Here we report 14 new individuals, including novel TAB2 variants, in order to expand the emerging syndromic clinical phenotype and provide further genotype-phenotype correlation.
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Affiliation(s)
- Emily Woods
- Department of Paediatrics, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Imogen Marson
- Medical School, University of Sheffield, Sheffield, UK
| | - Emanuele Coci
- Department of Pediatrics, Prignitz Hospital, Brandenburg Medical School, Prignitz, Germany.,Department of Clinical Genetics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Michael Spiller
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Ajith Kumar
- Department of Clinical Genetics, Great Ormond Street Hospital, London, UK
| | - Angela Brady
- Clinical Genetics Service, Northwick Park Hospital, London, UK
| | - Tessa Homfray
- Clinical Genetics Service, St George's Hospital, London, UK
| | - Richard Fisher
- Northern Genetics Service, Newcastle University Hospital NHS Trust, Newcastle, UK
| | - Peter Turnpenny
- Peninsula Clinical Genetics Service, Royal Devon and Exeter NHS Trust, Exeter, UK
| | - Julia Rankin
- Peninsula Clinical Genetics Service, Royal Devon and Exeter NHS Trust, Exeter, UK
| | - Farah Kanani
- Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Athina Ververi
- Department of Clinical Genetics, Great Ormond Street Hospital, London, UK
| | | | - Nourxan Bourboun
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Meena Balasubramanian
- Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK.,Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
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24
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Krey I, Platzer K, Lemke JR. Monogenetic epilepsies and how to approach them in 2022. MED GENET-BERLIN 2022. [DOI: 10.1515/medgen-2022-2143] [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: 11/15/2022]
Affiliation(s)
- Ilona Krey
- Institute of Human Genetics , University of Leipzig Medical Center , Leipzig , Germany
| | - Konrad Platzer
- Institute of Human Genetics , University of Leipzig Medical Center , Leipzig , 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
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25
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Cediel ML, Stawarski M, Blanc X, Nosková L, Magner M, Platzer K, Gburek-Augustat J, Baldridge D, Constantino JN, Ranza E, Bettler B, Antonarakis SE. GABBR1 monoallelic de novo variants linked to neurodevelopmental delay and epilepsy. Am J Hum Genet 2022; 109:1885-1893. [PMID: 36103875 PMCID: PMC9606381 DOI: 10.1016/j.ajhg.2022.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/28/2022] [Accepted: 08/15/2022] [Indexed: 01/25/2023] Open
Abstract
GABAB receptors are obligatory heterodimers responsible for prolonged neuronal inhibition in the central nervous system. The two receptor subunits are encoded by GABBR1 and GABBR2. Variants in GABBR2 have been associated with a Rett-like phenotype (MIM: 617903), epileptic encephalopathy (MIM: 617904), and milder forms of developmental delay with absence epilepsy. To date, however, no phenotypes associated with pathogenic variants of GABBR1 have been established. Through GeneMatcher, we have ascertained four individuals who each have a monoallelic GABBR1 de novo non-synonymous variant; these individuals exhibit motor and/or language delay, ranging from mild to severe, and in one case, epilepsy. Further phenotypic features include varying degrees of intellectual disability, learning difficulties, autism, ADHD, ODD, sleep disorders, and muscular hypotonia. We functionally characterized the four de novo GABBR1 variants, p.Glu368Asp, p.Ala397Val, p.Ala535Thr, and p.Gly673Asp, in transfected HEK293 cells. GABA fails to efficiently activate the variant receptors, most likely leading to an increase in the excitation/inhibition balance in the central nervous system. Variant p.Gly673Asp in transmembrane domain 3 (TMD3) renders the receptor completely inactive, consistent with failure of the receptor to reach the cell surface. p.Glu368Asp is located near the orthosteric binding site and reduces GABA potency and efficacy at the receptor. GABA exhibits normal potency but decreased efficacy at the p.Ala397Val and p.Ala535Thr variants. Functional characterization of GABBR1-related variants provides a rationale for understanding the severity of disease phenotypes and points to possible therapeutic strategies.
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Affiliation(s)
- Maria Lucia Cediel
- Medigenome, Swiss Institute of Genomic Medicine, 1207 Geneva, Switzerland
| | - Michal Stawarski
- Department of Biomedicine, Pharmazentrum, University of Basel, Klingelbergstrasse 50/70, 4056 Basel, Switzerland
| | - Xavier Blanc
- Medigenome, Swiss Institute of Genomic Medicine, 1207 Geneva, Switzerland
| | - Lenka Nosková
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Martin Magner
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic; Department of Pediatrics, First Faculty of Medicine, Charles University and University Thomayer Hospital in Prague, Prague, Czech Republic
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Janina Gburek-Augustat
- Division of Neuropaediatrics, Hospital for Children and Adolescents, University Hospital Leipzig, Leipzig, Germany
| | | | | | - Emmanuelle Ranza
- Medigenome, Swiss Institute of Genomic Medicine, 1207 Geneva, Switzerland
| | - Bernhard Bettler
- Department of Biomedicine, Pharmazentrum, University of Basel, Klingelbergstrasse 50/70, 4056 Basel, Switzerland
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26
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Krey I, Platzer K, Esterhuizen A, Berkovic SF, Helbig I, Hildebrand MS, Lerche H, Lowenstein D, Møller RS, Poduri A, Sadleir L, Sisodiya SM, Weckhuysen S, Wilmshurst JM, Weber Y, Lemke JR. Current practice in diagnostic genetic testing of the epilepsies. Epileptic Disord 2022; 24:765-786. [PMID: 35830287 PMCID: PMC10752379 DOI: 10.1684/epd.2022.1448] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [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: 02/02/2021] [Accepted: 05/10/2022] [Indexed: 01/19/2023]
Abstract
Epilepsy genetics is a rapidly developing field, in which novel disease-associated genes, novel mechanisms associated with epilepsy, and precision medicine approaches are continuously being identified. In the past decade, advances in genomic knowledge and analysis platforms have begun to make clinical genetic testing accessible for, in principle, people of all ages with epilepsy. For this reason, the Genetics Commission of the International League Against Epilepsy (ILAE) presents this update on clinical genetic testing practice, including current techniques, indications, yield of genetic testing, recommendations for pre- and post-test counseling, and follow-up after genetic testing is completed. We acknowledge that the resources vary across different settings but highlight that genetic diagnostic testing for epilepsy should be prioritized when the likelihood of an informative finding is high. Results of genetic testing, in particular the identification of causative genetic variants, are likely to improve individual care. We emphasize the importance of genetic testing for individuals with epilepsy as we enter the era of precision therapy.
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Affiliation(s)
- Ilona Krey
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Alina Esterhuizen
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Samuel F. Berkovic
- Epilepsy Research Centre, Department of Medicine, University of Melbourne (Austin Health), Heidelberg, VIC, Australia
| | - Ingo Helbig
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Building C, Arnold-Heller-Straße 3, 24105 Kiel, Germany
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, 19104 USA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104 USA
| | - Michael S. Hildebrand
- Epilepsy Research Centre, Department of Medicine, The University of Melbourne, Austin Health, Heidelberg and Murdoch Children’s Research Institute, Royal Children’s Hospital, Victoria, Australia
| | - Holger Lerche
- Department of Epileptology and Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Daniel Lowenstein
- Department of Neurology, University of California, San Francisco, USA
| | - Rikke S. Møller
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark
- Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark
| | - Annapurna Poduri
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Lynette Sadleir
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Sanjay M. Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology London, UK and Chalfont Centre for Epilepsy, Buckinghamshire, UK
| | - Sarah Weckhuysen
- Center for Molecular Neurology, VIB-University of Antwerp, VIB, Antwerp, Belgium; Department of Neurology, University Hospital Antwerp, Antwerp, Belgium
| | - Jo M. Wilmshurst
- Department of Paediatric Neurology, Paediatric and Child Health, Red Cross War Memorial Children’s Hospital, Neuroscience Institute, University of Cape Town, South Africa
| | - Yvonne Weber
- Department of Epileptology and Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
- Department of Epileptology and Neurology, University of Aachen, 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
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27
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Bögershausen N, Krawczyk HE, Jamra RA, Lin SJ, Yigit G, Hüning I, Polo AM, Vona B, Huang K, Schmidt J, Altmüller J, Luppe J, Platzer K, Dörgeloh BB, Busche A, Biskup S, Mendes MI, Smith DEC, Salomons GS, Zibat A, Bültmann E, Nürnberg P, Spielmann M, Lemke JR, Li Y, Zenker M, Varshney GK, Hillen HS, Kratz CP, Wollnik B. WARS1 and SARS1: Two tRNA synthetases implicated in autosomal recessive microcephaly. Hum Mutat 2022; 43:1454-1471. [PMID: 35790048 DOI: 10.1002/humu.24430] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/03/2021] [Revised: 06/10/2022] [Accepted: 07/01/2022] [Indexed: 02/04/2023]
Abstract
Aminoacylation of transfer RNA (tRNA) is a key step in protein biosynthesis, carried out by highly specific aminoacyl-tRNA synthetases (ARSs). ARSs have been implicated in autosomal dominant and autosomal recessive human disorders. Autosomal dominant variants in tryptophanyl-tRNA synthetase 1 (WARS1) are known to cause distal hereditary motor neuropathy and Charcot-Marie-Tooth disease, but a recessively inherited phenotype is yet to be clearly defined. Seryl-tRNA synthetase 1 (SARS1) has rarely been implicated in an autosomal recessive developmental disorder. Here, we report five individuals with biallelic missense variants in WARS1 or SARS1, who presented with an overlapping phenotype of microcephaly, developmental delay, intellectual disability, and brain anomalies. Structural mapping showed that the SARS1 variant is located directly within the enzyme's active site, most likely diminishing activity, while the WARS1 variant is located in the N-terminal domain. We further characterize the identified WARS1 variant by showing that it negatively impacts protein abundance and is unable to rescue the phenotype of a CRISPR/Cas9 wars1 knockout zebrafish model. In summary, we describe two overlapping autosomal recessive syndromes caused by variants in WARS1 and SARS1, present functional insights into the pathogenesis of the WARS1-related syndrome and define an emerging disease spectrum: ARS-related developmental disorders with or without microcephaly.
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Affiliation(s)
- Nina Bögershausen
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
| | - Hannah E Krawczyk
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
| | - Rami A Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Sheng-Jia Lin
- Genes & Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Gökhan Yigit
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
| | - Irina Hüning
- Institut für Humangenetik, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Anna M Polo
- MVZ Labor Krone, Filialpraxis für Humangenetik, Bielefeld, Germany
| | - Barbara Vona
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany.,Institute for Auditory Neuroscience and InnerEarLab, University Medical Center Göttingen, Göttingen, Germany
| | - Kevin Huang
- Genes & Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Julia Schmidt
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
| | - Janine Altmüller
- Cologne Center for Genomics (CCG), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Core Facility Genomics, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Johannes Luppe
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Beate B Dörgeloh
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Andreas Busche
- Institut für Humangenetik, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Saskia Biskup
- CeGaT GmbH, Center for Genomics and Transcriptomics, Tübingen, Germany
| | - Marisa I Mendes
- Laboratory Genetic Metabolic Diseases, Amsterdam Gastroenterology and Metabolism, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, Netherlands
| | - Desiree E C Smith
- Laboratory Genetic Metabolic Diseases, Amsterdam Gastroenterology and Metabolism, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, Netherlands
| | - Gajja S Salomons
- Laboratory Genetic Metabolic Diseases, Amsterdam Gastroenterology and Metabolism, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, Netherlands
| | - Arne Zibat
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
| | - Eva Bültmann
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Peter Nürnberg
- Cologne Center for Genomics (CCG), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Malte Spielmann
- Institut für Humangenetik, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Yun Li
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Zenker
- Institute of Human Genetics, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Gaurav K Varshney
- Genes & Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Hauke S Hillen
- Research Group Structure and Function of Molecular Machines, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany.,Department of Cellular Biochemistry, University Medical Center Göttingen, Göttingen, Germany.,Cluster of Excellence "Multiscale Bioimaging: From Molecular Machines to Networks of Excitable cells" (MBExC), University of Göttingen, Göttingen, Germany
| | - Christian P Kratz
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Bernd Wollnik
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany.,Cluster of Excellence "Multiscale Bioimaging: From Molecular Machines to Networks of Excitable cells" (MBExC), University of Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
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28
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Döring JH, Saffari A, Bast T, Brockmann K, Ehrhardt L, Fazeli W, Janzarik WG, Klabunde-Cherwon A, Kluger G, Muhle H, Pendziwiat M, Møller RS, Platzer K, Santos JL, Schröter J, Hoffmann GF, Kölker S, Syrbe S. Efficacy, Tolerability, and Retention of Antiseizure Medications in PRRT2-Associated Infantile Epilepsy. Neurol Genet 2022; 8:e200020. [PMID: 36187725 PMCID: PMC9520344 DOI: 10.1212/nxg.0000000000200020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022]
Abstract
Background and Objectives Pathogenic variants in PRRT2, encoding for the proline-rich transmembrane protein 2, were identified as the main cause of self-limiting sporadic and familial infantile epilepsy. Reported data on treatment response to antiseizure medications (ASMs) in defined monogenic epilepsies are limited. The aim of this study was to evaluate the treatment response of ASMs in children with monogenic PRRT2-associated infantile epilepsy. Methods A multicenter, retrospective, cross-sectional cohort study was conducted according to the Strengthening the Reporting of Observational Studies in Epidemiology criteria. Inclusion criteria were occurrence of infantile seizures and genetic diagnosis of likely pathogenic/pathogenic PRRT2 variants. Results Treatment response data from 52 individuals with PRRT2-associated infantile epilepsy with a total of 79 treatments (defined as each use of an ASM in an individual) were analyzed. Ninety-six percent (50/52) of all individuals received ASMs. Levetiracetam (LEV), oxcarbazepine (OXC), valproate (VPA), and phenobarbital (PB) were most frequently administered. Sodium channel blockers were used in 22 individuals and resulted in seizure freedom in all but 1 child, who showed a reduction of more than 50% in seizure frequency. By contrast, treatment with LEV was associated with worsening of seizure activity in 2/25 (8%) treatments and no effect in 10/25 (40%) of treatments. LEV was rated significantly less effective also compared with VPA and PB. The retention rate for LEV was significantly lower compared with all aforementioned ASMs. No severe adverse events were reported, and no discontinuation of treatment was reported because of side effects. Discussion In conclusion, a favorable effect of most ASMs, especially sodium channel blockers such as carbamezepine and OXC, was observed, whereas the efficacy and the retention rate of LEV was lower in PRRT2-associated childhood epilepsy. Tolerability in these young children was good for all ASMs reported in the cohort. Classification of Evidence This study provides Class IV evidence that in individuals with PRRT2-associated infantile epilepsy, sodium channel blockers are associated with reduced seizure frequency but levetiracetam is not.
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29
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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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30
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Platzer K, Sticht H, Bupp C, Ganapathi M, Pereira EM, Le Guyader G, Bilan F, Henderson LB, Lemke JR, Taschenberger H, Brose N, Jamra RA, Wojcik SM. De novo missense variants in
SLC32A1
cause a developmental and epileptic encephalopathy due to impaired
GABAergic
neurotransmission. Ann Neurol 2022; 92:958-973. [DOI: 10.1002/ana.26485] [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] [Received: 04/01/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Konrad Platzer
- Institute of Human Genetics University of Leipzig Medical Center Leipzig Germany
| | - Heinrich Sticht
- Institute of Biochemistry, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen Germany
| | - Caleb Bupp
- Spectrum Health Medical Genetics Grand Rapids MI USA
| | - Mythily Ganapathi
- Department of Pathology and Cell Biology Columbia University Medical Center New York NY USA
| | - Elaine M. Pereira
- Department of Pediatrics Columbia University Irving Medical Center New York NY USA
| | - Gwenaël Le Guyader
- Department of Genetics Poitiers University Hospital Center Poitiers Cedex France
| | - Frederic Bilan
- Department of Genetics Poitiers University Hospital Center Poitiers Cedex France
- Laboratoire de Neurosciences Expérimentales et Cliniques (LNEC) INSERM U1084 University of Poitiers Poitiers France
| | | | - 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
| | - Holger Taschenberger
- Department of Molecular Neurobiology Max Planck Institute for Multidisciplinary Sciences City Campus, Göttingen Germany
| | - Nils Brose
- Department of Molecular Neurobiology Max Planck Institute for Multidisciplinary Sciences City Campus, Göttingen Germany
| | - Rami Abou Jamra
- Institute of Human Genetics University of Leipzig Medical Center Leipzig Germany
| | - Sonja M. Wojcik
- Department of Molecular Neurobiology Max Planck Institute for Multidisciplinary Sciences City Campus, Göttingen Germany
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31
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Körner MB, Velluva A, Bundalian L, Radtke M, Lin CC, Zacher P, Bartolomaeus T, Kirstein AS, Mrestani A, Scholz N, Platzer K, Teichmann AC, Hentschel J, Langenhan T, Lemke JR, Garten A, Abou Jamra R, Le Duc D. Altered gene expression profiles impair the nervous system development in individuals with 15q13.3 microdeletion. Sci Rep 2022; 12:13507. [PMID: 35931711 PMCID: PMC9356015 DOI: 10.1038/s41598-022-17604-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/22/2022] [Accepted: 07/28/2022] [Indexed: 11/21/2022] Open
Abstract
The 15q13.3 microdeletion has pleiotropic effects ranging from apparently healthy to severely affected individuals. The underlying basis of the variable phenotype remains elusive. We analyzed gene expression using blood from three individuals with 15q13.3 microdeletion and brain cortex tissue from ten mice Df[h15q13]/+. We assessed differentially expressed genes (DEGs), protein–protein interaction (PPI) functional modules, and gene expression in brain developmental stages. The deleted genes’ haploinsufficiency was not transcriptionally compensated, suggesting a dosage effect may contribute to the pathomechanism. DEGs shared between tested individuals and a corresponding mouse model show a significant overlap including genes involved in monogenic neurodevelopmental disorders. Yet, network-wide dysregulatory effects suggest the phenotype is not caused by a single critical gene. A significant proportion of blood DEGs, silenced in adult brain, have maximum expression during the prenatal brain development. Based on DEGs and their PPI partners we identified altered functional modules related to developmental processes, including nervous system development. We show that the 15q13.3 microdeletion has a ubiquitous impact on the transcriptome pattern, especially dysregulation of genes involved in brain development. The high phenotypic variability seen in 15q13.3 microdeletion could stem from an increased vulnerability during brain development, instead of a specific pathomechanism.
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Affiliation(s)
- Marek B Körner
- Division of General Biochemistry, Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, Leipzig University, 04103, Leipzig, Germany.,Institute of Human Genetics, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - 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
| | - Linnaeus Bundalian
- Institute of Human Genetics, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Maximilian Radtke
- 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, 11221, Taiwan
| | - Pia Zacher
- Institute of Human Genetics, University of Leipzig Medical Center, 04103, Leipzig, Germany.,Epilepsy Center Kleinwachau, 01454, Radeberg, Germany
| | - Tobias Bartolomaeus
- Institute of Human Genetics, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Anna S Kirstein
- Pediatric Research Center, University Hospital for Children and Adolescents, Leipzig University, 04103, Leipzig, Germany
| | - Achmed Mrestani
- Division of General Biochemistry, Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, Leipzig University, 04103, Leipzig, Germany.,Department of Neurology, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Nicole Scholz
- Division of General Biochemistry, Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, Leipzig University, 04103, Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | | | - Julia Hentschel
- Institute of Human Genetics, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Tobias Langenhan
- Division of General Biochemistry, Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, Leipzig University, 04103, Leipzig, Germany
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Antje Garten
- Pediatric Research Center, University Hospital for Children and Adolescents, Leipzig University, 04103, Leipzig, Germany
| | - Rami Abou Jamra
- Institute of Human Genetics, 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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32
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Marcogliese PC, Deal SL, Andrews J, Harnish JM, Bhavana VH, Graves HK, Jangam S, Luo X, Liu N, Bei D, Chao YH, Hull B, Lee PT, Pan H, Bhadane P, Huang MC, Longley CM, Chao HT, Chung HL, Haelterman NA, Kanca O, Manivannan SN, Rossetti LZ, German RJ, Gerard A, Schwaibold EMC, Fehr S, Guerrini R, Vetro A, England E, Murali CN, Barakat TS, van Dooren MF, Wilke M, van Slegtenhorst M, Lesca G, Sabatier I, Chatron N, Brownstein CA, Madden JA, Agrawal PB, Keren B, Courtin T, Perrin L, Brugger M, Roser T, Leiz S, Mau-Them FT, Delanne J, Sukarova-Angelovska E, Trajkova S, Rosenhahn E, Strehlow V, Platzer K, Keller R, Pavinato L, Brusco A, Rosenfeld JA, Marom R, Wangler MF, Yamamoto S. Drosophila functional screening of de novo variants in autism uncovers damaging variants and facilitates discovery of rare neurodevelopmental diseases. Cell Rep 2022; 38:110517. [PMID: 35294868 PMCID: PMC8983390 DOI: 10.1016/j.celrep.2022.110517] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 02/02/2021] [Revised: 09/23/2021] [Accepted: 02/18/2022] [Indexed: 12/30/2022] Open
Abstract
Individuals with autism spectrum disorder (ASD) exhibit an increased burden of de novo mutations (DNMs) in a broadening range of genes. While these studies have implicated hundreds of genes in ASD pathogenesis, which DNMs cause functional consequences in vivo remains unclear. We functionally test the effects of ASD missense DNMs using Drosophila through "humanization" rescue and overexpression-based strategies. We examine 79 ASD variants in 74 genes identified in the Simons Simplex Collection and find 38% of them to cause functional alterations. Moreover, we identify GLRA2 as the cause of a spectrum of neurodevelopmental phenotypes beyond ASD in 13 previously undiagnosed subjects. Functional characterization of variants in ASD candidate genes points to conserved neurobiological mechanisms and facilitates gene discovery for rare neurodevelopmental diseases.
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Affiliation(s)
- Paul C Marcogliese
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA
| | - Samantha L Deal
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA; Program in Developmental Biology, BCM, Houston, TX 77030, USA
| | - Jonathan Andrews
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA
| | - J Michael Harnish
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA
| | - V Hemanjani Bhavana
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA
| | - Hillary K Graves
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA
| | - Sharayu Jangam
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA
| | - Xi Luo
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA; Department of Pediatrics, Division of Hematology/Oncology, BCM, Houston, TX 77030, USA
| | - Ning Liu
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA; Baylor Genetics Laboratories, Houston, TX 77021, USA
| | - Danqing Bei
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA
| | - Yu-Hsin Chao
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA
| | - Brooke Hull
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA
| | - Pei-Tseng Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA
| | - Hongling Pan
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA
| | - Pradnya Bhadane
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA
| | - Mei-Chu Huang
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA
| | - Colleen M Longley
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA; Program in Developmental Biology, BCM, Houston, TX 77030, USA
| | - Hsiao-Tuan Chao
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA; Department of Pediatrics, Division of Neurology and Developmental Neuroscience, BCM, Houston, TX 77030, USA; Department of Neuroscience, BCM, Houston, TX 77030, USA; McNair Medical Institute, The Robert and Janice McNair Foundation, Houston, TX 77030, USA; TCH, Houston, TX 77030, USA; Development, Disease Models & Therapeutics Graduate Program, BCM, Houston, TX 77030, USA
| | - Hyung-Lok Chung
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA; Howard Hughes Medical Institute, Houston, TX 77030, USA
| | - Nele A Haelterman
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA
| | - Oguz Kanca
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA
| | - Sathiya N Manivannan
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA
| | - Linda Z Rossetti
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA
| | - Ryan J German
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA
| | - Amanda Gerard
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; TCH, Houston, TX 77030, USA
| | | | - Sarah Fehr
- Praxis für Humangenetik Tübingen, Tübingen, Germany
| | - Renzo Guerrini
- Neuroscience Department, Children's Hospital Meyer-University of Florence, Florence, Italy
| | - Annalisa Vetro
- Neuroscience Department, Children's Hospital Meyer-University of Florence, Florence, Italy
| | - Eleina England
- The Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Chaya N Murali
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; TCH, Houston, TX 77030, USA
| | - Tahsin Stefan Barakat
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Marieke F van Dooren
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Martina Wilke
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Marjon van Slegtenhorst
- Department of Clinical Genetics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Gaetan Lesca
- Department of Medical Genetics, Lyon University Hospital, Université Claude Bernard Lyon 1, Lyon, France; Institut NeuroMyoGène, CNRS UMR 5310 - INSERM U1217, Université Claude Bernard Lyon 1, Lyon, France
| | - Isabelle Sabatier
- Department of Pediatric Neurology, Lyon University Hospitals, Lyon, France
| | - Nicolas Chatron
- Department of Medical Genetics, Lyon University Hospital, Université Claude Bernard Lyon 1, Lyon, France; Institut NeuroMyoGène, CNRS UMR 5310 - INSERM U1217, Université Claude Bernard Lyon 1, Lyon, France
| | - Catherine A Brownstein
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA; The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Jill A Madden
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA; The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA 02115, USA
| | - Pankaj B Agrawal
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA; The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA; Division of Newborn Medicine, Boston Children's Hospital, Boston, MA 02115, USA
| | - Boris Keren
- Genetic Department, Pitié-Salpêtrière Hospital, APHP.Sorbonne Université, Paris 75013, France
| | - Thomas Courtin
- Genetic Department, Pitié-Salpêtrière Hospital, APHP.Sorbonne Université, Paris 75013, France
| | - Laurence Perrin
- Genetic Department, Robert Debré Hospital, APHP.Nord-Université de Paris, Paris 75019, France
| | - Melanie Brugger
- Institute of Human Genetics, Technical University Munich, Munich, Germany
| | - Timo Roser
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Lindwurmstraße 4, 80337 Munich, Germany
| | - Steffen Leiz
- Department of Pediatrics and Adolescent Medicine, Hospital Dritter Orden, Munich, Germany
| | - Frederic Tran Mau-Them
- INSERM U1231, LNC UMR1231 GAD, Burgundy University, 21000 Dijon, France; Laboratoire de Génétique, Innovation en Diagnostic Génomique des Maladies Rares UF6254, Plateau Technique de Biologie, CHU Dijon, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Julian Delanne
- INSERM U1231, LNC UMR1231 GAD, Burgundy University, 21000 Dijon, France
| | - Elena Sukarova-Angelovska
- Department of Endocrinology and Genetics, University Clinic for Children's Diseases, Medical Faculty, University Sv. Kiril i Metodij, Skopje, Republic of Macedonia
| | - Slavica Trajkova
- Department of Medical Sciences, University of Torino, Turin, Italy
| | - Erik Rosenhahn
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Vincent Strehlow
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Roberto Keller
- Adult Autism Center, Mental Health Department, Health Unit ASL Città di Torino, Turin, Italy
| | - Lisa Pavinato
- Department of Medical Sciences, University of Torino, Turin, Italy; Institute of Human Genetics and Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Alfredo Brusco
- Department of Medical Sciences, University of Torino, Turin, Italy; Medical Genetics Unit, Città della Salute e della Scienza, University Hospital, Turin, Italy
| | - Jill A Rosenfeld
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Baylor Genetics Laboratories, Houston, TX 77021, USA
| | - Ronit Marom
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; TCH, Houston, TX 77030, USA
| | - Michael F Wangler
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA; TCH, Houston, TX 77030, USA; Development, Disease Models & Therapeutics Graduate Program, BCM, Houston, TX 77030, USA.
| | - Shinya Yamamoto
- Department of Molecular and Human Genetics, Baylor College of Medicine (BCM), Houston, TX 77030, USA; Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital (TCH), Houston, TX 77030, USA; Program in Developmental Biology, BCM, Houston, TX 77030, USA; Department of Neuroscience, BCM, Houston, TX 77030, USA; Development, Disease Models & Therapeutics Graduate Program, BCM, Houston, TX 77030, USA.
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33
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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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Klöckner C, Murray JPF, Tavasoli M, Sticht H, Stoltenburg-Didinger G, Scholle LM, Bakhtiari S, Kruer MC, Darvish H, Firouzabadi SG, Pagnozzi A, Shukla A, Girisha KM, Narayanan DL, Kaur P, Maroofian R, Zaki MS, Noureldeen MM, Merkenschlager A, Gburek-Augustat J, Cali E, Banu S, Nahar K, Efthymiou S, Houlden H, Jamra RA, Williams J, McMaster CR, Platzer K. Bi-allelic variants in CHKA cause a neurodevelopmental disorder with epilepsy and microcephaly. Brain 2022; 145:1916-1923. [PMID: 35202461 DOI: 10.1093/brain/awac074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/15/2021] [Revised: 12/15/2021] [Accepted: 02/06/2022] [Indexed: 11/14/2022] Open
Abstract
The Kennedy pathways catalyze the de novo synthesis of phosphatidylcholine and phosphatidylethanolamine, the most abundant components of eukaryotic cell membranes. In recent years, these pathways have moved into clinical focus since four out of ten genes involved have been associated with a range of autosomal recessive rare diseases such as a neurodevelopmental disorder with muscular dystrophy (CHKB), bone abnormalities and cone-rod dystrophy (PCYT1A), and spastic paraplegia (PCYT2, SELENOI). We identified six individuals from five families with bi-allelic variants in CHKA presenting with severe global developmental delay, epilepsy, movement disorders, and microcephaly. Using structural molecular modeling and functional testing of the variants in a in a cell-based S. cerevisiae model, we determined that these variants reduce the enzymatic activity of CHKA and confer a significant impairment of the first enzymatic step of the Kennedy pathway. In summary, we present CHKA as a novel autosomal recessive gene for a neurodevelopmental disorder with epilepsy and microcephaly.
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Affiliation(s)
- Chiara Klöckner
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | | | - Mahtab Tavasoli
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia B3N 0A1, Canada
| | - Heinrich Sticht
- Institute of Biochemistry, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | | | - Somayeh Bakhtiari
- Pediatric Movement Disorders Program, Division of Pediatric Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Departments of Child Health, Neurology, Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Michael C Kruer
- Pediatric Movement Disorders Program, Division of Pediatric Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Departments of Child Health, Neurology, Cellular & Molecular Medicine and Program in Genetics, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Hossein Darvish
- Neuroscience Research Center, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Alex Pagnozzi
- CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Brisbane, QLD 4029, Australia
| | - Anju Shukla
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Katta Mohan Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Dhanya Lakshmi Narayanan
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Parneet Kaur
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Reza Maroofian
- Department of Neuromuscular Disorders, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Maha S Zaki
- Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - Mahmoud M Noureldeen
- Department of Pediatrics, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Andreas Merkenschlager
- Division of Neuropaediatrics, Hospital for Children and Adolescents, University Hospital Leipzig, Leipzig, Germany
| | - Janina Gburek-Augustat
- Division of Neuropaediatrics, Hospital for Children and Adolescents, University Hospital Leipzig, Leipzig, Germany
| | - Elisa Cali
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, UK
| | - Selina Banu
- Department of Pediatric Neurology, Dr. M.R. Khan Shishu (Children) Hospital and ICH, Mirpur, Dhaka, Bangladesh
| | - Kamrun Nahar
- Department of Pediatric Neurology, Dr. M.R. Khan Shishu (Children) Hospital and ICH, Mirpur, Dhaka, Bangladesh
| | - Stephanie Efthymiou
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, UK
| | - Henry Houlden
- Department of Neuromuscular Disorders, Queen Square Institute of Neurology, University College London, London, UK
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Jason Williams
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia B3N 0A1, Canada
| | | | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
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35
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Kumble S, Levy AM, Punetha J, Gao H, Ah Mew N, Anyane-Yeboa K, Benke PJ, Berger SM, Bjerglund L, Campos-Xavier B, Ciliberto M, Cohen JS, Comi AM, Curry C, Damaj L, Denommé-Pichon AS, Emrick L, Faivre L, Fasano MB, Fiévet A, Finkel RS, García-Miñaúr S, Gerard A, Gomez-Puertas P, Guillen Sacoto MJ, Hoffman TL, Howard L, Iglesias AD, Izumi K, Larson A, Leiber A, Lozano R, Marcos-Alcalde I, Mintz CS, Mullegama SV, Møller RS, Odent S, Oppermann H, Ostergaard E, Pacio-Míguez M, Palomares-Bralo M, Parikh S, Paulson AM, Platzer K, Posey JE, Potocki L, Revah-Politi A, Rio M, Ritter AL, Robinson S, Rosenfeld JA, Santos-Simarro F, Sousa SB, Wéber M, Xie Y, Chung WK, Brown NJ, Tümer Z. The clinical and molecular spectrum of QRICH1 associated neurodevelopmental disorder. Hum Mutat 2022; 43:266-282. [PMID: 34859529 DOI: 10.1002/humu.24308] [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: 06/03/2021] [Revised: 11/09/2021] [Accepted: 11/28/2021] [Indexed: 11/10/2022]
Abstract
De novo variants in QRICH1 (Glutamine-rich protein 1) has recently been reported in 11 individuals with intellectual disability (ID). The function of QRICH1 is largely unknown but it is likely to play a key role in the unfolded response of endoplasmic reticulum stress through transcriptional control of proteostasis. In this study, we present 27 additional individuals and delineate the clinical and molecular spectrum of the individuals (n = 38) with QRICH1 variants. The main clinical features were mild to moderate developmental delay/ID (71%), nonspecific facial dysmorphism (92%) and hypotonia (39%). Additional findings included poor weight gain (29%), short stature (29%), autism spectrum disorder (29%), seizures (24%) and scoliosis (18%). Minor structural brain abnormalities were reported in 52% of the individuals with brain imaging. Truncating or splice variants were found in 28 individuals and 10 had missense variants. Four variants were inherited from mildly affected parents. This study confirms that heterozygous QRICH1 variants cause a neurodevelopmental disorder including short stature and expands the phenotypic spectrum to include poor weight gain, scoliosis, hypotonia, minor structural brain anomalies, and seizures. Inherited variants from mildly affected parents are reported for the first time, suggesting variable expressivity.
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Affiliation(s)
- Smitha Kumble
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Amanda M Levy
- Department of Clinical Genetics, Kennedy Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jaya Punetha
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Hua Gao
- Department of Review Analysis, GeneDx LLC, Maryland, USA
| | - Nicholas Ah Mew
- Rare Disease Institute, Children's National Hospital, Washington, District of Columbia, USA
| | - Kwame Anyane-Yeboa
- Department of Pediatrics, Columbia University Irving Medical Center, New York City, New York, USA
| | - Paul J Benke
- Division of Genetics, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Sara M Berger
- Department of Pediatrics, Columbia University Irving Medical Center, New York City, New York, USA
| | - Lise Bjerglund
- Department of Pediatrics, University Hospital Hvidovre, Hvidovre, Denmark
| | - Belinda Campos-Xavier
- Medical Genetics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Division of Genetic Medicine, Lausanne University Hospital and University of Lausanne (CHUV), Lausanne, Switzerland
| | - Michael Ciliberto
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Julie S Cohen
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anne M Comi
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Cynthia Curry
- Deptartment of Pediatrics, Genetic Medicine, UCSF/Fresno, Fresno, California, USA
| | - Lena Damaj
- Service de pédiatrie et de génétique clinique, CHU Rennes, Rennes, France
| | - Anne-Sophie Denommé-Pichon
- INSERM UMR1231 Equipe GAD, Université de Bourgogne, Dijon, France
- Unité Fonctionnelle Innovation en Diagnostic génomique des maladies rares, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Lisa Emrick
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Laurence Faivre
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU Dijon, Dijon, France
- Inserm UMR1231 GAD, Génétique des Anomalies du Développement, Université de Bourgogne, Dijon, France
| | - Mary Beth Fasano
- Internal Medicine & Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Alice Fiévet
- Laboratoire de biologie médicale multisites Seqoia-FMG2025, Paris, France
- Service Génétique des Tumeurs, Gustave Roussy, Villejuif, France
| | - Richard S Finkel
- Nemours Children's Hospital, Orlando, Florida, USA
- Center for Experimental Neurotherapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Sixto García-Miñaúr
- Institute of Medical and Molecular Genetics (INGEMM), La Paz University Hospital, Idipaz, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, U753), Instituto Carlos III, Madrid, Spain
| | - Amanda Gerard
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, Texas, USA
| | - Paulino Gomez-Puertas
- Molecular Modelling Group, Severo Ochoa Molecular Biology Centre (CBMSO, CSIC-UAM), Madrid, Spain
| | | | - Trevor L Hoffman
- Regional Department of Genetics, Southern California Kaiser Permanente Medical Group, Pasadena, California, USA
| | - Lillian Howard
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Alejandro D Iglesias
- Division of Clinical Genetics, Columbia University Irving Medical Center, New York City, New York, USA
| | - Kosuke Izumi
- Divison of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Austin Larson
- Section of Genetics, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Anja Leiber
- Department of Neuropediatrics, Childrens Hospital of Eastern Switzerland St. Gallen, St. Gallen, Switzerland
| | - Reymundo Lozano
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Iñigo Marcos-Alcalde
- Molecular Modelling Group, Severo Ochoa Molecular Biology Centre (CBMSO, CSIC-UAM), Madrid, Spain
- Biosciences Research Institute, School of Experimental Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Cassie S Mintz
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | - Rikke S Møller
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Centre, Dianalund, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Sylvie Odent
- CHU Rennes, Hôpital Sud, Service de Génétique Clinique, Univ Rennes, CNRS IGDR UMR 6290, Centre de référence Anomalies du développement CLAD-Ouest, ERN ITHACA, Rennes, France
| | - Henry Oppermann
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Elsebet Ostergaard
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marta Pacio-Míguez
- Institute of Medical and Molecular Genetics (INGEMM), La Paz University Hospital, Idipaz, Madrid, Spain
| | - Maria Palomares-Bralo
- Institute of Medical and Molecular Genetics (INGEMM), La Paz University Hospital, Idipaz, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, U753), Instituto Carlos III, Madrid, Spain
| | - Sumit Parikh
- Mitochondrial Medicine & Neurogenetics, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anna M Paulson
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Jennifer E Posey
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Lorraine Potocki
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, Texas, USA
| | - Anya Revah-Politi
- Institute for Genomic Medicine, Columbia University Medical Center, New York City, New York, USA
- Precision Genomics Laboratory, Columbia University Irving Medical Center, New York City, New York, USA
| | - Marlene Rio
- Service de Génétique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Alyssa L Ritter
- Divison of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Scott Robinson
- Department of Pediatrics, Columbia University Irving Medical Center, New York City, New York, USA
| | - Jill A Rosenfeld
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Baylor Genetics Laboratories, Houston, Texas, USA
| | - Fernando Santos-Simarro
- Institute of Medical and Molecular Genetics (INGEMM), La Paz University Hospital, Idipaz, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, U753), Instituto Carlos III, Madrid, Spain
| | - Sérgio B Sousa
- Medical Genetics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- University Clinic of Genetics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Mathys Wéber
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, CHU Dijon, Dijon, France
| | - Yili Xie
- Clinical Genomics Program, GeneDx, Maryland, USA
| | - Wendy K Chung
- Department of Pediatrics, Columbia University Irving Medical Center, New York City, New York, USA
| | - Natasha J Brown
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Melbourne, Australia
| | - Zeynep Tümer
- Department of Clinical Genetics, Kennedy Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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36
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Velluva A, Radtke M, Horn S, Popp B, Platzer K, Gjermeni E, Lin CC, Lemke JR, Garten A, Schöneberg T, Blüher M, Abou Jamra R, Le Duc D. Phenotype-tissue expression and exploration (PTEE) resource facilitates the choice of tissue for RNA-seq-based clinical genetics studies. BMC Genomics 2021; 22:802. [PMID: 34743696 PMCID: PMC8573933 DOI: 10.1186/s12864-021-08125-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/12/2021] [Accepted: 10/26/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND RNA-seq emerges as a valuable method for clinical genetics. The transcriptome is "dynamic" and tissue-specific, but typically the probed tissues to analyze (TA) are different from the tissue of interest (TI) based on pathophysiology. RESULTS We developed Phenotype-Tissue Expression and Exploration (PTEE), a tool to facilitate the decision about the most suitable TA for RNA-seq. We integrated phenotype-annotated genes, used 54 tissues from GTEx to perform correlation analyses and identify expressed genes and transcripts between TAs and TIs. We identified skeletal muscle as the most appropriate TA to inquire for cardiac arrhythmia genes and skin as a good proxy to study neurodevelopmental disorders. We also explored RNA-seq limitations and show that on-off switching of gene expression during ontogenesis or circadian rhythm can cause blind spots for RNA-seq-based analyses. CONCLUSIONS PTEE aids the identification of tissues suitable for RNA-seq for a given pathology to increase the success rate of diagnosis and gene discovery. PTEE is freely available at https://bioinf.eva.mpg.de/PTEE/.
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Affiliation(s)
- Akhil Velluva
- Department of Evolutionary Genetics, Max Planck Institute for Evolutionary Anthropology, 04103, Leipzig, Germany.
- Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, University of Leipzig, Johannisallee 30, 04103, Leipzig, Germany.
| | - Maximillian Radtke
- Institute of Human Genetics, University Medical Center Leipzig, 04103, Leipzig, Germany
| | - Susanne Horn
- Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, University of Leipzig, Johannisallee 30, 04103, Leipzig, Germany
| | - Bernt Popp
- Institute of Human Genetics, University Medical Center Leipzig, 04103, Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University Medical Center Leipzig, 04103, Leipzig, Germany
| | - Erind Gjermeni
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, 04289, Leipzig, Germany
- Department of Cardiology, Median Centre for Rehabilitation Schmannewitz, 04774, Dahlen, Germany
| | - Chen-Ching Lin
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, 11221, Taiwan
| | - Johannes R Lemke
- Institute of Human Genetics, University Medical Center Leipzig, 04103, Leipzig, Germany
| | - Antje Garten
- Pediatric Research Center, University Hospital for Children and Adolescents, Leipzig University, 04103, Leipzig, Germany
| | - Torsten Schöneberg
- Rudolf Schönheimer Institute of Biochemistry, Medical Faculty, University of Leipzig, Johannisallee 30, 04103, Leipzig, Germany
| | - Matthias Blüher
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, 04103, Leipzig, Germany
| | - Rami Abou Jamra
- Institute of Human Genetics, University Medical Center Leipzig, 04103, Leipzig, Germany
| | - Diana Le Duc
- Department of Evolutionary Genetics, Max Planck Institute for Evolutionary Anthropology, 04103, Leipzig, Germany.
- Institute of Human Genetics, University Medical Center Leipzig, 04103, Leipzig, Germany.
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, 04103, Leipzig, Germany.
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37
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Ahring PK, Liao VWY, Gardella E, Johannesen KM, Krey I, Selmer KK, Stadheim BF, Davis H, Peinhardt C, Koko M, Coorg RK, Syrbe S, Bertsche A, Santiago-Sim T, Diemer T, Fenger CD, Platzer K, Eichler EE, Lerche H, Lemke JR, Chebib M, Møller RS. Gain-of-function variants in GABRD reveal a novel pathway for neurodevelopmental disorders and epilepsy. Brain 2021; 145:1299-1309. [PMID: 34633442 DOI: 10.1093/brain/awab391] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 07/23/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 11/14/2022] Open
Abstract
A potential link between GABRD encoding the δ subunit of extrasynaptic GABAA receptors and neurodevelopmental disorders has largely been disregarded due to conflicting conclusions from early studies. However, we identified seven heterozygous missense GABRD variants in 10 patients with neurodevelopmental disorders and generalized epilepsy. One variant occurred in two sibs of healthy parents with presumed somatic mosaicism, another segregated with the disease in three affected family members, and the remaining five occurred de novo in sporadic patients. Electrophysiological measurements were used to determine the functional consequence of the seven missense δ subunit variants in receptor combinations of α1β3δ and α4β2δ GABAA receptors. This was accompanied by analysis of electro-clinical phenotypes of the affected individuals. We determined that five of the seven variants caused altered function of the resulting α1β3δ and α4β2δ GABAA receptors. Surprisingly, four of the five variants led to gain-of-function effects whereas one led to a loss-of-function effect. The stark differences between the gain-of-function and loss-of function effects were mirrored by the clinical phenotypes. Six patients with gain-of-function variants shared common phenotypes: neurodevelopmental disorders with generalized epilepsy, behavioral issues, and various degrees of intellectual disability. Six patients with gain-of-function variants shared common phenotypes: neurodevelopmental disorders with behavioral issues, various degrees of intellectual disability, generalized epilepsy with atypical absences and generalized myoclonic and/or bilateral tonic-clonic seizures. The EEG showed qualitative analogies among the different gain-of-function variant carriers consisting of focal slowing in the occipital regions often preceding irregular generalized epileptiform discharges, with frontal predominance. In contrast, the one patient carrying a loss-of-function variant had normal intelligence, no seizure history but has a diagnosis of autism spectrum disorder and suffering from elevated internalizing psychiatric symptoms. We hypothesize that increase in tonic GABA-evoked current levels mediated by δ-containing extrasynaptic GABAA receptors lead to abnormal neurotransmission, which represent a novel mechanism for severe neurodevelopmental disorders. In support of this, the electro-clinical findings for the gain-of-function GABRD variants resemble the phenotypic spectrum reported in patients with missense SLC6A1 (GABA uptake transporter) variants. This also indicates that the phenomenon of extrasynaptic receptor over-activity is observed in a broader range of patients with neurodevelopmental disorders, since SLC6A1 loss-of-function variants also lead to overactive extrasynaptic δ-containing GABAA receptors. These findings have implications when selecting potential treatment options, since a substantial portion of available anti-seizure medication act by enhancing GABAergic function either directly or indirectly, which could exacerbate symptoms in patients with gain-of-function GABRD variants.
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Affiliation(s)
- Philip K Ahring
- Brain and Mind Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney; Sydney, New South Wales, Australia
| | - Vivian W Y Liao
- Brain and Mind Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney; Sydney, New South Wales, Australia
| | - Elena Gardella
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Centre; Dianalund, Denmark.,Department of Regional Health Research, University of Southern Denmark; Odense, Denmark
| | - Katrine M Johannesen
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Centre; Dianalund, Denmark.,Department of Regional Health Research, University of Southern Denmark; Odense, Denmark
| | - Ilona Krey
- Institute of Human Genetics, University of Leipzig Medical Center; Leipzig, Germany
| | - Kaja K Selmer
- National Centre for Rare Epilepsy-Related Disorders, Oslo University Hospital; Oslo, Norway.,Department of Medical Genetics, Oslo University Hospital; Oslo, Norway
| | - Barbro F Stadheim
- Department of Medical Genetics, Oslo University Hospital; Oslo, Norway
| | - Hannah Davis
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine; Atlanta, GA, USA
| | - Charlotte Peinhardt
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine; Atlanta, GA, USA
| | - Mahmoud Koko
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen; Tübingen, Germany
| | - Rohini K Coorg
- Department of Pediatrics and Neurology, Neurophysiology and Epilepsy, Baylor College of Medicine; Houston, Texas, USA
| | - Steffen Syrbe
- Division of Paediatric Epileptology, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg; Heidelberg, Germany
| | - Astrid Bertsche
- University Hospital for Children and Adolescents, Neuropaediatrics; Rostock, Germany.,University Hospital for Children and Adolescents, Center for Pediatric Research; Leipzig, Germany
| | | | - Tue Diemer
- Department of Clinical Genetics, Aalborg University Hospital; Aalborg, Denmark
| | - Christina D Fenger
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Centre; Dianalund, Denmark.,Department of Regional Health Research, University of Southern Denmark; Odense, Denmark
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center; Leipzig, Germany
| | - Evan E Eichler
- Department of Genome Sciences, University of Washington School of Medicine; Seattle, WA, USA.,Howard Hughes Medical Institute, University of Washington; Seattle, WA 98195, USA
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen; Tübingen, Germany
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Medical Center; Leipzig, Germany
| | - Mary Chebib
- Brain and Mind Centre, School of Pharmacy, 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; Dianalund, Denmark.,Department of Regional Health Research, University of Southern Denmark; Odense, Denmark
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38
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Ravenscroft TA, Phillips JB, Fieg E, Bajikar SS, Peirce J, Wegner J, Luna AA, Fox EJ, Yan YL, Rosenfeld JA, Zirin J, Kanca O, Benke PJ, Cameron ES, Strehlow V, Platzer K, Jamra RA, Klöckner C, Osmond M, Licata T, Rojas S, Dyment D, Chong JSC, Lincoln S, Stoler JM, Postlethwait JH, Wangler MF, Yamamoto S, Krier J, Westerfield M, Bellen HJ. Heterozygous loss-of-function variants significantly expand the phenotypes associated with loss of GDF11. Genet Med 2021; 23:1889-1900. [PMID: 34113007 PMCID: PMC8487929 DOI: 10.1038/s41436-021-01216-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 01/25/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Growth differentiation factor 11 (GDF11) is a key signaling protein required for proper development of many organ systems. Only one prior study has associated an inherited GDF11 variant with a dominant human disease in a family with variable craniofacial and vertebral abnormalities. Here, we expand the phenotypic spectrum associated with GDF11 variants and document the nature of the variants. METHODS We present a cohort of six probands with de novo and inherited nonsense/frameshift (4/6 patients) and missense (2/6) variants in GDF11. We generated gdf11 mutant zebrafish to model loss of gdf11 phenotypes and used an overexpression screen in Drosophila to test variant functionality. RESULTS Patients with variants in GDF11 presented with craniofacial (5/6), vertebral (5/6), neurological (6/6), visual (4/6), cardiac (3/6), auditory (3/6), and connective tissue abnormalities (3/6). gdf11 mutant zebrafish show craniofacial abnormalities and body segmentation defects that match some patient phenotypes. Expression of the patients' variants in the fly showed that one nonsense variant in GDF11 is a severe loss-of-function (LOF) allele whereas the missense variants in our cohort are partial LOF variants. CONCLUSION GDF11 is needed for human development, particularly neuronal development, and LOF GDF11 alleles can affect the development of numerous organs and tissues.
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Affiliation(s)
- Thomas A Ravenscroft
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children Hospital, Houston, TX, USA
| | | | | | - Sameer S Bajikar
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children Hospital, Houston, TX, USA
| | - Judy Peirce
- Institute of Neuroscience, University of Oregon, Eugene, OR, USA
| | - Jeremy Wegner
- Institute of Neuroscience, University of Oregon, Eugene, OR, USA
| | - Alia A Luna
- Institute of Neuroscience, University of Oregon, Eugene, OR, USA
| | - Eric J Fox
- Institute of Neuroscience, University of Oregon, Eugene, OR, USA
| | - Yi-Lin Yan
- Institute of Neuroscience, University of Oregon, Eugene, OR, USA
| | - Jill A Rosenfeld
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Baylor Genetics Laboratories, Houston, TX, USA
| | - Jonathan Zirin
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Oguz Kanca
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children Hospital, Houston, TX, USA
| | - Paul J Benke
- Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | | | - Vincent Strehlow
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Chiara Klöckner
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Matthew Osmond
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Thomas Licata
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Samantha Rojas
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - David Dyment
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Josephine S C Chong
- The Chinese University of Hong Kong-Baylor College of Medicine Joint Center of Medical Genetics, Hong Kong Special Administrative Region, The People's Republic of China
| | | | | | | | - Michael F Wangler
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children Hospital, Houston, TX, USA
| | - Shinya Yamamoto
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children Hospital, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Joel Krier
- Brigham and Women's Hospital, Boston, MA, USA
| | | | - Hugo J Bellen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.
- Jan and Dan Duncan Neurological Research Institute, Texas Children Hospital, Houston, TX, USA.
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA.
- Howard Hughes Medical Institute, Baylor College of Medicine, Houston, TX, USA.
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Rodan LH, Spillmann RC, Kurata HT, Lamothe SM, Maghera J, Jamra RA, Alkelai A, Antonarakis SE, Atallah I, Bar-Yosef O, Bilan F, Bjorgo K, Blanc X, Van Bogaert P, Bolkier Y, Burrage LC, Christ BU, Granadillo JL, Dickson P, Donald KA, Dubourg C, Eliyahu A, Emrick L, Engleman K, Gonfiantini MV, Good JM, Kalser J, Kloeckner C, Lachmeijer G, Macchiaiolo M, Nicita F, Odent S, O'Heir E, Ortiz-Gonzalez X, Pacio-Miguez M, Palomares-Bralo M, Pena L, Platzer K, Quinodoz M, Ranza E, Rosenfeld JA, Roulet-Perez E, Santani A, Santos-Simarro F, Pode-Shakked B, Skraban C, Slaugh R, Superti-Furga A, Thiffault I, van Jaabrsveld RH, Vincent M, Wang HG, Zacher P, Rush E, Pitt GS, Au PYB, Shashi V. Correction: Phenotypic expansion of CACNA1C-associated disorders to include isolated neurological manifestations. Genet Med 2021; 23:2016. [PMID: 34522029 DOI: 10.1038/s41436-021-01306-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Lance H Rodan
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Rebecca C Spillmann
- Division of Medical Genetics, Department of Pediatrics, Duke Health, Durham, NC, USA
| | - Harley T Kurata
- Department of Pharmacology, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
| | - Shawn M Lamothe
- Department of Pharmacology, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
| | - Jasmine Maghera
- Department of Pharmacology, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Anna Alkelai
- Institute for Genomic Medicine, Columbia University Medical Center, New York, NY, USA
| | | | - Isis Atallah
- Division of Genetic Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Omer Bar-Yosef
- Pediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hahsomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Frédéric Bilan
- CHU de Poitiers, Service de Génétique, EA3808 NEUVACOD, Poitiers, France
| | - Kathrine Bjorgo
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Xavier Blanc
- Medigenome, Swiss Institute of Genomic Medicine, Geneva, Switzerland
| | | | - Yoav Bolkier
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Cardiology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hahsomer, Israel
| | - Lindsay C Burrage
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Björn U Christ
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, SA, South Africa
| | - Jorge L Granadillo
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Patricia Dickson
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, SA, South Africa
| | - Christèle Dubourg
- Service de Génétique Moléculaire et Génomique, CHU, Rennes, France
- University of Rennes, CNRS, IGDR, UMR 6290, Rennes, France
| | - Aviva Eliyahu
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Danek Gertner Insitute of Human Genetics, Sheba Medical Center, Tel-Hahsomer, Israel
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hahsomer, Israel
| | - Lisa Emrick
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Kendra Engleman
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, MO, USA
| | | | - Jean-Marc Good
- Pediatric Neurology, Lausanne University Hospital, Lausanne, Switzerland
| | - Judith Kalser
- Pediatric Neurology, Lausanne University Hospital, Lausanne, Switzerland
| | - Chiara Kloeckner
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Guus Lachmeijer
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marina Macchiaiolo
- Rare Diseases and Medical Genetic Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Nicita
- Unit of Neuromuscular and Neurodegenerative Diseases, Department of Neurosciences and Neurorehabilitation, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Sylvie Odent
- Service de Génétique Clinique, Centre de référence "Maladies Rares" Anomalies du développement CLAD-Ouest, Hôpital SUD, Échirolles, France
| | - Emily O'Heir
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Center for Mendelian Genomics and Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Xilma Ortiz-Gonzalez
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marta Pacio-Miguez
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, CIBERER, ISCIII, Madrid, Spain
| | - María Palomares-Bralo
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, CIBERER, ISCIII, Madrid, Spain
| | - Loren Pena
- Cincinnati Children's Hospital and Medical Center Cincinnati, Cincinnati, OH, USA
- University of Cincinnati College of Medicine Cincinnati, Cincinnati, OH, USA
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Mathieu Quinodoz
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Emmanuelle Ranza
- Medigenome, Swiss Institute of Genomic Medicine, Geneva, Switzerland
| | - Jill A Rosenfeld
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | | | - Avni Santani
- Division of Genomic Diagnostics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Fernando Santos-Simarro
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, CIBERER, ISCIII, Madrid, Spain
| | - Ben Pode-Shakked
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Institute of Rare Diseases, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hahsomer, Israel
| | - Cara Skraban
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel Slaugh
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | - Isabelle Thiffault
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, MO, USA
| | | | - Marie Vincent
- Service de Génétique Médicale, CHU Nantes, France; Inserm, CNRS, Univ Nantes, l'institut du thorax, Nantes, France
| | - Hong-Gang Wang
- Cardiovascular Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Pia Zacher
- The Saxon Epilepsy Center Kleinwachau, Radeberg, Germany
| | - Eric Rush
- The Children's Mercy Hospital, Kansas City, MO, USA
- Department of Pediatrics University of Missouri-Kansas City, Kansas City, MO, USA
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, USA
| | - Geoffrey S Pitt
- Cardiovascular Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Ping Yee Billie Au
- Alberta Children's Hospital Research Institute, Department of Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Vandana Shashi
- Division of Medical Genetics, Department of Pediatrics, Duke Health, Durham, NC, USA.
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40
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Rodan LH, Spillmann RC, Kurata HT, Lamothe SM, Maghera J, Jamra RA, Alkelai A, Antonarakis SE, Atallah I, Bar-Yosef O, Bilan F, Bjorgo K, Blanc X, Van Bogaert P, Bolkier Y, Burrage LC, Christ BU, Granadillo JL, Dickson P, Donald KA, Dubourg C, Eliyahu A, Emrick L, Engleman K, Gonfiantini MV, Good JM, Kalser J, Kloeckner C, Lachmeijer G, Macchiaiolo M, Nicita F, Odent S, O'Heir E, Ortiz-Gonzalez X, Pacio-Miguez M, Palomares-Bralo M, Pena L, Platzer K, Quinodoz M, Ranza E, Rosenfeld JA, Roulet-Perez E, Santani A, Santos-Simarro F, Pode-Shakked B, Skraban C, Slaugh R, Superti-Furga A, Thiffault I, van Jaabrsveld RH, Vincent M, Wang HG, Zacher P, Rush E, Pitt GS, Au PYB, Shashi V. Phenotypic expansion of CACNA1C-associated disorders to include isolated neurological manifestations. Genet Med 2021; 23:1922-1932. [PMID: 34163037 PMCID: PMC8488020 DOI: 10.1038/s41436-021-01232-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/09/2020] [Accepted: 05/14/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE CACNA1C encodes the alpha-1-subunit of a voltage-dependent L-type calcium channel expressed in human heart and brain. Heterozygous variants in CACNA1C have previously been reported in association with Timothy syndrome and long QT syndrome. Several case reports have suggested that CACNA1C variation may also be associated with a primarily neurological phenotype. METHODS We describe 25 individuals from 22 families with heterozygous variants in CACNA1C, who present with predominantly neurological manifestations. RESULTS Fourteen individuals have de novo, nontruncating variants and present variably with developmental delays, intellectual disability, autism, hypotonia, ataxia, and epilepsy. Functional studies of a subgroup of missense variants via patch clamp experiments demonstrated differential effects on channel function in vitro, including loss of function (p.Leu1408Val), neutral effect (p.Leu614Arg), and gain of function (p.Leu657Phe, p.Leu614Pro). The remaining 11 individuals from eight families have truncating variants in CACNA1C. The majority of these individuals have expressive language deficits, and half have autism. CONCLUSION We expand the phenotype associated with CACNA1C variants to include neurodevelopmental abnormalities and epilepsy, in the absence of classic features of Timothy syndrome or long QT syndrome.
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Affiliation(s)
- Lance H Rodan
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Rebecca C Spillmann
- Division of Medical Genetics, Department of Pediatrics, Duke Health, Durham, NC, USA
| | - Harley T Kurata
- Department of Pharmacology, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
| | - Shawn M Lamothe
- Department of Pharmacology, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
| | - Jasmine Maghera
- Department of Pharmacology, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Anna Alkelai
- Institute for Genomic Medicine, Columbia University Medical Center, New York, NY, USA
| | | | - Isis Atallah
- Division of Genetic Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Omer Bar-Yosef
- Pediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hahsomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Frédéric Bilan
- CHU de Poitiers, Service de Génétique, EA3808 NEUVACOD, Poitiers, France
| | - Kathrine Bjorgo
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Xavier Blanc
- Medigenome, Swiss Institute of Genomic Medicine, Geneva, Switzerland
| | | | - Yoav Bolkier
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Cardiology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hahsomer, Israel
| | - Lindsay C Burrage
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Björn U Christ
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, SA, South Africa
| | - Jorge L Granadillo
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Patricia Dickson
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, SA, South Africa
| | - Christèle Dubourg
- Service de Génétique Moléculaire et Génomique, CHU, Rennes, France
- University of Rennes, CNRS, IGDR, UMR 6290, Rennes, France
| | - Aviva Eliyahu
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Danek Gertner Insitute of Human Genetics, Sheba Medical Center, Tel-Hahsomer, Israel
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hahsomer, Israel
| | - Lisa Emrick
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Kendra Engleman
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, MO, USA
| | | | - Jean-Marc Good
- Pediatric Neurology, Lausanne University Hospital, Lausanne, Switzerland
| | - Judith Kalser
- Pediatric Neurology, Lausanne University Hospital, Lausanne, Switzerland
| | - Chiara Kloeckner
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Guus Lachmeijer
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marina Macchiaiolo
- Rare Diseases and Medical Genetic Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Nicita
- Unit of Neuromuscular and Neurodegenerative Diseases, Department of Neurosciences and Neurorehabilitation, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Sylvie Odent
- Service de Génétique Clinique, Centre de référence "Maladies Rares" Anomalies du développement CLAD-Ouest, Hôpital SUD, Échirolles, France
| | - Emily O'Heir
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Center for Mendelian Genomics and Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Xilma Ortiz-Gonzalez
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marta Pacio-Miguez
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, CIBERER, ISCIII, Madrid, Spain
| | - María Palomares-Bralo
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, CIBERER, ISCIII, Madrid, Spain
| | - Loren Pena
- Cincinnati Children's Hospital and Medical Center Cincinnati, Cincinnati, OH, USA
- University of Cincinnati College of Medicine Cincinnati, Cincinnati, OH, USA
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Mathieu Quinodoz
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Emmanuelle Ranza
- Medigenome, Swiss Institute of Genomic Medicine, Geneva, Switzerland
| | - Jill A Rosenfeld
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | | | - Avni Santani
- Division of Genomic Diagnostics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Fernando Santos-Simarro
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPAZ, CIBERER, ISCIII, Madrid, Spain
| | - Ben Pode-Shakked
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Institute of Rare Diseases, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hahsomer, Israel
| | - Cara Skraban
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel Slaugh
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | - Isabelle Thiffault
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, Kansas City, MO, USA
| | | | - Marie Vincent
- Service de Génétique Médicale, CHU Nantes, France; Inserm, CNRS, Univ Nantes, l'institut du thorax, Nantes, France
| | - Hong-Gang Wang
- Cardiovascular Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Pia Zacher
- The Saxon Epilepsy Center Kleinwachau, Radeberg, Germany
| | - Eric Rush
- The Children's Mercy Hospital, Kansas City, MO, USA
- Department of Pediatrics University of Missouri-Kansas City, Kansas City, MO, USA
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, MO, USA
| | - Geoffrey S Pitt
- Cardiovascular Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Ping Yee Billie Au
- Alberta Children's Hospital Research Institute, Department of Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Vandana Shashi
- Division of Medical Genetics, Department of Pediatrics, Duke Health, Durham, NC, USA.
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Dworschak GC, Punetha J, Kalanithy JC, Mingardo E, Erdem HB, Akdemir ZC, Karaca E, Mitani T, Marafi D, Fatih JM, Jhangiani SN, Hunter JV, Dakal TC, Dhabhai B, Dabbagh O, Alsaif HS, Alkuraya FS, Maroofian R, Houlden H, Efthymiou S, Dominik N, Salpietro V, Sultan T, Haider S, Bibi F, Thiele H, Hoefele J, Riedhammer KM, Wagner M, Guella I, Demos M, Keren B, Buratti J, Charles P, Nava C, Héron D, Heide S, Valkanas E, Waddell LB, Jones KJ, Oates EC, Cooper ST, MacArthur D, Syrbe S, Ziegler A, Platzer K, Okur V, Chung WK, O'Shea SA, Alcalay R, Fahn S, Mark PR, Guerrini R, Vetro A, Hudson B, Schnur RE, Hoganson GE, Burton JE, McEntagart M, Lindenberg T, Yilmaz Ö, Odermatt B, Pehlivan D, Posey JE, Lupski JR, Reutter H. Biallelic and monoallelic variants in PLXNA1 are implicated in a novel neurodevelopmental disorder with variable cerebral and eye anomalies. Genet Med 2021; 23:1715-1725. [PMID: 34054129 PMCID: PMC8460429 DOI: 10.1038/s41436-021-01196-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 09/02/2020] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the effect of PLXNA1 variants on the phenotype of patients with autosomal dominant and recessive inheritance patterns and to functionally characterize the zebrafish homologs plxna1a and plxna1b during development. METHODS We assembled ten patients from seven families with biallelic or de novo PLXNA1 variants. We describe genotype-phenotype correlations, investigated the variants by structural modeling, and used Morpholino knockdown experiments in zebrafish to characterize the embryonic role of plxna1a and plxna1b. RESULTS Shared phenotypic features among patients include global developmental delay (9/10), brain anomalies (6/10), and eye anomalies (7/10). Notably, seizures were predominantly reported in patients with monoallelic variants. Structural modeling of missense variants in PLXNA1 suggests distortion in the native protein. Our zebrafish studies enforce an embryonic role of plxna1a and plxna1b in the development of the central nervous system and the eye. CONCLUSION We propose that different biallelic and monoallelic variants in PLXNA1 result in a novel neurodevelopmental syndrome mainly comprising developmental delay, brain, and eye anomalies. We hypothesize that biallelic variants in the extracellular Plexin-A1 domains lead to impaired dimerization or lack of receptor molecules, whereas monoallelic variants in the intracellular Plexin-A1 domains might impair downstream signaling through a dominant-negative effect.
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Affiliation(s)
- Gabriel C Dworschak
- Institute of Human Genetics, Medical Faculty, University of Bonn, Bonn, Germany.
- Institute of Anatomy and Cell Biology, Medical Faculty, University of Bonn, Bonn, Germany.
- Department of Pediatrics, University Hospital Bonn, Bonn, Germany.
| | - Jaya Punetha
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeshurun C Kalanithy
- Institute of Human Genetics, Medical Faculty, University of Bonn, Bonn, Germany
- Institute of Anatomy and Cell Biology, Medical Faculty, University of Bonn, Bonn, Germany
| | - Enrico Mingardo
- Institute of Human Genetics, Medical Faculty, University of Bonn, Bonn, Germany
- Institute of Anatomy and Cell Biology, Medical Faculty, University of Bonn, Bonn, Germany
| | - Haktan B Erdem
- Department of Medical Genetics, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Zeynep C Akdemir
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Ender Karaca
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tadahiro Mitani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Dana Marafi
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Jawid M Fatih
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Shalini N Jhangiani
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Jill V Hunter
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Tikam Chand Dakal
- Genome and Computational Biology Lab, Department of Biotechnology, Mohanlal Sukhadia University, Udaipur, Rajasthan, India
| | - Bhanupriya Dhabhai
- Genome and Computational Biology Lab, Department of Biotechnology, Mohanlal Sukhadia University, Udaipur, Rajasthan, India
| | - Omar Dabbagh
- Department of Neuroscience, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hessa S Alsaif
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Fowzan S Alkuraya
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Department of Anatomy and Cell Biology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Reza Maroofian
- Department of Neuromuscular Disorders, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Henry Houlden
- Department of Neuromuscular Disorders, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Stephanie Efthymiou
- Department of Neuromuscular Disorders, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Natalia Dominik
- Department of Neuromuscular Disorders, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Vincenzo Salpietro
- Department of Neuromuscular Disorders, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Tipu Sultan
- Department of Pediatric Neurology, Institute of Child Health, The Children's Hospital Lahore, Lahore, Pakistan
| | - Shahzad Haider
- Department of Paediatric Medicine, Wah Medical College, Rawalpindi, Pakistan
| | - Farah Bibi
- University Institute of Biochemistry & Biotechnology, PMAS - Arid Agriculture University, Rawalpindi, Pakistan
| | - Holger Thiele
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Julia Hoefele
- Institute of Human Genetics, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Korbinian M Riedhammer
- Institute of Human Genetics, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Nephrology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Matias Wagner
- Institute of Human Genetics, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Neurogenomics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Ilaria Guella
- Department of Medical Genetics, Centre for Applied Neurogenetics, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Demos
- Division of Neurology, Department of Pediatrics, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
| | - Boris Keren
- AP-HP, Hôpital Pitié-Salpêtrière, Département de Génétique, Paris, France
| | - Julien Buratti
- AP-HP, Hôpital Pitié-Salpêtrière, Département de Génétique, Paris, France
| | - Perrine Charles
- AP-HP, Hôpital Pitié-Salpêtrière, Département de Génétique, Paris, France
| | - Caroline Nava
- AP-HP, Hôpital Pitié-Salpêtrière, Département de Génétique, Paris, France
- Institut du Cerveau et de la Moelle épinière, Sorbonne Université, UMR S 1127, Inserm U1127, CNRS UMR 7225, Paris, France
| | - Delphine Héron
- AP-HP, Hôpital Pitié-Salpêtrière, Département de Génétique, Paris, France
| | - Solveig Heide
- AP-HP, Hôpital Pitié-Salpêtrière, Département de Génétique, Paris, France
| | - Elise Valkanas
- Center for Mendelian Genomics, The Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Leigh B Waddell
- Kids Neuroscience Centre, Kids Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Kristi J Jones
- Kids Neuroscience Centre, Kids Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Emily C Oates
- Kids Neuroscience Centre, Kids Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
- School of Biotechnology and Biomolecular Sciences, Faculty of Science, The University of New South Wales, Sydney, NSW, Australia
| | - Sandra T Cooper
- Kids Neuroscience Centre, Kids Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Children's Medical Research Institute, Westmead, NSW, Australia
| | - Daniel MacArthur
- Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Steffen Syrbe
- Division of Pediatric Epileptology, Centre for Paediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Ziegler
- Division of Pediatric Neurology and Metabolic Medicine, Centre for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Volkan Okur
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Wendy K Chung
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Sarah A O'Shea
- Department of Neurology, Columbia University, New York, NY, USA
| | - Roy Alcalay
- Department of Neurology, Columbia University, New York, NY, USA
| | - Stanley Fahn
- Department of Neurology, Columbia University, New York, NY, USA
| | - Paul R Mark
- Division of Medical Genetics, Helen DeVos Children's Hospital Grand Rapids, New York, MI, USA
| | - Renzo Guerrini
- Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Annalisa Vetro
- Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | | | | | - George E Hoganson
- Department of Pediatrics, University of Illinois, College of Medicine, Chicago, IL, USA
| | - Jennifer E Burton
- Department of Pediatrics, University of Illinois, College of Medicine, Peoria, IL, USA
| | - Meriel McEntagart
- South West Thames Regional Genetics Centre, St. George's Healthcare NHS Trust, St. George's, University of London, London, United Kingdom
| | - Tobias Lindenberg
- Institute of Neuroanatomy, Medical Faculty, University of Bonn, Bonn, Germany
| | - Öznur Yilmaz
- Institute of Anatomy and Cell Biology, Medical Faculty, University of Bonn, Bonn, Germany
| | - Benjamin Odermatt
- Institute of Anatomy and Cell Biology, Medical Faculty, University of Bonn, Bonn, Germany
- Institute of Neuroanatomy, Medical Faculty, University of Bonn, Bonn, Germany
| | - Davut Pehlivan
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Section of Neurology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer E Posey
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - James R Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Heiko Reutter
- Institute of Human Genetics, Medical Faculty, University of Bonn, Bonn, Germany
- Department of Neonatology and Pediatric Intensive Care, University Hospital Bonn, Bonn, Germany
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Duncan AR, Polovitskaya MM, Gaitán-Peñas H, Bertelli S, VanNoy GE, Grant PE, O’Donnell-Luria A, Valivullah Z, Lovgren AK, England EM, Agolini E, Madden JA, Schmitz-Abe K, Kritzer A, Hawley P, Novelli A, Alfieri P, Colafati GS, Wieczorek D, Platzer K, Luppe J, Koch-Hogrebe M, Abou Jamra R, Neira-Fresneda J, Lehman A, Boerkoel CF, Seath K, Clarke L, van Ierland Y, Argilli E, Sherr EH, Maiorana A, Diel T, Hempel M, Bierhals T, Estévez R, Jentsch TJ, Pusch M, Agrawal PB, Agrawal PB. Unique variants in CLCN3, encoding an endosomal anion/proton exchanger, underlie a spectrum of neurodevelopmental disorders. Am J Hum Genet 2021; 108:1450-1465. [PMID: 34186028 DOI: 10.1016/j.ajhg.2021.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 01/15/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022] Open
Abstract
The genetic causes of global developmental delay (GDD) and intellectual disability (ID) are diverse and include variants in numerous ion channels and transporters. Loss-of-function variants in all five endosomal/lysosomal members of the CLC family of Cl- channels and Cl-/H+ exchangers lead to pathology in mice, humans, or both. We have identified nine variants in CLCN3, the gene encoding CIC-3, in 11 individuals with GDD/ID and neurodevelopmental disorders of varying severity. In addition to a homozygous frameshift variant in two siblings, we identified eight different heterozygous de novo missense variants. All have GDD/ID, mood or behavioral disorders, and dysmorphic features; 9/11 have structural brain abnormalities; and 6/11 have seizures. The homozygous variants are predicted to cause loss of ClC-3 function, resulting in severe neurological disease similar to the phenotype observed in Clcn3-/- mice. Their MRIs show possible neurodegeneration with thin corpora callosa and decreased white matter volumes. Individuals with heterozygous variants had a range of neurodevelopmental anomalies including agenesis of the corpus callosum, pons hypoplasia, and increased gyral folding. To characterize the altered function of the exchanger, electrophysiological analyses were performed in Xenopus oocytes and mammalian cells. Two variants, p.Ile607Thr and p.Thr570Ile, had increased currents at negative cytoplasmic voltages and loss of inhibition by luminal acidic pH. In contrast, two other variants showed no significant difference in the current properties. Overall, our work establishes a role for CLCN3 in human neurodevelopment and shows that both homozygous loss of ClC-3 and heterozygous variants can lead to GDD/ID and neuroanatomical abnormalities.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pankaj B Agrawal
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, MA 02115, USA; The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA 02115, USA; Division of Genetics & Genomics, Department of Pediatrics, Boston Children's Hospital, MA 02115, USA.
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43
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Chopra M, McEntagart M, Clayton-Smith J, Platzer K, Shukla A, Girisha KM, Kaur A, Kaur P, Pfundt R, Veenstra-Knol H, Mancini GM, Cappuccio G, Brunetti-Pierri N, Kortüm F, Hempel M, Denecke J, Lehman A, Kleefstra T, Stuurman KE, Wilke M, Thompson ML, Bebin EM, Bijlsma EK, Hoffer MJ, Peeters-Scholte C, Slavotinek A, Weiss WA, Yip T, Hodoglugil U, Whittle A, diMonda J, Neira J, Yang S, Kirby A, Pinz H, Lechner R, Sleutels F, Helbig I, McKeown S, Helbig K, Willaert R, Juusola J, Semotok J, Hadonou M, Short J, Yachelevich N, Lala S, Fernández-Jaen A, Pelayo JP, Klöckner C, Kamphausen SB, Abou Jamra R, Arelin M, Innes AM, Niskakoski A, Amin S, Williams M, Evans J, Smithson S, Smedley D, de Burca A, Kini U, Delatycki MB, Gallacher L, Yeung A, Pais L, Field M, Martin E, Charles P, Courtin T, Keren B, Iascone M, Cereda A, Poke G, Abadie V, Chalouhi C, Parthasarathy P, Halliday BJ, Robertson SP, Lyonnet S, Amiel J, Gordon CT, Amiel J, Gordon CT. Heterozygous ANKRD17 loss-of-function variants cause a syndrome with intellectual disability, speech delay, and dysmorphism. Am J Hum Genet 2021; 108:1138-1150. [PMID: 33909992 DOI: 10.1016/j.ajhg.2021.04.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/05/2021] [Indexed: 01/02/2023] Open
Abstract
ANKRD17 is an ankyrin repeat-containing protein thought to play a role in cell cycle progression, whose ortholog in Drosophila functions in the Hippo pathway as a co-factor of Yorkie. Here, we delineate a neurodevelopmental disorder caused by de novo heterozygous ANKRD17 variants. The mutational spectrum of this cohort of 34 individuals from 32 families is highly suggestive of haploinsufficiency as the underlying mechanism of disease, with 21 truncating or essential splice site variants, 9 missense variants, 1 in-frame insertion-deletion, and 1 microdeletion (1.16 Mb). Consequently, our data indicate that loss of ANKRD17 is likely the main cause of phenotypes previously associated with large multi-gene chromosomal aberrations of the 4q13.3 region. Protein modeling suggests that most of the missense variants disrupt the stability of the ankyrin repeats through alteration of core structural residues. The major phenotypic characteristic of our cohort is a variable degree of developmental delay/intellectual disability, particularly affecting speech, while additional features include growth failure, feeding difficulties, non-specific MRI abnormalities, epilepsy and/or abnormal EEG, predisposition to recurrent infections (mostly bacterial), ophthalmological abnormalities, gait/balance disturbance, and joint hypermobility. Moreover, many individuals shared similar dysmorphic facial features. Analysis of single-cell RNA-seq data from the developing human telencephalon indicated ANKRD17 expression at multiple stages of neurogenesis, adding further evidence to the assertion that damaging ANKRD17 variants cause a neurodevelopmental disorder.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jeanne Amiel
- Département de Génétique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris (AP-HP), and Institut Imagine, Paris 75015, France; Laboratory of embryology and genetics of human malformations, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Institut Imagine, Université de Paris, Paris 75015, France
| | - Christopher T Gordon
- Laboratory of embryology and genetics of human malformations, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1163, Institut Imagine, Université de Paris, Paris 75015, France.
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44
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Zarate YA, Uehara T, Abe K, Oginuma M, Harako S, Ishitani S, Lehesjoki AE, Bierhals T, Kloth K, Ehmke N, Horn D, Holtgrewe M, Anderson K, Viskochil D, Edgar-Zarate CL, Sacoto MJG, Schnur RE, Morrow MM, Sanchez-Valle A, Pappas J, Rabin R, Muona M, Anttonen AK, Platzer K, Luppe J, Gburek-Augustat J, Kaname T, Okamoto N, Mizuno S, Kaido Y, Ohkuma Y, Hirose Y, Ishitani T, Kosaki K. CDK19-related disorder results from both loss-of-function and gain-of-function de novo missense variants. Genet Med 2021; 23:1050-1057. [PMID: 33495529 DOI: 10.1038/s41436-020-01091-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/19/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To expand the recent description of a new neurodevelopmental syndrome related to alterations in CDK19. METHODS Individuals were identified through international collaboration. Functional studies included autophosphorylation assays for CDK19 Gly28Arg and Tyr32His variants and in vivo zebrafish assays of the CDK19G28R and CDK19Y32H. RESULTS We describe 11 unrelated individuals (age range: 9 months to 14 years) with de novo missense variants mapped to the kinase domain of CDK19, including two recurrent changes at residues Tyr32 and Gly28. In vitro autophosphorylation and substrate phosphorylation assays revealed that kinase activity of protein was lower for p.Gly28Arg and higher for p.Tyr32His substitutions compared with that of the wild-type protein. Injection of CDK19 messenger RNA (mRNA) with either the Tyr32His or the Gly28Arg variants using in vivo zebrafish model significantly increased fraction of embryos with morphological abnormalities. Overall, the phenotype of the now 14 individuals with CDK19-related disorder includes universal developmental delay and facial dysmorphism, hypotonia (79%), seizures (64%), ophthalmologic anomalies (64%), and autism/autistic traits (56%). CONCLUSION CDK19 de novo missense variants are responsible for a novel neurodevelopmental disorder. Both kinase assay and zebrafish experiments showed that the pathogenetic mechanism may be more diverse than previously thought.
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Affiliation(s)
- Yuri A Zarate
- Section of Genetics and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Tomoko Uehara
- Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan
| | - Kota Abe
- Department of Homeostatic Regulation, Division of Cellular and Molecular Biology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan
| | - Masayuki Oginuma
- Department of Homeostatic Regulation, Division of Cellular and Molecular Biology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan
| | - Sora Harako
- Laboratory of Gene Regulation, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Shizuka Ishitani
- Department of Homeostatic Regulation, Division of Cellular and Molecular Biology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan
| | | | - Tatjana Bierhals
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katja Kloth
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nadja Ehmke
- Institute of Medical and Human Genetics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Denise Horn
- Institute of Medical and Human Genetics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Manuel Holtgrewe
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- Core Unit Bioinformatics - CUBI, Berlin Institute of Health, Berlin, Germany
| | - Katherine Anderson
- Department of Pediatrics, University of Vermont Medical Center, Burlington, VT, USA
| | - David Viskochil
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | | | | | | | | | - Amarilis Sanchez-Valle
- Division of Genetics and Metabolism, Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - John Pappas
- NYU Grossman School of Medicine, Dept of Pediatrics, Clinical Genetic Services, New York, NY, USA
| | - Rachel Rabin
- NYU Grossman School of Medicine, Dept of Pediatrics, Clinical Genetic Services, New York, NY, USA
| | - Mikko Muona
- Folkhälsan Research Center and University of Helsinki, Helsinki, Finland
- Blueprint Genetics, Helsinki, Finland
| | - Anna-Kaisa Anttonen
- Folkhälsan Research Center and University of Helsinki, Helsinki, Finland
- Department of Genetics, HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Johannes Luppe
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Janina Gburek-Augustat
- Division of Neuropaediatrics, Hospital for Children and Adolescents, University Leipzig, Leipzig, Germany
| | - Tadashi Kaname
- Department of Genome Medicine, National Center for Child Health and Developemt, Tokyo, Japan
| | - Nobuhiko Okamoto
- Department of Medical Genetics, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Seiji Mizuno
- Department of Clinical Genetics, Central Hospital, Aichi Developmental Disability Center, Aichi, Japan
| | - Yusaku Kaido
- Laboratory of Gene Regulation, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Yoshiaki Ohkuma
- Laboratory of Gene Regulation, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Yutaka Hirose
- Laboratory of Gene Regulation, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Tohru Ishitani
- Department of Homeostatic Regulation, Division of Cellular and Molecular Biology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan
| | - Kenjiro Kosaki
- Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan
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45
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Kour S, Rajan DS, Fortuna TR, Anderson EN, Ward C, Lee Y, Lee S, Shin YB, Chae JH, Choi M, Siquier K, Cantagrel V, Amiel J, Stolerman ES, Barnett SS, Cousin MA, Castro D, McDonald K, Kirmse B, Nemeth AH, Rajasundaram D, Innes AM, Lynch D, Frosk P, Collins A, Gibbons M, Yang M, Desguerre I, Boddaert N, Gitiaux C, Rydning SL, Selmer KK, Urreizti R, Garcia-Oguiza A, Osorio AN, Verdura E, Pujol A, McCurry HR, Landers JE, Agnihotri S, Andriescu EC, Moody SB, Phornphutkul C, Sacoto MJG, Begtrup A, Houlden H, Kirschner J, Schorling D, Rudnik-Schöneborn S, Strom TM, Leiz S, Juliette K, Richardson R, Yang Y, Zhang Y, Wang M, Wang J, Wang X, Platzer K, Donkervoort S, Bönnemann CG, Wagner M, Issa MY, Elbendary HM, Stanley V, Maroofian R, Gleeson JG, Zaki MS, Senderek J, Pandey UB. Loss of function mutations in GEMIN5 cause a neurodevelopmental disorder. Nat Commun 2021; 12:2558. [PMID: 33963192 PMCID: PMC8105379 DOI: 10.1038/s41467-021-22627-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 10/15/2020] [Accepted: 03/19/2021] [Indexed: 02/01/2023] Open
Abstract
GEMIN5, an RNA-binding protein is essential for assembly of the survival motor neuron (SMN) protein complex and facilitates the formation of small nuclear ribonucleoproteins (snRNPs), the building blocks of spliceosomes. Here, we have identified 30 affected individuals from 22 unrelated families presenting with developmental delay, hypotonia, and cerebellar ataxia harboring biallelic variants in the GEMIN5 gene. Mutations in GEMIN5 perturb the subcellular distribution, stability, and expression of GEMIN5 protein and its interacting partners in patient iPSC-derived neurons, suggesting a potential loss-of-function mechanism. GEMIN5 mutations result in disruption of snRNP complex assembly formation in patient iPSC neurons. Furthermore, knock down of rigor mortis, the fly homolog of human GEMIN5, leads to developmental defects, motor dysfunction, and a reduced lifespan. Interestingly, we observed that GEMIN5 variants disrupt a distinct set of transcripts and pathways as compared to SMA patient neurons, suggesting different molecular pathomechanisms. These findings collectively provide evidence that pathogenic variants in GEMIN5 perturb physiological functions and result in a neurodevelopmental delay and ataxia syndrome.
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Affiliation(s)
- Sukhleen Kour
- Department of Pediatrics, Childrens Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Deepa S Rajan
- Department of Pediatrics, Childrens Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tyler R Fortuna
- Department of Pediatrics, Childrens Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Eric N Anderson
- Department of Pediatrics, Childrens Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Caroline Ward
- Department of Pediatrics, Childrens Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Youngha Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sangmoon Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong Beom Shin
- Department of Rehabilitative Medicine, Pusan National University School of Medicine, Pusan, Republic of Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Murim Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Karine Siquier
- Developmental Brain Disorders Laboratory, Paris University, Imagine Institute, INSERM UMR, Paris, France
| | - Vincent Cantagrel
- Developmental Brain Disorders Laboratory, Paris University, Imagine Institute, INSERM UMR, Paris, France
| | - Jeanne Amiel
- Department of Genetics, AP-HP, Necker Enfants Malades Hospital, Paris University, Imagine Institute, Paris, France
| | | | - Sarah S Barnett
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Margot A Cousin
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Diana Castro
- Department of Pediatrics and Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Brian Kirmse
- Division of Genetics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Andrea H Nemeth
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Centre for Genomic Medicine, Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK
| | - Dhivyaa Rajasundaram
- Department of Pediatrics, Division of Health Informatics, Childrens Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - A Micheil Innes
- Department of Medical Genetics and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Danielle Lynch
- Department of Medical Genetics and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Patrick Frosk
- Department of Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Abigail Collins
- Department of Pediatrics and Neurology, Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Melissa Gibbons
- Department of Pediatrics and Neurology, Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michele Yang
- Department of Pediatrics and Neurology, Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Isabelle Desguerre
- Department of Pediatric Neurology, AP-HP, Necker Enfants Malades Hospital, Paris University Imagine Institute, Paris, France
| | - Nathalie Boddaert
- Department of Pediatric Radiology, AP-HP, Necker Enfants Malades Hospital, Paris University Imagine Institute, Paris, France
| | - Cyril Gitiaux
- Department of Pediatric Neurophysiology AP-HP, Necker Enfants Malades Hospital, Paris University, Paris, France
| | | | - Kaja K Selmer
- Department of Research and Development, Division of Neuroscience, Oslo University Hospital and the University of Oslo, Oslo, Norway
| | - Roser Urreizti
- Department of Clinical Biochemistry, Institut de Recerca Sant Joan de Déu and CIBERER, Barcelona, Spain
| | | | | | - Edgard Verdura
- Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Aurora Pujol
- Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Hannah R McCurry
- Center for Mendelian Genomics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - John E Landers
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sameer Agnihotri
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - E Corina Andriescu
- Department of Pediatrics, University of Texas Health Science Center, Houston, TX, USA
| | - Shade B Moody
- Department of Pediatrics, University of Texas Health Science Center, Houston, TX, USA
| | - Chanika Phornphutkul
- Department of Pediatrics, Division of Human Genetics, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders, Medical Center,, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David Schorling
- Department of Neuropediatrics and Muscle Disorders, Medical Center,, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Tim M Strom
- Institute of Human Genetics, Faculty of Medicine, Technical University Munich, Munich, Germany
| | - Steffen Leiz
- Clinic for Children and Adolescents Dritter Orden, Divison of Neuropediatrics, Munchen, Germany
| | - Kali Juliette
- Department of Neurology, Gillette Children's Specialty Healthcare, St Paul, MN, USA
| | - Randal Richardson
- Department of Neurology, Gillette Children's Specialty Healthcare, St Paul, MN, USA
| | - Ying Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yuehua Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Minghui Wang
- The First People's Hospital of Changde City, Hunan, China
| | | | | | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Sandra Donkervoort
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Carsten G Bönnemann
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Matias Wagner
- Institute of Human Genetics, Klinikum rechts der IsarTechnical, University of Munich, Munich, Germany
| | - Mahmoud Y Issa
- Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - Hasnaa M Elbendary
- Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - Valentina Stanley
- Departments of Neurosciences and Pediatrics, Rady Children's Institute for Genomic Medicine, Howard Hughes Medical Institute, University of California, San Diego, La Jolla, CA, USA
| | - Reza Maroofian
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Joseph G Gleeson
- Departments of Neurosciences and Pediatrics, Rady Children's Institute for Genomic Medicine, Howard Hughes Medical Institute, University of California, San Diego, La Jolla, CA, USA
| | - Maha S Zaki
- Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - Jan Senderek
- Department of Neurology, Friedrich-Baur-Institute, University Hospital, LMU Munich, Munich, Germany
| | - Udai Bhan Pandey
- Department of Pediatrics, Childrens Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
- Children's Neuroscience Institute, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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46
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Muir AM, Gardner JF, van Jaarsveld RH, de Lange IM, van der Smagt JJ, Wilson GN, Dubbs H, Goldberg EM, Zitano L, Bupp C, Martinez J, Srour M, Accogli A, Alhakeem A, Meltzer M, Gropman A, Brewer C, Caswell RC, Montgomery T, McKenna C, McKee S, Powell C, Vasudevan PC, Brady AF, Joss S, Tysoe C, Noh G, Tarnopolsky M, Brady L, Zafar M, Schrier Vergano SA, Murray B, Sawyer L, Hainline BE, Sapp K, DeMarzo D, Huismann DJ, Wentzensen IM, Schnur RE, Monaghan KG, Juusola J, Rhodes L, Dobyns WB, Lecoquierre F, Goldenberg A, Polster T, Axer-Schaefer S, Platzer K, Klöckner C, Hoffman TL, MacArthur DG, O'Leary MC, VanNoy GE, England E, Varghese VC, Mefford HC. Variants in GNAI1 cause a syndrome associated with variable features including developmental delay, seizures, and hypotonia. Genet Med 2021; 23:881-887. [PMID: 33473207 PMCID: PMC8107131 DOI: 10.1038/s41436-020-01076-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 09/25/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Neurodevelopmental disorders (NDDs) encompass a spectrum of genetically heterogeneous disorders with features that commonly include developmental delay, intellectual disability, and autism spectrum disorders. We sought to delineate the molecular and phenotypic spectrum of a novel neurodevelopmental disorder caused by variants in the GNAI1 gene. METHODS Through large cohort trio-based exome sequencing and international data-sharing, we identified 24 unrelated individuals with NDD phenotypes and a variant in GNAI1, which encodes the inhibitory Gαi1 subunit of heterotrimeric G-proteins. We collected detailed genotype and phenotype information for each affected individual. RESULTS We identified 16 unique variants in GNAI1 in 24 affected individuals; 23 occurred de novo and 1 was inherited from a mosaic parent. Most affected individuals have a severe neurodevelopmental disorder. Core features include global developmental delay, intellectual disability, hypotonia, and epilepsy. CONCLUSION This collaboration establishes GNAI1 variants as a cause of NDDs. GNAI1-related NDD is most often characterized by severe to profound delays, hypotonia, epilepsy that ranges from self-limiting to intractable, behavior problems, and variable mild dysmorphic features.
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Affiliation(s)
- Alison M Muir
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Iris M de Lange
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Golder N Wilson
- Texas Tech Health Science Center, Lubbock and KinderGenome Medical Genetics, Dallas, TX, USA
| | - Holly Dubbs
- Department of Pediatrics, Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ethan M Goldberg
- Department of Pediatrics, Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lia Zitano
- Spectrum Health Medical Genetics, Grand Rapids, MI, USA
| | - Caleb Bupp
- Spectrum Health Medical Genetics, Grand Rapids, MI, USA
| | - Jose Martinez
- Department of Pediatrics and Adolescent Medicine, Division of Genetics, University of South Alabama, Mobile, AL, USA
| | - Myriam Srour
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, USA
| | - Andrea Accogli
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, USA
| | - Afnan Alhakeem
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, USA
| | - Meira Meltzer
- Department of Neurology, Children's National Hospital, Washington, DC, USA
| | - Andrea Gropman
- Department of Neurology, Children's National Hospital, Washington, DC, USA
| | - Carole Brewer
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Richard C Caswell
- Exeter Genomics Laboratory, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Tara Montgomery
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Washington, USA
| | | | - Shane McKee
- Northern Ireland Regional Genetics Service, Exeter, UK
| | - Corinna Powell
- University Hospitals of Leicester NHS Trust Leicester Royal Infirmary Leicester, Exeter, UK
| | - Pradeep C Vasudevan
- University Hospitals of Leicester NHS Trust Leicester Royal Infirmary Leicester, Exeter, UK
| | - Angela F Brady
- North West Thames Regional Genetics Service, Northwick Park and St. Mark's Hospitals, Harrow, UK
| | | | - Carolyn Tysoe
- Royal Devon and Exeter NHS Foundation Trust, Scotland, UK
| | - Grace Noh
- Department of Genetics, Southern California Kaiser Permanente Medical Group, Pasadena, CA, USA
| | - Mark Tarnopolsky
- Department of Pediatrics, Division of Neuromuscular and Neurometabolic Disorders, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Lauren Brady
- Department of Pediatrics, Division of Neuromuscular and Neurometabolic Disorders, McMaster Children's Hospital, Hamilton, ON, Canada
| | | | | | - Brianna Murray
- Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
| | - Lindsey Sawyer
- Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
| | - Bryan E Hainline
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Katherine Sapp
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Danielle DeMarzo
- Department of Pediatrics, Section of Genetics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Darcy J Huismann
- Department of Pediatrics, Section of Genetics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | | | | | | | | | - William B Dobyns
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, WA, USA.,Division of Genetic Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Francois Lecoquierre
- Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, Normandie Univ, UNIROUEN, Inserm U1245 and Rouen University Hospital, Rouen, France
| | - Alice Goldenberg
- Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, Normandie Univ, UNIROUEN, Inserm U1245 and Rouen University Hospital, Rouen, France
| | - Tilman Polster
- Paediatric Epileptology Krankenhaus Mara Bethel Epilepsy Centre Bielefeld, Bielefeld, Germany
| | - Susanne Axer-Schaefer
- Paediatric Epileptology Krankenhaus Mara Bethel Epilepsy Centre Bielefeld, Bielefeld, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Chiara Klöckner
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Trevor L Hoffman
- Department of Genetics, Southern California Kaiser Permanente Medical Group, Pasadena, CA, USA
| | - Daniel G MacArthur
- Center for Mendelian Genomics, Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Centre for Population Genomics, Garvan Institute of Medical Research, and University of New South Wales Sydney, Sydney, Australia.,Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Australia
| | - Melanie C O'Leary
- Center for Mendelian Genomics, Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Grace E VanNoy
- Center for Mendelian Genomics, Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Eleina England
- Center for Mendelian Genomics, Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Heather C Mefford
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, WA, USA.
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47
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Le Duc D, Hentschel J, Neuser S, Stiller M, Meier C, Jäger E, Abou Jamra R, Platzer K, Monecke A, Ziemer M, Markovic A, Bläker H, Lemke JR. In cis TP53 and RAD51C pathogenic variants may predispose to sebaceous gland carcinomas. Eur J Hum Genet 2020; 29:489-494. [PMID: 33319852 PMCID: PMC7940394 DOI: 10.1038/s41431-020-00781-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/07/2020] [Accepted: 11/17/2020] [Indexed: 11/22/2022] Open
Abstract
Pathogenic variants in TP53 have been classically thought to cause Li-Fraumeni syndrome (LFS), a cancer predisposition with high risks for various childhood- and adult-onset malignancies. However, increased genetic testing has lately revealed, that pathogenic variant carriers exhibit a broader range of phenotypes and that penetrance may be dependent both on variant type and modifiers. Using next generation sequencing and short tandem repeat analysis, we identified germline pathogenic variants in TP53 and RAD51C located in cis on chromosome 17 in a 43-year-old male, who has developed a rare sebaceous gland carcinoma (SGC) but so far no tumors of the LFS spectrum. This course mirrors a Trp53-Rad51c-double-mutant cis mouse-model, which similarly develops SGC, while the characteristic Trp53-associated tumor spectrum occurs with significantly lower frequency. Therefore, we propose that co-occurent pathogenic variants in RAD51C and TP53 may predispose to SGC, reminiscent of Muir-Torre syndrome. Further, this report supports the diversity of clinical presentations associated with germline TP53 alterations, and thus, the proposed expansion of LFS to heritable TP53-related cancer syndrome.
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Affiliation(s)
- 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.
| | - Julia Hentschel
- Institute of Human Genetics, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Sonja Neuser
- Institute of Human Genetics, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Mathias Stiller
- Institute of Human Genetics, University of Leipzig Medical Center, 04103, Leipzig, Germany.,Institute of Pathology, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Carolin Meier
- Institute of Human Genetics, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Elisabeth Jäger
- Department of Endocrinology, Nephrology, and Rheumatology, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Astrid Monecke
- Institute of Pathology, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Mirjana Ziemer
- Department of Dermatology, Venereology and Allergology, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Aleksander Markovic
- Department of Dermatology, Venereology and Allergology, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Hendrik Bläker
- Institute of Pathology, University of Leipzig Medical Center, 04103, Leipzig, Germany
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Medical Center, 04103, Leipzig, Germany.
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48
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Klöckner C, Sticht H, Zacher P, Popp B, Babcock HE, Bakker DP, Barwick K, Bonfert MV, Bönnemann CG, Brilstra EH, Chung WK, Clarke AJ, Devine P, Donkervoort S, Fraser JL, Friedman J, Gates A, Ghoumid J, Hobson E, Horvath G, Keller-Ramey J, Keren B, Kurian MA, Lee V, Leppig KA, Lundgren J, McDonald MT, McLaughlin HM, McTague A, Mefford HC, Mignot C, Mikati MA, Nava C, Raymond FL, Sampson JR, Sanchis-Juan A, Shashi V, Shieh JTC, Shinawi M, Slavotinek A, Stödberg T, Stong N, Sullivan JA, Taylor AC, Toler TL, van den Boogaard MJ, van der Crabben SN, van Gassen KLI, van Jaarsveld RH, Van Ziffle J, Wadley AF, Wagner M, Wigby K, Wortmann SB, Zarate YA, Møller RS, Lemke JR, Platzer K. De novo variants in SNAP25 cause an early-onset developmental and epileptic encephalopathy. Genet Med 2020; 23:653-660. [PMID: 33299146 DOI: 10.1038/s41436-020-01020-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE This study aims to provide a comprehensive description of the phenotypic and genotypic spectrum of SNAP25 developmental and epileptic encephalopathy (SNAP25-DEE) by reviewing newly identified and previously reported individuals. METHODS Individuals harboring heterozygous missense or loss-of-function variants in SNAP25 were assembled through collaboration with international colleagues, matchmaking platforms, and literature review. For each individual, detailed phenotyping, classification, and structural modeling of the identified variant were performed. RESULTS The cohort comprises 23 individuals with pathogenic or likely pathogenic de novo variants in SNAP25. Intellectual disability and early-onset epilepsy were identified as the core symptoms of SNAP25-DEE, with recurrent findings of movement disorders, cerebral visual impairment, and brain atrophy. Structural modeling for all variants predicted possible functional defects concerning SNAP25 or impaired interaction with other components of the SNARE complex. CONCLUSION We provide a comprehensive description of SNAP25-DEE with intellectual disability and early-onset epilepsy mostly occurring before the age of two years. These core symptoms and additional recurrent phenotypes show an overlap to genes encoding other components or associated proteins of the SNARE complex such as STX1B, STXBP1, or VAMP2. Thus, these findings advance the concept of a group of neurodevelopmental disorders that may be termed "SNAREopathies."
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Affiliation(s)
- Chiara Klöckner
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Heinrich Sticht
- Institute of Biochemistry, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Pia Zacher
- The Saxon Epilepsy Center Kleinwachau, Radeberg, Germany
| | - Bernt Popp
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Holly E Babcock
- Rare Disease Institute, Children's National Hospital, Washington, DC, USA
| | - Dewi P Bakker
- Department of Child Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Katy Barwick
- Institute of Child Health, University Collge London, London, UK
| | - Michaela V Bonfert
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU - University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Carsten G Bönnemann
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Eva H Brilstra
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, NY, USA
| | - Angus J Clarke
- Division of Cancer & Genetics, School of Medicine, Cardiff University, Wales, UK
| | - Patrick Devine
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Sandra Donkervoort
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Jamie L Fraser
- Rare Disease Institute, Division of Genetics and Metabolism, Children's National Hospital, Washington, DC, USA
| | - Jennifer Friedman
- Departments of Neurosciences and Pediatrics, University of California San Diego and Division of Neurology, Rady Children's Hospital, San Diego, CA, USA.,Rady Children's Institute for Genomic Medicine, San Diego, CA, USA
| | - Alyssa Gates
- Department of Genetic Services, Kaiser Permanente Washington, Seattle, WA, USA
| | - Jamal Ghoumid
- Service de Génétique Clinique, Hôpital Jeanne de Flandre, CHU Lille, Lille, France
| | - Emma Hobson
- Yorkshire Clinical Genetics Service, Chapel Allerton Hospital, Leeds, UK
| | - Gabriella Horvath
- Department of Pediatrics, Division of Biochemical Diseases, University of British Columbia, Vancouver, Canada
| | | | - Boris Keren
- APHP, Département de Génétique, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Manju A Kurian
- Institute of Child Health, University Collge London, London, UK
| | - Virgina Lee
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Kathleen A Leppig
- Department of Genetic Services, Kaiser Permanente Washington, Seattle, WA, USA
| | - Johan Lundgren
- Institute of Clinical Sciences, Skane University Hospital, Lund, Sweden
| | - Marie T McDonald
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | | | - Amy McTague
- Institute of Child Health, University Collge London, London, UK
| | - Heather C Mefford
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Cyril Mignot
- Département de Génétique, Centre de Référence Déficiences Intellectuelles de Causes Rares, Groupe Hospitalier Pitié Salpêtrière et Hôpital Trousseau, APHP, Sorbonne Université, Paris, France
| | - Mohamad A Mikati
- Division of Pediatric Neurology, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Caroline Nava
- Sorbonne University, Paris Brain Institute, Inserm U1127, CNRS UMR 7225, AP-HP, Pitié Salpêtrière Hospital, Department of Genetics, Paris, France
| | - F Lucy Raymond
- NIHR BioResource, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK.,Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Julian R Sampson
- Division of Cancer & Genetics, School of Medicine, Cardiff University, Wales, UK
| | - Alba Sanchis-Juan
- NIHR BioResource, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK.,Department of Haematology, University of Cambridge, NHS Blood and Transplant Centre, Cambridge, UK
| | - Vandana Shashi
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Joseph T C Shieh
- Division of Medical Genetics, University of California, San Francisco, San Francisco, CA, USA.,Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - Marwan Shinawi
- Department of Pediatrics, Division of Genetics and Genomic Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Anne Slavotinek
- Division of Medical Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - Tommy Stödberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Nicholas Stong
- Institute for Genomic Medicine, Columbia University, New York, NY, USA
| | - Jennifer A Sullivan
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Ashley C Taylor
- Section of Genetics, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Tomi L Toler
- Department of Pediatrics, Division of Genetics and Genomic Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Saskia N van der Crabben
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Koen L I van Gassen
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Jessica Van Ziffle
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | | | - Matias Wagner
- Institute of Neurogenomics, Helmholtz Zentrum Munich, Neuherberg, Germany
| | - Kristen Wigby
- Department of Pediatrics, Division of Genetics, University of California, San Diego and Rady Children's Hospital-San Diego, San Diego, CA, USA
| | - Saskia B Wortmann
- Amalia Children's Hospital, Radboud University Nijmegen, Nijmegen, The Netherlands.,University Childrens Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Yuri A Zarate
- Section of Genetics and Metabolism, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rikke S Møller
- Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark.,Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre Filadelfia, Dianalund, Denmark
| | - 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.
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49
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Mochel F, Rastetter A, Ceulemans B, Platzer K, Yang S, Shinde DN, Helbig KL, Lopergolo D, Mari F, Renieri A, Benetti E, Canitano R, Waisfisz Q, Plomp AS, Huisman SA, Wilson GN, Cathey SS, Louie RJ, Gaudio DD, Waggoner D, Kacker S, Nugent KM, Roeder ER, Bruel AL, Thevenon J, Ehmke N, Horn D, Holtgrewe M, Kaiser FJ, Kamphausen SB, Abou Jamra R, Weckhuysen S, Dalle C, Depienne C. Variants in the SK2 channel gene (KCNN2) lead to dominant neurodevelopmental movement disorders. Brain 2020; 143:3564-3573. [PMID: 33242881 DOI: 10.1093/brain/awaa346] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/25/2020] [Revised: 07/17/2020] [Accepted: 09/08/2020] [Indexed: 11/14/2022] Open
Abstract
KCNN2 encodes the small conductance calcium-activated potassium channel 2 (SK2). Rodent models with spontaneous Kcnn2 mutations show abnormal gait and locomotor activity, tremor and memory deficits, but human disorders related to KCNN2 variants are largely unknown. Using exome sequencing, we identified a de novo KCNN2 frameshift deletion in a patient with learning disabilities, cerebellar ataxia and white matter abnormalities on brain MRI. This discovery prompted us to collect data from nine additional patients with de novo KCNN2 variants (one nonsense, one splice site, six missense variants and one in-frame deletion) and one family with a missense variant inherited from the affected mother. We investigated the functional impact of six selected variants on SK2 channel function using the patch-clamp technique. All variants tested but one, which was reclassified to uncertain significance, led to a loss-of-function of SK2 channels. Patients with KCNN2 variants had motor and language developmental delay, intellectual disability often associated with early-onset movement disorders comprising cerebellar ataxia and/or extrapyramidal symptoms. Altogether, our findings provide evidence that heterozygous variants, likely causing a haploinsufficiency of the KCNN2 gene, lead to novel autosomal dominant neurodevelopmental movement disorders mirroring phenotypes previously described in rodents.
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Affiliation(s)
- Fanny Mochel
- Institut du Cerveau et de la Moelle épinière (ICM), Sorbonne Université, UMR S 1127, Inserm U1127, CNRS UMR 7225, F-75013 Paris, France.,AP-HP, Hôpital Pitié-Salpêtrière, Département de Génétique and Centre de Référence Neurométabolique Adulte, F-75013, Paris, France
| | - Agnès Rastetter
- Institut du Cerveau et de la Moelle épinière (ICM), Sorbonne Université, UMR S 1127, Inserm U1127, CNRS UMR 7225, F-75013 Paris, France
| | - Berten Ceulemans
- Division of Paediatric Neurology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | | | - Deepali N Shinde
- Department of Clinical Diagnostics, Ambry Genetics, Aliso Viejo, CA, USA
| | - Katherine L Helbig
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,The Epilepsy Neurogenetics Initiative, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Diego Lopergolo
- Medical Genetics, University of Siena, Siena, Italy.,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Francesca Mari
- Medical Genetics, University of Siena, Siena, Italy.,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alessandra Renieri
- Medical Genetics, University of Siena, Siena, Italy.,Genetica Medica, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Elisa Benetti
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Roberto Canitano
- Division of Child and Adolescent Neuropsychiatry, University Hospital of Siena, Siena, Italy
| | - Quinten Waisfisz
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Astrid S Plomp
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sylvia A Huisman
- Department of Pediatrics, Amsterdam UMC, Amsterdam, The Netherlands.,Prinsenstichting, Purmerend, The Netherlands
| | - Golder N Wilson
- Department of Pediatrics, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | - Sara S Cathey
- Greenwood Genetic Center, Greenwood, South Carolina, 29646, USA
| | - Raymond J Louie
- Department of Human Genetics, University of Chicago, Chicago, IL, 60637, USA
| | - Daniela Del Gaudio
- Department of Human Genetics, University of Chicago, Chicago, IL, 60637, USA
| | - Darrel Waggoner
- Department of Human Genetics, University of Chicago, Chicago, IL, 60637, USA
| | - Shawn Kacker
- Department of Pediatrics, Section of Child Neurology, University of Chicago, Chicago, IL, 60637, USA
| | - Kimberly M Nugent
- Department of Pediatrics, Baylor College of Medicine, San Antonio, TX, 78207, USA.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Elizabeth R Roeder
- Department of Pediatrics, Baylor College of Medicine, San Antonio, TX, 78207, USA.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Ange-Line Bruel
- UMR1231 GAD, Inserm - Université Bourgogne-Franche Comté, Dijon, France.,Centre de référence maladies rares 'déficiences intellectuelles de causes rares', Centre de Génétique, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Julien Thevenon
- Service de Génétique, Génomique, et Procréation, Centre Hospitalier Universitaire Grenoble Alpes, 38700 La Tronche, France.,INSERM 1209, CNRS UMR 5309, Institute for Advanced Biosciences, Université Grenoble Alpes, 38706 Grenoble, France
| | - Nadja Ehmke
- Institute for Human Genetics and Medical Genetics, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Denise Horn
- Institute for Human Genetics and Medical Genetics, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Manuel Holtgrewe
- Core Unit Bioinformatics - CUBI, Berlin Institute of Health (BIH), Berlin, Germany
| | - Frank J Kaiser
- Institute of Human Genetics, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | | | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Sarah Weckhuysen
- Applied and Translational Neurogenomics Group, VIB Center for Molecular Neurology, VIB, Antwerp, Belgium.,Translational Neurosciences, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,Department of Neurology, University Hospital Antwerp, Antwerp, Belgium
| | - Carine Dalle
- Institut du Cerveau et de la Moelle épinière (ICM), Sorbonne Université, UMR S 1127, Inserm U1127, CNRS UMR 7225, F-75013 Paris, France
| | - Christel Depienne
- Institut du Cerveau et de la Moelle épinière (ICM), Sorbonne Université, UMR S 1127, Inserm U1127, CNRS UMR 7225, F-75013 Paris, France.,Institute of Human Genetics, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
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50
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Connaughton DM, Dai R, Owen DJ, Marquez J, Mann N, Graham-Paquin AL, Nakayama M, Coyaud E, Laurent EMN, St-Germain JR, Blok LS, Vino A, Klämbt V, Deutsch K, Wu CHW, Kolvenbach CM, Kause F, Ottlewski I, Schneider R, Kitzler TM, Majmundar AJ, Buerger F, Onuchic-Whitford AC, Youying M, Kolb A, Salmanullah D, Chen E, van der Ven AT, Rao J, Ityel H, Seltzsam S, Rieke JM, Chen J, Vivante A, Hwang DY, Kohl S, Dworschak GC, Hermle T, Alders M, Bartolomaeus T, Bauer SB, Baum MA, Brilstra EH, Challman TD, Zyskind J, Costin CE, Dipple KM, Duijkers FA, Ferguson M, Fitzpatrick DR, Fick R, Glass IA, Hulick PJ, Kline AD, Krey I, Kumar S, Lu W, Marco EJ, Wentzensen IM, Mefford HC, Platzer K, Povolotskaya IS, Savatt JM, Shcherbakova NV, Senguttuvan P, Squire AE, Stein DR, Thiffault I, Voinova VY, Somers MJG, Ferguson MA, Traum AZ, Daouk GH, Daga A, Rodig NM, Terhal PA, van Binsbergen E, Eid LA, Tasic V, Rasouly HM, Lim TY, Ahram DF, Gharavi AG, Reutter HM, Rehm HL, MacArthur DG, Lek M, Laricchia KM, Lifton RP, Xu H, Mane SM, Sanna-Cherchi S, Sharrocks AD, Raught B, Fisher SE, Bouchard M, Khokha MK, Shril S, Hildebrandt F. Mutations of the Transcriptional Corepressor ZMYM2 Cause Syndromic Urinary Tract Malformations. Am J Hum Genet 2020; 107:727-742. [PMID: 32891193 PMCID: PMC7536580 DOI: 10.1016/j.ajhg.2020.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/02/2020] [Accepted: 08/14/2020] [Indexed: 01/10/2023] Open
Abstract
Congenital anomalies of the kidney and urinary tract (CAKUT) constitute one of the most frequent birth defects and represent the most common cause of chronic kidney disease in the first three decades of life. Despite the discovery of dozens of monogenic causes of CAKUT, most pathogenic pathways remain elusive. We performed whole-exome sequencing (WES) in 551 individuals with CAKUT and identified a heterozygous de novo stop-gain variant in ZMYM2 in two different families with CAKUT. Through collaboration, we identified in total 14 different heterozygous loss-of-function mutations in ZMYM2 in 15 unrelated families. Most mutations occurred de novo, indicating possible interference with reproductive function. Human disease features are replicated in X. tropicalis larvae with morpholino knockdowns, in which expression of truncated ZMYM2 proteins, based on individual mutations, failed to rescue renal and craniofacial defects. Moreover, heterozygous Zmym2-deficient mice recapitulated features of CAKUT with high penetrance. The ZMYM2 protein is a component of a transcriptional corepressor complex recently linked to the silencing of developmentally regulated endogenous retrovirus elements. Using protein-protein interaction assays, we show that ZMYM2 interacts with additional epigenetic silencing complexes, as well as confirming that it binds to FOXP1, a transcription factor that has also been linked to CAKUT. In summary, our findings establish that loss-of-function mutations of ZMYM2, and potentially that of other proteins in its interactome, as causes of human CAKUT, offering new routes for studying the pathogenesis of the disorder.
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Affiliation(s)
- Dervla M Connaughton
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Division of Nephrology, Department of Medicine, University Hospital - London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, 339 Windermere Road, London, ON N6A 5A5, Canada
| | - Rufeng Dai
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Department of Nephrology, Children's Hospital of Fudan University, 201102 Shanghai, China
| | - Danielle J Owen
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PT, UK
| | - Jonathan Marquez
- Pediatric Genomics Discovery Program, Department of Pediatrics and Genetics, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Nina Mann
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Adda L Graham-Paquin
- Rosalind & Morris Goodman Cancer Research Centre and Department of Biochemistry, McGill University, Montréal, QC H3A 1A3, Canada
| | - Makiko Nakayama
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Etienne Coyaud
- Princess Margaret Cancer Centre, University Health Network & Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada; Univ. Lille, Inserm, CHU Lille, U1192 - Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, 59000 Lille, France
| | - Estelle M N Laurent
- Princess Margaret Cancer Centre, University Health Network & Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada; Univ. Lille, Inserm, CHU Lille, U1192 - Protéomique Réponse Inflammatoire Spectrométrie de Masse - PRISM, 59000 Lille, France
| | - Jonathan R St-Germain
- Princess Margaret Cancer Centre, University Health Network & Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Lot Snijders Blok
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, 6525 XD Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6500HE Nijmegen, the Netherlands; Human Genetics Department, Radboud University Medical Center, 6500HB Nijmegen, the Netherlands
| | - Arianna Vino
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, 6525 XD Nijmegen, the Netherlands
| | - Verena Klämbt
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Konstantin Deutsch
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Chen-Han Wilfred Wu
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Caroline M Kolvenbach
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Franziska Kause
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Isabel Ottlewski
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ronen Schneider
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Thomas M Kitzler
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Amar J Majmundar
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Florian Buerger
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ana C Onuchic-Whitford
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Mao Youying
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Amy Kolb
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Daanya Salmanullah
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Evan Chen
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Amelie T van der Ven
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jia Rao
- Department of Nephrology, Children's Hospital of Fudan University, 201102 Shanghai, China
| | - Hadas Ityel
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Steve Seltzsam
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Johanna M Rieke
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jing Chen
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Asaf Vivante
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Tel Aviv University, Faculty of Medicine, Tel Aviv-Yafo 6997801, Israel
| | - Daw-Yang Hwang
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Stefan Kohl
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Gabriel C Dworschak
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Tobias Hermle
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Mariëlle Alders
- Amsterdam UMC, University of Amsterdam, Department of Clinical Genetics, Meibergdreef 9, 1105 Amsterdam, Netherlands
| | - Tobias Bartolomaeus
- Institute of Human Genetics, University of Leipzig Medical Center, Philipp-Rosenthal- Straße 55, 04103 Leipzig, Germany
| | - Stuart B Bauer
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Michelle A Baum
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Eva H Brilstra
- Department of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Thomas D Challman
- Geisinger, Autism & Developmental Medicine Institute, 100 N Academy Avenue, Danville, PA 17822, USA
| | - Jacob Zyskind
- Department of Clinical Genomics, GeneDx, 207 Perry Pkwy, Gaithersburg, MD 20877, USA
| | - Carrie E Costin
- Department of Clinical Genetics, Akron Children's Hospital, One Perkins Square, Akron, OH 44308, USA
| | - Katrina M Dipple
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Floor A Duijkers
- Department of Clinical Genetics, University of Amsterdam, 1012 WX Amsterdam, the Netherlands
| | - Marcia Ferguson
- Department of Clinical Genetics, Harvey Institute for Human Genetics, 6701 Charles St, Towson, MD 21204, USA
| | - David R Fitzpatrick
- MRC Institute of Genetics & Molecular Medicine, Royal Hospital for Sick Children, The University of Edinburgh, 2XU, Crewe Rd S, Edinburgh EH4 2XU, UK
| | - Roger Fick
- Mary Bridge Childrens Hospital, 316 Martin Luther King JR Way, Tacoma, WA 98405, USA
| | - Ian A Glass
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Peter J Hulick
- Center for Medical Genetics, NorthShore University HealthSystem, 1000 Central Street, Suite 610, Evanston, IL 60201, USA
| | - Antonie D Kline
- Department of Clinical Genetics, Harvey Institute for Human Genetics, 6701 Charles St, Towson, MD 21204, USA
| | - Ilona Krey
- Institute of Human Genetics, University of Leipzig Medical Center, Philipp-Rosenthal- Straße 55, 04103 Leipzig, Germany; Swiss Epilepsy Center, Klinik Lengg, Bleulerstrasse 60, 8000 Zürich, Switzerland
| | - Selvin Kumar
- Department of Pediatric Nephrology, Institute of Child Health and Hospital for Children, Tamil Salai, Egmore, Chennai, Tamil Nadu 600008, India
| | - Weining Lu
- Renal Section, Department of Medicine, Boston University Medical Center, 650 Albany Street, Boston, MA 02118, USA
| | - Elysa J Marco
- Cortica Healthcare, 4000 Civic Center Drive, Ste 100, San Rafael, CA 94939, USA
| | - Ingrid M Wentzensen
- Department of Clinical Genomics, GeneDx, 207 Perry Pkwy, Gaithersburg, MD 20877, USA
| | - Heather C Mefford
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Philipp-Rosenthal- Straße 55, 04103 Leipzig, Germany
| | - Inna S Povolotskaya
- Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University of the Russian Ministry of Health, Moscow 117997, Russia
| | - Juliann M Savatt
- Geisinger, Autism & Developmental Medicine Institute, 100 N Academy Avenue, Danville, PA 17822, USA
| | - Natalia V Shcherbakova
- Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University of the Russian Ministry of Health, Moscow 117997, Russia
| | - Prabha Senguttuvan
- Department of Pediatric Nephrology, Dr. Mehta's Multi-Specialty Hospital, No.2, Mc Nichols Rd, Chetpet, Chennai, Tamil Nadu 600031, India
| | - Audrey E Squire
- Seattle Children's Hospital, Department of Genetic Medicine, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Deborah R Stein
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Isabelle Thiffault
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, USA; Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals, Kansas City, MO 64108, USA; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, 5000 Holmes St, Kansas City, MO 64110, USA
| | - Victoria Y Voinova
- Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University of the Russian Ministry of Health, Moscow 117997, Russia
| | - Michael J G Somers
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Michael A Ferguson
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Avram Z Traum
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ghaleb H Daouk
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ankana Daga
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Nancy M Rodig
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Paulien A Terhal
- Department of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Ellen van Binsbergen
- Department of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Loai A Eid
- Pediatric Nephrology Department, Dubai Hospital, Dubai, United Arab Emirates
| | - Velibor Tasic
- Medical Faculty Skopje, University Children's Hospital, Skopje 1000, North Macedonia
| | - Hila Milo Rasouly
- Division of Nephrology, Columbia University, 630 W 168th St, New York, NY 10032, USA
| | - Tze Y Lim
- Division of Nephrology, Columbia University, 630 W 168th St, New York, NY 10032, USA
| | - Dina F Ahram
- Division of Nephrology, Columbia University, 630 W 168th St, New York, NY 10032, USA
| | - Ali G Gharavi
- Division of Nephrology, Columbia University, 630 W 168th St, New York, NY 10032, USA
| | - Heiko M Reutter
- Institute of Human Genetics, University Hospital Bonn, 53127 Bonn, Germany; Section of Neonatology and Pediatric Intensive Care, Clinic for Pediatrics, University Hospital Bonn, Adenauerallee 119, 53313 Bonn, Germany
| | - Heidi L Rehm
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA
| | - Daniel G MacArthur
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA
| | - Monkol Lek
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA
| | - Kristen M Laricchia
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, USA
| | - Richard P Lifton
- The Rockefeller University, 1230 York Ave, New York, NY 10065, USA
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, 201102 Shanghai, China
| | - Shrikant M Mane
- Department of Genetics, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Simone Sanna-Cherchi
- Division of Nephrology, Columbia University, 630 W 168th St, New York, NY 10032, USA
| | - Andrew D Sharrocks
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PT, UK
| | - Brian Raught
- Princess Margaret Cancer Centre, University Health Network & Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Simon E Fisher
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, 6525 XD Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6500HE Nijmegen, the Netherlands
| | - Maxime Bouchard
- Rosalind & Morris Goodman Cancer Research Centre and Department of Biochemistry, McGill University, Montréal, QC H3A 1A3, Canada
| | - Mustafa K Khokha
- Pediatric Genomics Discovery Program, Department of Pediatrics and Genetics, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Shirlee Shril
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Friedhelm Hildebrandt
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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