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Magielski J, Ruggiero SM, Xian J, Parthasarathy S, Galer P, Ganesan S, Back A, McKee J, McSalley I, Gonzalez AK, Morgan A, Donaher J, Helbig I. The clinical and genetic spectrum of paediatric speech and language disorders in 52,143 individuals. medRxiv 2024:2024.04.23.24306192. [PMID: 38712155 PMCID: PMC11071575 DOI: 10.1101/2024.04.23.24306192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Speech and language disorders are known to have a substantial genetic contribution. Although frequently examined as components of other conditions, research on the genetic basis of linguistic differences as separate phenotypic subgroups has been limited so far. Here, we performed an in-depth characterization of speech and language disorders in 52,143 individuals, reconstructing clinical histories using a large-scale data mining approach of the Electronic Medical Records (EMR) from an entire large paediatric healthcare network. The reported frequency of these disorders was the highest between 2 and 5 years old and spanned a spectrum of twenty-six broad speech and language diagnoses. We used Natural Language Processing to assess to which degree clinical diagnosis in full-text notes were reflected in ICD-10 diagnosis codes. We found that aphasia and speech apraxia could be easily retrieved through ICD-10 diagnosis codes, while stuttering as a speech phenotype was only coded in 12% of individuals through appropriate ICD-10 codes. We found significant comorbidity of speech and language disorders in neurodevelopmental conditions (30.31%) and to a lesser degree with epilepsies (6.07%) and movement disorders (2.05%). The most common genetic disorders retrievable in our EMR analysis were STXBP1 (n=21), PTEN (n=20), and CACNA1A (n=18). When assessing associations of genetic diagnoses with specific linguistic phenotypes, we observed associations of STXBP1 and aphasia (P=8.57 × 10-7, CI=18.62-130.39) and MYO7A with speech and language development delay due to hearing loss (P=1.24 × 10-5, CI=17.46-Inf). Finally, in a sub-cohort of 726 individuals with whole exome sequencing data, we identified an enrichment of rare variants in synaptic protein and neuronal receptor pathways and associations of UQCRC1 with expressive aphasia and WASHC4 with abnormality of speech or vocalization. In summary, our study outlines the landscape of paediatric speech and language disorders, confirming the phenotypic complexity of linguistic traits and novel genotype-phenotype associations. Subgroups of paediatric speech and language disorders differ significantly with respect to the composition of monogenic aetiologies.
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Affiliation(s)
- Jan Magielski
- 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, 19146, USA
| | - Sarah M. Ruggiero
- 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
| | - Julie Xian
- 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, 19146, USA
| | - Shridhar Parthasarathy
- 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, 19146, USA
| | - Peter Galer
- 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, 19146, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Shiva Ganesan
- 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, 19146, USA
| | - Amanda Back
- 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
| | - Jillian McKee
- 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, 19146, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Ian McSalley
- 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, 19146, USA
| | - Alexander K. Gonzalez
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, 19146, USA
| | - Angela Morgan
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville 3052, Australia
| | - Joseph Donaher
- Center for Childhood Communication, Children’s Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Otorhinolaryngology, University of Pennsylvania Perelman School of Medicine, 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, 19146, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
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Xu Y, Song R, Perszyk RE, Chen W, Kim S, Park KL, Allen JP, Nocilla KA, Zhang J, XiangWei W, Tankovic A, McDaniels ED, Sheikh R, Mizu RK, Karamchandani MM, Hu C, Kusumoto H, Pecha J, Cappuccio G, Gaitanis J, Sullivan J, Shashi V, Petrovski S, Jauss RT, Lee HK, Bozarth X, Lynch DR, Helbig I, Pierson TM, Boerkoel CF, Myers SJ, Lemke JR, Benke TA, Yuan H, Traynelis SF. De novo GRIN variants in M3 helix associated with neurological disorders control channel gating of NMDA receptor. Cell Mol Life Sci 2024; 81:153. [PMID: 38538865 PMCID: PMC10973091 DOI: 10.1007/s00018-023-05069-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 05/18/2024]
Abstract
N-methyl-D-aspartate receptors (NMDARs) are members of the glutamate receptor family and participate in excitatory postsynaptic transmission throughout the central nervous system. Genetic variants in GRIN genes encoding NMDAR subunits are associated with a spectrum of neurological disorders. The M3 transmembrane helices of the NMDAR couple directly to the agonist-binding domains and form a helical bundle crossing in the closed receptors that occludes the pore. The M3 functions as a transduction element whose conformational change couples ligand binding to opening of an ion conducting pore. In this study, we report the functional consequences of 48 de novo missense variants in GRIN1, GRIN2A, and GRIN2B that alter residues in the M3 transmembrane helix. These de novo variants were identified in children with neurological and neuropsychiatric disorders including epilepsy, developmental delay, intellectual disability, hypotonia and attention deficit hyperactivity disorder. All 48 variants in M3 for which comprehensive testing was completed produce a gain-of-function (28/48) compared to loss-of-function (9/48); 11 variants had an indeterminant phenotype. This supports the idea that a key structural feature of the M3 gate exists to stabilize the closed state so that agonist binding can drive channel opening. Given that most M3 variants enhance channel gating, we assessed the potency of FDA-approved NMDAR channel blockers on these variant receptors. These data provide new insight into the structure-function relationship of the NMDAR gate, and suggest that variants within the M3 transmembrane helix produce a gain-of-function.
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Affiliation(s)
- Yuchen Xu
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Department of Neurology, The First Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China
| | - Rui Song
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Riley E Perszyk
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Wenjuan Chen
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sukhan Kim
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Center for Functional Evaluation of Rare Variants (CFERV), Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Kristen L Park
- Departments of Pediatrics and Neurology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - James P Allen
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Kelsey A Nocilla
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Jing Zhang
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Wenshu XiangWei
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Department of Pediatrics and Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Anel Tankovic
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ellington D McDaniels
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Rehan Sheikh
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ruth K Mizu
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Manish M Karamchandani
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Chun Hu
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Hirofumi Kusumoto
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Joseph Pecha
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Gerarda Cappuccio
- Department of Translational Medicine, Section of Pediatrics, Federico II University, Via Pansini 5, 80131, Naples, Italy
- Department of Pediatrics-Neurology, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - John Gaitanis
- Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jennifer Sullivan
- Department of Pediatrics, Division of Medical Genetics, Duke University, Durham, NC, USA
| | - Vandana Shashi
- Department of Pediatrics, Division of Medical Genetics, Duke University, Durham, NC, USA
| | - Slave Petrovski
- Ce Department of Medicine, University of Melbourne, Austin Health, Melbourne, VIC, Australia
- Centre for Genomics Research, Discovery Sciences, AstraZeneca, BioPharmaceuticals R&D, Cambridge, UK
| | - Robin-Tobias Jauss
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Hyun Kyung Lee
- Provincial Medical Genetics Program, Department of Medical Genetics, University of British Columbia, Children's and Women's Health Centre of BC, Vancouver, B.C, V6H 3N1, Canada
| | - Xiuhua Bozarth
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
- Division of Pediatric Neurology, Department of Neurology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - David R Lynch
- Departments of Pediatrics and Neurology, Perelman School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Ingo Helbig
- Division of Child Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Tyler Mark Pierson
- Department of Pediatrics and Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Center for the Undiagnosed Patient, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cornelius F Boerkoel
- Provincial Medical Genetics Program, Department of Medical Genetics, University of British Columbia, Children's and Women's Health Centre of BC, Vancouver, B.C, V6H 3N1, Canada
| | - Scott J Myers
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Center for Functional Evaluation of Rare Variants (CFERV), Emory University School of Medicine, Atlanta, GA, 30322, 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
| | - Timothy A Benke
- Departments of Pediatrics and Neurology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Hongjie Yuan
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA.
- Center for Functional Evaluation of Rare Variants (CFERV), Emory University School of Medicine, Atlanta, GA, 30322, USA.
| | - Stephen F Traynelis
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA.
- Center for Functional Evaluation of Rare Variants (CFERV), Emory University School of Medicine, Atlanta, GA, 30322, USA.
- Emory Neurodegenerative Disease Center, Emory University School of Medicine, Atlanta, GA, 30322, USA.
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Scala M, Tomati V, Ferla M, Lena M, Cohen JS, Fatemi A, Brokamp E, Bican A, Phillips JA, Koziura ME, Nicouleau M, Rio M, Siquier K, Boddaert N, Musante I, Tamburro S, Baldassari S, Iacomino M, Scudieri P, Rosenfeld JA, Bellus G, Reed S, Al Saif H, Russo RS, Walsh MB, Cantagrel V, Crunk A, Gustincich S, Ruggiero SM, Fitzgerald MP, Helbig I, Striano P, Severino M, Salpietro V, Pedemonte N, Zara F. De novo variants in DENND5B cause a neurodevelopmental disorder. Am J Hum Genet 2024; 111:529-543. [PMID: 38387458 PMCID: PMC10940048 DOI: 10.1016/j.ajhg.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
The Rab family of guanosine triphosphatases (GTPases) includes key regulators of intracellular transport and membrane trafficking targeting specific steps in exocytic, endocytic, and recycling pathways. DENND5B (Rab6-interacting Protein 1B-like protein, R6IP1B) is the longest isoform of DENND5, an evolutionarily conserved DENN domain-containing guanine nucleotide exchange factor (GEF) that is highly expressed in the brain. Through exome sequencing and international matchmaking platforms, we identified five de novo variants in DENND5B in a cohort of five unrelated individuals with neurodevelopmental phenotypes featuring cognitive impairment, dysmorphism, abnormal behavior, variable epilepsy, white matter abnormalities, and cortical gyration defects. We used biochemical assays and confocal microscopy to assess the impact of DENND5B variants on protein accumulation and distribution. Then, exploiting fluorescent lipid cargoes coupled to high-content imaging and analysis in living cells, we investigated whether DENND5B variants affected the dynamics of vesicle-mediated intracellular transport of specific cargoes. We further generated an in silico model to investigate the consequences of DENND5B variants on the DENND5B-RAB39A interaction. Biochemical analysis showed decreased protein levels of DENND5B mutants in various cell types. Functional investigation of DENND5B variants revealed defective intracellular vesicle trafficking, with significant impairment of lipid uptake and distribution. Although none of the variants affected the DENND5B-RAB39A interface, all were predicted to disrupt protein folding. Overall, our findings indicate that DENND5B variants perturb intracellular membrane trafficking pathways and cause a complex neurodevelopmental syndrome with variable epilepsy and white matter involvement.
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Affiliation(s)
- Marcello Scala
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy; Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy; UOC Genetica Medica, IRCCS Giannina Gaslini, Genoa, Italy
| | - Valeria Tomati
- UOC Genetica Medica, IRCCS Giannina Gaslini, Genoa, Italy
| | - Matteo Ferla
- Oxford Protein Informatics Group, Department of Statistics, University of Oxford, Oxford, UK
| | - Mariateresa Lena
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Julie S Cohen
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ali Fatemi
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elly Brokamp
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anna Bican
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John A Phillips
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mary E Koziura
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Nicouleau
- Université Paris Cité, Imagine Institute, Developmental Brain Disorders Laboratory, INSERM UMR 1163, 75015 Paris, France
| | - Marlene Rio
- Université Paris Cité, Imagine Institute, Developmental Brain Disorders Laboratory, INSERM UMR 1163, 75015 Paris, France; Service de Génétique, Necker Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Pairs, Paris, France
| | - Karine Siquier
- Université Paris Cité, Imagine Institute, Developmental Brain Disorders Laboratory, INSERM UMR 1163, 75015 Paris, France
| | - Nathalie Boddaert
- Département de Radiologie Pédiatrique, INSERM UMR 1163 and INSERM U1000, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Ilaria Musante
- UOC Genetica Medica, IRCCS Giannina Gaslini, Genoa, Italy
| | | | | | | | - Paolo Scudieri
- UOC Genetica Medica, IRCCS Giannina Gaslini, Genoa, Italy
| | - Jill A Rosenfeld
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA; Baylor Genetics Laboratories, Houston, TX, USA
| | - Gary Bellus
- Clinical Genetics, Geisinger Medical Center, Danville, PA 17822, USA
| | - Sara Reed
- Clinical Genetics, Geisinger Medical Center, Danville, PA 17822, USA
| | - Hind Al Saif
- Department of Human and Molecular Genetics, Division of Clinical Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | | | - Matthew B Walsh
- Department of Human Genetics, Emory University, Atlanta, GA 30322, USA
| | - Vincent Cantagrel
- Université Paris Cité, Imagine Institute, Developmental Brain Disorders Laboratory, INSERM UMR 1163, 75015 Paris, France
| | | | - Stefano Gustincich
- Department of Neuroscience and Brain Technologies, Istituto Italiano di Tecnologia, 16163 Genoa, Italy
| | - Sarah M Ruggiero
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - 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, USA; Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 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, USA; Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA; Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy; Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Vincenzo Salpietro
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy; Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | | | - Federico Zara
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy; UOC Genetica Medica, IRCCS Giannina Gaslini, Genoa, Italy
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Thalwitzer KM, Xian J, de Campo D, Parthasarathy S, Magielski J, Sullivan KR, Goss J, Rigby CS, Boland M, Prosser B, Ruggiero SM, Syrbe S, Helbig I. Early life seizures and epileptic spasms in STXBP1-related disorders. Epilepsia 2024; 65:805-816. [PMID: 38279907 DOI: 10.1111/epi.17886] [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: 07/09/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVE Individuals with disease-causing variants in STXBP1 frequently have epilepsy onset in the first year of life with a variety of seizure types, including epileptic spasms. However, the impact of early onset seizures and antiseizure medication (ASM) on the risk of developing epileptic spasms and impact on their trajectory are poorly understood, limiting informed and anticipatory treatment, as well as trial design. METHODS We retrospectively reconstructed seizure and medication histories in weekly intervals for individuals with STXBP1 developmental and epileptic encephalopathy (DEE) with epilepsy onset in the first year of life and quantitatively analyzed longitudinal seizure histories and medication response. RESULTS We included 61 individuals with early onset seizures, 29 of whom had epileptic spasms. Individuals with neonatal seizures were likely to have continued seizures after the neonatal period (25/26). The risk of developing epileptic spasms was not increased in individuals with neonatal seizures or early infantile seizures (21/41 vs. 8/16, odds ratio [OR] = 1, 95% confidence interval [CI] = .3-3.9, p = 1). We did not find any ASM associated with the development of epileptic spasms following prior seizures. Individuals with prior seizures (n = 16/21, 76%) had a higher risk of developing refractory epileptic spasms (n = 5/8, 63%, OR = 1.9, 95% CI = .2-14.6, p = .6). Individuals with refractory epileptic spasms had a later onset of epileptic spasms (n = 20, median = 20 weeks) compared to individuals with nonrefractory epileptic spasms (n = 8, median = 13 weeks, p = .08). SIGNIFICANCE We provide a comprehensive assessment of early onset seizures in STXBP1-DEE and show that the risk of epileptic spasms is not increased following a prior history of early life seizures, nor by certain ASMs. Our study provides baseline information for targeted treatment and prognostication in early life seizures in STXBP1-DEE.
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Affiliation(s)
- Kim M Thalwitzer
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Pediatric Epileptology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Julie Xian
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- The Center for Epilepsy and NeuroDevelopmental Disorders, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Danielle de Campo
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- The Center for Epilepsy and NeuroDevelopmental Disorders, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shridhar Parthasarathy
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jan Magielski
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Neuroscience Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katie R Sullivan
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- The Center for Epilepsy and NeuroDevelopmental Disorders, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James Goss
- STXBP1 Foundation, Apex, Holly Springs, North Carolina, USA
| | | | - Michael Boland
- The Center for Epilepsy and NeuroDevelopmental Disorders, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Institute for Genomic Medicine, Columbia University, New York, New York, USA
| | - Ben Prosser
- The Center for Epilepsy and NeuroDevelopmental Disorders, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Physiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah M Ruggiero
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- The Center for Epilepsy and NeuroDevelopmental Disorders, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steffen Syrbe
- Division of Pediatric Epileptology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Ingo Helbig
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- The Center for Epilepsy and NeuroDevelopmental Disorders, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Jeffries L, Mis EK, McWalter K, Donkervoort S, Brodsky NN, Carpier JM, Ji W, Ionita C, Roy B, Morrow JS, Darbinyan A, Iyer K, Aul RB, Banka S, Chao KR, Cobbold L, Cohen S, Custodio HM, Drummond-Borg M, Elmslie F, Finanger E, Hainline BE, Helbig I, Hewson S, Hu Y, Jackson A, Josifova D, Konstantino M, Leach ME, Mak B, McCormick D, McGee E, Nelson S, Nguyen J, Nugent K, Ortega L, Goodkin HP, Roeder E, Roy S, Sapp K, Saade D, Sisodiya SM, Stals K, Towner S, Wilson W, Khokha MK, Bönnemann CG, Lucas CL, Lakhani SA. Biallelic CRELD1 variants cause a multisystem syndrome, including neurodevelopmental phenotypes, cardiac dysrhythmias, and frequent infections. Genet Med 2024; 26:101023. [PMID: 37947183 PMCID: PMC10932913 DOI: 10.1016/j.gim.2023.101023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE We sought to delineate a multisystem disorder caused by recessive cysteine-rich with epidermal growth factor-like domains 1 (CRELD1) gene variants. METHODS The impact of CRELD1 variants was characterized through an international collaboration utilizing next-generation DNA sequencing, gene knockdown, and protein overexpression in Xenopus tropicalis, and in vitro analysis of patient immune cells. RESULTS Biallelic variants in CRELD1 were found in 18 participants from 14 families. Affected individuals displayed an array of phenotypes involving developmental delay, early-onset epilepsy, and hypotonia, with about half demonstrating cardiac arrhythmias and some experiencing recurrent infections. Most harbored a frameshift in trans with a missense allele, with 1 recurrent variant, p.(Cys192Tyr), identified in 10 families. X tropicalis tadpoles with creld1 knockdown displayed developmental defects along with increased susceptibility to induced seizures compared with controls. Additionally, human CRELD1 harboring missense variants from affected individuals had reduced protein function, indicated by a diminished ability to induce craniofacial defects when overexpressed in X tropicalis. Finally, baseline analyses of peripheral blood mononuclear cells showed similar proportions of immune cell subtypes in patients compared with healthy donors. CONCLUSION This patient cohort, combined with experimental data, provide evidence of a multisystem clinical syndrome mediated by recessive variants in CRELD1.
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Affiliation(s)
- Lauren Jeffries
- Yale University School of Medicine, Department of Pediatrics, New Haven, CT; Yale Pediatric Genomics Discovery Program, New Haven, CT
| | - Emily K Mis
- Yale University School of Medicine, Department of Pediatrics, New Haven, CT; Yale Pediatric Genomics Discovery Program, New Haven, CT
| | | | - Sandra Donkervoort
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Nina N Brodsky
- Yale University School of Medicine, Department of Pediatrics, New Haven, CT; Yale Pediatric Genomics Discovery Program, New Haven, CT; Yale University School of Medicine, Department of Immunobiology, New Haven, CT
| | - Jean-Marie Carpier
- Yale University School of Medicine, Department of Immunobiology, New Haven, CT
| | - Weizhen Ji
- Yale University School of Medicine, Department of Pediatrics, New Haven, CT; Yale Pediatric Genomics Discovery Program, New Haven, CT
| | - Cristian Ionita
- Yale University School of Medicine, Department of Pediatrics, New Haven, CT
| | - Bhaskar Roy
- Yale University School of Medicine, Department of Neurology, New Haven, CT
| | - Jon S Morrow
- Yale University School of Medicine, Department of Pathology, New Haven, CT
| | - Armine Darbinyan
- Yale University School of Medicine, Department of Pathology, New Haven, CT
| | - Krishna Iyer
- Yale University School of Medicine, Department of Pathology, New Haven, CT
| | - Ritu B Aul
- Hospital for Sick Children, Division of Clinical and Metabolic Genetics, Toronto, Ontario, Canada
| | - Siddharth Banka
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Health Innovation Manchester, Manchester, United Kingdom; Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Katherine R Chao
- Center for Mendelian Genomics, Broad Institute of MIT and Harvard, Cambridge, MA
| | - Laura Cobbold
- South West Thames Regional Genetics Service, St George's, University of London, London, United Kingdom
| | - Stacey Cohen
- Children's Hospital of Philadelphia, Division of Neurology, Philadelphia, PA; The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA
| | - Helena M Custodio
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom
| | | | - Frances Elmslie
- South West Thames Regional Genetics Service, St George's, University of London, London, United Kingdom
| | | | - Bryan E Hainline
- Indiana University School of Medicine, Indiana University Health Physicians, Indianapolis, IN
| | - Ingo Helbig
- Children's Hospital of Philadelphia, Division of Neurology, Philadelphia, PA; University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA
| | - Stacy Hewson
- Hospital for Sick Children, Division of Clinical and Metabolic Genetics, Toronto, Ontario, Canada
| | - Ying Hu
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Adam Jackson
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Health Innovation Manchester, Manchester, United Kingdom; Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Dragana Josifova
- Guys and St Thomas NHS Trust, Clinical Genetics, London, United Kingdom
| | | | | | - Bryan Mak
- University of California Los Angeles, David Geffen School of Medicine, Department of Human Genetics, Los Angeles, CA; Current affiliation: Genome Medical, South San Francisco, CA
| | - David McCormick
- King's College Hospital, Paediatric Neurosciences, London, United Kingdom
| | - Elisabeth McGee
- University of California Los Angeles, David Geffen School of Medicine, Department of Human Genetics, Los Angeles, CA; University of California Los Angeles, Clinical Genomics Center, Los Angeles, CA; University of California Los Angeles, Center for Duchenne Muscular Dystrophy, Los Angeles, CA
| | - Stanley Nelson
- University of California Los Angeles, David Geffen School of Medicine, Department of Human Genetics, Los Angeles, CA; University of California Los Angeles, Clinical Genomics Center, Los Angeles, CA; University of California Los Angeles, Center for Duchenne Muscular Dystrophy, Los Angeles, CA
| | - Joanne Nguyen
- Cook Children's Medical Center, Division of Genetics, Fort Worth, TX
| | - Kimberly Nugent
- Baylor College of Medicine, Department of Pediatrics, Houston, TX; Baylor College of Medicine, Department of Molecular and Human Genetics, Houston, TX; Current affiliation: Cooper Surgical, Trumbull, CT
| | - Lucy Ortega
- Cook Children's Medical Center, Division of Genetics, Fort Worth, TX
| | | | - Elizabeth Roeder
- Baylor College of Medicine, Department of Pediatrics, Houston, TX; Baylor College of Medicine, Department of Molecular and Human Genetics, Houston, TX
| | - Sani Roy
- Cook Children's Medical Center, Division of Endocrinology and Diabetes, Fort Worth, TX
| | - Katie Sapp
- Indiana University School of Medicine, Indiana University Health Physicians, Indianapolis, IN
| | - Dimah Saade
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Current affiliation: University of Iowa Carver College of Medicine, Iowa City, IA
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, London, WC1N 3BG, United Kingdom; Chalfont Centre for Epilepsy, Buckinghamshire, United Kingdom
| | - Karen Stals
- Royal Devon & Exeter NHS Foundation Trust, Exeter Genomics Laboratory, Exeter, United Kingdom
| | - Shelley Towner
- University of Virginia School of Medicine, Charlottesville, VA
| | - William Wilson
- University of Virginia School of Medicine, Charlottesville, VA
| | - Mustafa K Khokha
- Yale University School of Medicine, Department of Pediatrics, New Haven, CT; Yale Pediatric Genomics Discovery Program, New Haven, CT; Yale University School of Medicine, Department of Genetics, New Haven, CT
| | - Carsten G Bönnemann
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Carrie L Lucas
- Yale Pediatric Genomics Discovery Program, New Haven, CT; Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Saquib A Lakhani
- Yale University School of Medicine, Department of Pediatrics, New Haven, CT; Yale Pediatric Genomics Discovery Program, New Haven, CT.
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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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7
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Clatot J, Currin CB, Liang Q, Pipatpolkai T, Massey SL, Helbig I, Delemotte L, Vogels TP, Covarrubias M, Goldberg EM. A structurally precise mechanism links an epilepsy-associated KCNC2 potassium channel mutation to interneuron dysfunction. Proc Natl Acad Sci U S A 2024; 121:e2307776121. [PMID: 38194456 PMCID: PMC10801864 DOI: 10.1073/pnas.2307776121] [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: 05/24/2023] [Accepted: 11/17/2023] [Indexed: 01/11/2024] Open
Abstract
De novo heterozygous variants in KCNC2 encoding the voltage-gated potassium (K+) channel subunit Kv3.2 are a recently described cause of developmental and epileptic encephalopathy (DEE). A de novo variant in KCNC2 c.374G > A (p.Cys125Tyr) was identified via exome sequencing in a patient with DEE. Relative to wild-type Kv3.2, Kv3.2-p.Cys125Tyr induces K+ currents exhibiting a large hyperpolarizing shift in the voltage dependence of activation, accelerated activation, and delayed deactivation consistent with a relative stabilization of the open conformation, along with increased current density. Leveraging the cryogenic electron microscopy (cryo-EM) structure of Kv3.1, molecular dynamic simulations suggest that a strong π-π stacking interaction between the variant Tyr125 and Tyr156 in the α-6 helix of the T1 domain promotes a relative stabilization of the open conformation of the channel, which underlies the observed gain of function. A multicompartment computational model of a Kv3-expressing parvalbumin-positive cerebral cortex fast-spiking γ-aminobutyric acidergic (GABAergic) interneuron (PV-IN) demonstrates how the Kv3.2-Cys125Tyr variant impairs neuronal excitability and dysregulates inhibition in cerebral cortex circuits to explain the resulting epilepsy.
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Affiliation(s)
- Jerome Clatot
- Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA19104
- The Epilepsy Neurogenetics Initiative, The Children’s Hospital of Philadelphia, Philadelphia,PA19104
| | | | - Qiansheng Liang
- Department of Neuroscience and Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA19107
| | - Tanadet Pipatpolkai
- Department of Applied Physics, Science for Life Laboratory, Royal Institute of Technology, SolnaSE-171 21, Sweden
| | - Shavonne L. Massey
- Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA19104
- The Epilepsy Neurogenetics Initiative, The Children’s Hospital of Philadelphia, Philadelphia,PA19104
- The Department of Neurology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA19104
| | - Ingo Helbig
- Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA19104
- The Epilepsy Neurogenetics Initiative, The Children’s Hospital of Philadelphia, Philadelphia,PA19104
- The Department of Neurology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA19104
- Department of Biomedical and Health Informatics, The Children’s Hospital of Philadelphia, Philadelphia, PA19104
| | - Lucie Delemotte
- Department of Applied Physics, Science for Life Laboratory, Royal Institute of Technology, SolnaSE-171 21, Sweden
| | - Tim P. Vogels
- The Institute of Science and Technology Austria, Klosterneuburg3400, Austria
| | - Manuel Covarrubias
- Department of Neuroscience and Vickie and Jack Farber Institute for Neuroscience, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA19107
| | - Ethan M. Goldberg
- Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA19104
- The Epilepsy Neurogenetics Initiative, The Children’s Hospital of Philadelphia, Philadelphia,PA19104
- The Department of Neurology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA19104
- The Department of Neuroscience, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA19104
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8
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Gargano MA, Matentzoglu N, Coleman B, Addo-Lartey EB, Anagnostopoulos A, Anderton J, Avillach P, Bagley AM, Bakštein E, Balhoff JP, Baynam G, Bello SM, Berk M, Bertram H, Bishop S, Blau H, Bodenstein DF, Botas P, Boztug K, Čady J, Callahan TJ, Cameron R, Carbon S, Castellanos F, Caufield JH, Chan LE, Chute C, Cruz-Rojo J, Dahan-Oliel N, Davids JR, de Dieuleveult M, de Souza V, de Vries BBA, de Vries E, DePaulo JR, Derfalvi B, Dhombres F, Diaz-Byrd C, Dingemans AJM, Donadille B, Duyzend M, Elfeky R, Essaid S, Fabrizzi C, Fico G, Firth HV, Freudenberg-Hua Y, Fullerton JM, Gabriel DL, Gilmour K, Giordano J, Goes FS, Moses RG, Green I, Griese M, Groza T, Gu W, Guthrie J, Gyori B, Hamosh A, Hanauer M, Hanušová K, He Y(O, Hegde H, Helbig I, Holasová K, Hoyt CT, Huang S, Hurwitz E, Jacobsen JOB, Jiang X, Joseph L, Keramatian K, King B, Knoflach K, Koolen DA, Kraus M, Kroll C, Kusters M, Ladewig MS, Lagorce D, Lai MC, Lapunzina P, Laraway B, Lewis-Smith D, Li X, Lucano C, Majd M, Marazita ML, Martinez-Glez V, McHenry TH, McInnis MG, McMurry JA, Mihulová M, Millett CE, Mitchell PB, Moslerová V, Narutomi K, Nematollahi S, Nevado J, Nierenberg AA, Čajbiková NN, Nurnberger JI, Ogishima S, Olson D, Ortiz A, Pachajoa H, Perez de Nanclares G, Peters A, Putman T, Rapp CK, Rath A, Reese J, Rekerle L, Roberts A, Roy S, Sanders SJ, Schuetz C, Schulte EC, Schulze TG, Schwarz M, Scott K, Seelow D, Seitz B, Shen Y, Similuk MN, Simon ES, Singh B, Smedley D, Smith CL, Smolinsky JT, Sperry S, Stafford E, Stefancsik R, Steinhaus R, Strawbridge R, Sundaramurthi JC, Talapova P, Tenorio Castano JA, Tesner P, Thomas RH, Thurm A, Turnovec M, van Gijn ME, Vasilevsky NA, Vlčková M, Walden A, Wang K, Wapner R, Ware JS, Wiafe AA, Wiafe SA, Wiggins LD, Williams AE, Wu C, Wyrwoll MJ, Xiong H, Yalin N, Yamamoto Y, Yatham LN, Yocum AK, Young AH, Yüksel Z, Zandi PP, Zankl A, Zarante I, Zvolský M, Toro S, Carmody LC, Harris NL, Munoz-Torres MC, Danis D, Mungall CJ, Köhler S, Haendel MA, Robinson PN. The Human Phenotype Ontology in 2024: phenotypes around the world. Nucleic Acids Res 2024; 52:D1333-D1346. [PMID: 37953324 PMCID: PMC10767975 DOI: 10.1093/nar/gkad1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
The Human Phenotype Ontology (HPO) is a widely used resource that comprehensively organizes and defines the phenotypic features of human disease, enabling computational inference and supporting genomic and phenotypic analyses through semantic similarity and machine learning algorithms. The HPO has widespread applications in clinical diagnostics and translational research, including genomic diagnostics, gene-disease discovery, and cohort analytics. In recent years, groups around the world have developed translations of the HPO from English to other languages, and the HPO browser has been internationalized, allowing users to view HPO term labels and in many cases synonyms and definitions in ten languages in addition to English. Since our last report, a total of 2239 new HPO terms and 49235 new HPO annotations were developed, many in collaboration with external groups in the fields of psychiatry, arthrogryposis, immunology and cardiology. The Medical Action Ontology (MAxO) is a new effort to model treatments and other measures taken for clinical management. Finally, the HPO consortium is contributing to efforts to integrate the HPO and the GA4GH Phenopacket Schema into electronic health records (EHRs) with the goal of more standardized and computable integration of rare disease data in EHRs.
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Affiliation(s)
| | | | - Ben Coleman
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | | | | | - Joel Anderton
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Anita M Bagley
- Shriners Children's Northern California, Sacramento, CA, USA
| | - Eduard Bakštein
- National Institute of Mental Health, Klecany, Czech Republic
| | - James P Balhoff
- Renaissance Computing Institute, University of North Carolina, Chapel Hill, NC 27517, USA
| | - Gareth Baynam
- Rare Care Centre, Perth Children's Hospital, Perth, Australia
| | | | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Holli Bertram
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Somer Bishop
- Department of Psychiatry and Behavioral Sciences, UCSF Weil Institute for Neuroscience, San Francisco, CA, USA
| | - Hannah Blau
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - David F Bodenstein
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | | | - Kaan Boztug
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Jolana Čady
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Tiffany J Callahan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, NY, NY, USA
| | | | - Seth J Carbon
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | | | - J Harry Caufield
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Lauren E Chan
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA
| | - Christopher G Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Jaime Cruz-Rojo
- UDISGEN (Dysmorphology and Genetics Unit), 12 de Octubre Hospital, Madrid, Spain
| | - Noémi Dahan-Oliel
- Department of Clinical Research, Shriners Hospitals for Children, Montreal, Quebec, Canada
| | - Jon R Davids
- Shriners Children's Northern California, Sacramento, CA, USA
| | - Maud de Dieuleveult
- Département I&D, AP-HP, Banque Nationale de Données Maladies Rares, Paris, France
| | - Vinicius de Souza
- European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton CB10 1SD, UK
| | - Bert B A de Vries
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - J Raymond DePaulo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Beata Derfalvi
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Ferdinand Dhombres
- Fetal Medicine Department, Armand Trousseau Hospital, Sorbonne University, GRC26, INSERM, Limics, Paris, France
| | - Claudia Diaz-Byrd
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Alexander J M Dingemans
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bruno Donadille
- St Antoine Hospital, Reference Center for Rare Growth Endocrine Disorders, Sorbonne University, AP-HP, INSERM, US14 - Orphanet, Plateforme Maladies Rares, Paris, France
| | | | - Reem Elfeky
- Department of Immunology, GOS Hospital for Children NHS Foundation Trust, University College London, London, UK
| | - Shahim Essaid
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Helen V Firth
- Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Yun Freudenberg-Hua
- Department of Psychiatry, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | | | - Davera L Gabriel
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | | | - Jessica Giordano
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Rachel Gore Moses
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ian Green
- SNOMED International, London W2 6BD, UK
| | - Matthias Griese
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, German center for Lung research (DZL), Munich, Germany
| | - Tudor Groza
- Rare Care Centre, Perth Children's Hospital, Perth, Australia
| | | | - Julia Guthrie
- Department of Structural and Computational Biology, University of Vienna; Max Perutz Labs, Vienna, Austria
| | - Benjamin Gyori
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
| | - Ada Hamosh
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Marc Hanauer
- INSERM, US14 - Orphanet, Plateforme Maladies Rares, Paris, France
| | - Kateřina Hanušová
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | | | - Harshad Hegde
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Ingo Helbig
- Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Kateřina Holasová
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Charles Tapley Hoyt
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
| | | | - Eric Hurwitz
- University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Julius O B Jacobsen
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Lisa Joseph
- Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, Bethesda, MD, USA
| | - Kamyar Keramatian
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Bryan King
- Department of Psychiatry and Behavioral Sciences, UCSF Weil Institute for Neuroscience, San Francisco, CA, USA
| | - Katrin Knoflach
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, German center for Lung research (DZL), Munich, Germany
| | - David A Koolen
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Megan L Kraus
- University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Carlo Kroll
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Maaike Kusters
- Immunology, NIHR Great Ormond Street Hospital BRC, London, UK
| | - Markus S Ladewig
- Department of Ophthalmology, University Clinic Marburg - Campus Fulda, Fulda, Germany
| | - David Lagorce
- INSERM, US14 - Orphanet, Plateforme Maladies Rares, Paris, France
| | - Meng-Chuan Lai
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Pablo Lapunzina
- Institute of Medical and Molecular Genetics, Hospital Univ. La Paz, Madrid, Spain
| | - Bryan Laraway
- University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - David Lewis-Smith
- Translational and Clinical Research Institute, Henry Wellcome Building, Framlington Place, Newcastle University, Newcastle-Upon-Tyne NE14LP, UK
| | | | - Caterina Lucano
- INSERM, US14 - Orphanet, Plateforme Maladies Rares, Paris, France
| | - Marzieh Majd
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mary L Marazita
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Victor Martinez-Glez
- Center for Genomic Medicine, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | - Toby H McHenry
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Julie A McMurry
- University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Michaela Mihulová
- Department of Biology and Medical Genetics, 2nd Medical Faculty of Charles University and University Hospital Motol, Prague, Czech Republic
| | - Caitlin E Millett
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Philip B Mitchell
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Veronika Moslerová
- Department of Biology and Medical Genetics, 2nd Medical Faculty of Charles University and University Hospital Motol, Prague, Czech Republic
| | - Kenji Narutomi
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center
| | - Shahrzad Nematollahi
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Julian Nevado
- Institute of Medical and Molecular Genetics, Hospital Univ. La Paz, Madrid, Spain
| | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | - Nikola Novák Čajbiková
- Department of Biology and Medical Genetics, 2nd Medical Faculty of Charles University and University Hospital Motol, Prague, Czech Republic
| | - John I Nurnberger
- Stark Neurosciences Research Institute, Departments of Psychiatry and Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Daniel Olson
- Data Collaboration Center, Data Science, Critical Path Institute, Tucson, AZ, USA
| | - Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Harry Pachajoa
- Centro de Investigaciones en Anomalías Congénitas y Enfermedades Raras (CIACER), Universidad Icesi, Cali, Colombia
| | - Guiomar Perez de Nanclares
- Molecular (epi) genetics lab, Bioaraba Health Research Institute, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Amy Peters
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Tim Putman
- University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Christina K Rapp
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, German center for Lung research (DZL), Munich, Germany
| | - Ana Rath
- INSERM, US14 - Orphanet, Plateforme Maladies Rares, Paris, France
| | - Justin Reese
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Lauren Rekerle
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Angharad M Roberts
- National Heart & Lung Institute & MRC London Institute of Medical Sciences, Imperial College London, London W12 0HS, UK
| | - Suzy Roy
- SNOMED International, London W2 6BD, UK
| | - Stephan J Sanders
- Department of Paediatrics, Institute of Developmental and Regenerative Medicine, University of Oxford, Oxford, UK
| | - Catharina Schuetz
- Universitätsklinikum Carl Gustav Carus, Medizinische Fakultät, TU, Dresden, Germany
| | - Eva C Schulte
- Institute of Psychiatric Phenomics and Genomics (IPPG), LMU University Hospital, LMU Munich, Munich, Germany
| | - Thomas G Schulze
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Martin Schwarz
- Department of Biology and Medical Genetics, 2nd Medical Faculty of Charles University and University Hospital Motol, Prague, Czech Republic
| | - Katie Scott
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Dominik Seelow
- Exploratory Diagnostic Sciences, Berliner Institut für Gesundheitsforschung - Charité, Berlin, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg/Saar, Germany
| | | | - Morgan N Similuk
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Eric S Simon
- Eisenberg Family Depression Center, University of Michigan, Ann Arbor, MI, USA
| | - Balwinder Singh
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Damian Smedley
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Jake T Smolinsky
- Human Genetics Institute of New Jersey, Rutgers University, Piscataway, NJ, USA
| | - Sarah Sperry
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | - Ray Stefancsik
- European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton CB10 1SD, UK
| | - Robin Steinhaus
- Exploratory Diagnostic Sciences, Berliner Institut für Gesundheitsforschung - Charité, Berlin, Germany
| | - Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Polina Talapova
- Institute for Research and Health Policy Studies, Tufts Medicine, Boston, MA 2111, USA
| | | | - Pavel Tesner
- Department of Biology and Medical Genetics, 2nd Medical Faculty of Charles University and University Hospital Motol, Prague, Czech Republic
| | - Rhys H Thomas
- Translational and Clinical Research Institute, Henry Wellcome Building, Framlington Place, Newcastle University, Newcastle-Upon-Tyne NE14LP, UK
| | - Audrey Thurm
- Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, Bethesda, MD, USA
| | - Marek Turnovec
- Department of Biology and Medical Genetics, 2nd Medical Faculty of Charles University and University Hospital Motol, Prague, Czech Republic
| | - Marielle E van Gijn
- Department of Genetics, University Medical Center Groningen, Groningen, Netherlands
| | | | - Markéta Vlčková
- Department of Biology and Medical Genetics, 2nd Medical Faculty of Charles University and University Hospital Motol, Prague, Czech Republic
| | - Anita Walden
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kai Wang
- Chinese HPO Consortium, Beijing, China
| | - Ron Wapner
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - James S Ware
- National Heart & Lung Institute & MRC London Institute of Medical Sciences, Imperial College London, London W12 0HS, UK
| | | | | | - Lisa D Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrew E Williams
- Institute for Research and Health Policy Studies, Tufts Medicine, Boston, MA 2111, USA
| | - Chen Wu
- Chinese HPO Consortium, Beijing, China
| | - Margot J Wyrwoll
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, Institute for Stem Cell Research, University of Edinburgh, Edinburgh, UK
| | - Hui Xiong
- Chinese HPO Consortium, Beijing, China
| | - Nefize Yalin
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Yasunori Yamamoto
- Database Center for Life Science, Joint Support-Center for Data Science Research, Research Organization of Information and Systems, Japan
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Anastasia K Yocum
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Allan H Young
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, London SE5 8AF, UK
| | - Zafer Yüksel
- Department of Human Genetics, Bioscientia Healthcare GmbH, Ingelheim, Germany
| | - Peter P Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Andreas Zankl
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Ignacio Zarante
- Institute of Human Genetics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Miroslav Zvolský
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Sabrina Toro
- University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Leigh C Carmody
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Nomi L Harris
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Monica C Munoz-Torres
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Daniel Danis
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Christopher J Mungall
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | | | - Melissa A Haendel
- University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Peter N Robinson
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
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9
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Li D, Wang Q, Bayat A, Battig MR, Zhou Y, Bosch DG, van Haaften G, Granger L, Petersen AK, Pérez-Jurado LA, Aznar-Laín G, Aneja A, Hancarova M, Bendova S, Schwarz M, Kremlikova Pourova R, Sedlacek Z, Keena BA, March ME, Hou C, O’Connor N, Bhoj EJ, Harr MH, Lemire G, Boycott KM, Towne M, Li M, Tarnopolsky M, Brady L, Parker MJ, Faghfoury H, Parsley LK, Agolini E, Dentici ML, Novelli A, Wright M, Palmquist R, Lai K, Scala M, Striano P, Iacomino M, Zara F, Cooper A, Maarup TJ, Byler M, Lebel RR, Balci TB, Louie R, Lyons M, Douglas J, Nowak C, Afenjar A, Hoyer J, Keren B, Maas SM, Motazacker MM, Martinez-Agosto JA, Rabani AM, McCormick EM, Falk MJ, Ruggiero SM, Helbig I, Møller RS, Tessarollo L, Tomassoni Ardori F, Palko ME, Hsieh TC, Krawitz PM, Ganapathi M, Gelb BD, Jobanputra V, Wilson A, Greally J, Jacquemont S, Jizi K, Bruel AL, Quelin C, Misra VK, Chick E, Romano C, Greco D, Arena A, Morleo M, Nigro V, Seyama R, Uchiyama Y, Matsumoto N, Taira R, Tashiro K, Sakai Y, Yigit G, Wollnik B, Wagner M, Kutsche B, Hurst AC, Thompson ML, Schmidt R, Randolph L, Spillmann RC, Shashi V, Higginbotham EJ, Cordeiro D, Carnevale A, Costain G, Khan T, Funalot B, Tran Mau-Them F, Fernandez Garcia Moya L, García-Miñaúr S, Osmond M, Chad L, Quercia N, Carrasco D, Li C, Sanchez-Valle A, Kelley M, Nizon M, Jensson BO, Sulem P, Stefansson K, Gorokhova S, Busa T, Rio M, Hadj Habdallah H, Lesieur-Sebellin M, Amiel J, Pingault V, Mercier S, Vincent M, Philippe C, Fatus-Fauconnier C, Friend K, Halligan RK, Biswas S, Rosser J, Shoubridge C, Corbett M, Barnett C, Gecz J, Leppig K, Slavotinek A, Marcelis C, Pfundt R, de Vries BB, van Slegtenhorst MA, Brooks AS, Cogne B, Rambaud T, Tümer Z, Zackai EH, Akizu N, Song Y, Hakonarson H. Spliceosome malfunction causes neurodevelopmental disorders with overlapping features. J Clin Invest 2024; 134:e171235. [PMID: 37962958 PMCID: PMC10760965 DOI: 10.1172/jci171235] [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: 04/06/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023] Open
Abstract
Pre-mRNA splicing is a highly coordinated process. While its dysregulation has been linked to neurological deficits, our understanding of the underlying molecular and cellular mechanisms remains limited. We implicated pathogenic variants in U2AF2 and PRPF19, encoding spliceosome subunits in neurodevelopmental disorders (NDDs), by identifying 46 unrelated individuals with 23 de novo U2AF2 missense variants (including 7 recurrent variants in 30 individuals) and 6 individuals with de novo PRPF19 variants. Eight U2AF2 variants dysregulated splicing of a model substrate. Neuritogenesis was reduced in human neurons differentiated from human pluripotent stem cells carrying two U2AF2 hyper-recurrent variants. Neural loss of function (LoF) of the Drosophila orthologs U2af50 and Prp19 led to lethality, abnormal mushroom body (MB) patterning, and social deficits, which were differentially rescued by wild-type and mutant U2AF2 or PRPF19. Transcriptome profiling revealed splicing substrates or effectors (including Rbfox1, a third splicing factor), which rescued MB defects in U2af50-deficient flies. Upon reanalysis of negative clinical exomes followed by data sharing, we further identified 6 patients with NDD who carried RBFOX1 missense variants which, by in vitro testing, showed LoF. Our study implicates 3 splicing factors as NDD-causative genes and establishes a genetic network with hierarchy underlying human brain development and function.
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Affiliation(s)
- Dong Li
- Center for Applied Genomics, and
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Qin Wang
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Allan Bayat
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department for Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | | | - Yijing Zhou
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Daniëlle G.M. Bosch
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gijs van Haaften
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Leslie Granger
- Department of Genetics and Metabolism, Randall Children’s Hospital at Legacy Emanuel Medical Center, Portland, Oregon, USA
| | - Andrea K. Petersen
- Department of Genetics and Metabolism, Randall Children’s Hospital at Legacy Emanuel Medical Center, Portland, Oregon, USA
| | - Luis A. Pérez-Jurado
- Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain
- Genetic Service, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Gemma Aznar-Laín
- Universitat Pompeu Fabra, Barcelona, Spain
- Pediatric Neurology, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Anushree Aneja
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Miroslava Hancarova
- Department of Biology and Medical Genetics, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Sarka Bendova
- Department of Biology and Medical Genetics, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Martin Schwarz
- Department of Biology and Medical Genetics, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Radka Kremlikova Pourova
- Department of Biology and Medical Genetics, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Zdenek Sedlacek
- Department of Biology and Medical Genetics, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic
| | - Beth A. Keena
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Elizabeth J. Bhoj
- Center for Applied Genomics, and
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Gabrielle Lemire
- Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kym M. Boycott
- Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Megan Li
- Invitae, San Francisco, California, USA
| | - Mark Tarnopolsky
- Division of Neuromuscular and Neurometabolic Disorders, Department of Paediatrics, McMaster University Children’s Hospital, Hamilton, Ontario, Canada
| | - Lauren Brady
- Division of Neuromuscular and Neurometabolic Disorders, Department of Paediatrics, McMaster University Children’s Hospital, Hamilton, Ontario, Canada
| | - Michael J. Parker
- Department of Clinical Genetics, Sheffield Children’s Hospital, Sheffield, United Kingdom
| | | | - Lea Kristin Parsley
- University of Illinois College of Medicine, Mercy Health Systems, Rockford, Illinois, USA
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Maria Lisa Dentici
- Medical Genetics Unit, Academic Department of Pediatrics, IRCCS, Ospedale Pediatrico Bambino Gesù, Rome, Italy
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Antonio Novelli
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Meredith Wright
- Rady Children’s Institute for Genomic Medicine, San Diego, California, USA
| | - Rachel Palmquist
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Khanh Lai
- Division of Pediatric Pulmonary and Sleep Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Marcello Scala
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università Degli Studi di Genova, Genoa, Italy
- Pediatric Neurology and Muscular Diseases Unit, and
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università Degli Studi di Genova, Genoa, Italy
- Pediatric Neurology and Muscular Diseases Unit, and
| | - Michele Iacomino
- Medical Genetics Unit, IRCCS, Istituto Giannina Gaslini, Genoa, Italy
| | - Federico Zara
- Medical Genetics Unit, IRCCS, Istituto Giannina Gaslini, Genoa, Italy
| | - Annina Cooper
- Department of Genetics, Southern California Permanente Medical Group, Kaiser Permanente, San Diego, California, USA
| | - Timothy J. Maarup
- Department of Genetics, Kaiser Permanente, Los Angeles, California, USA
| | - Melissa Byler
- Center for Development, Behavior and Genetics, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Robert Roger Lebel
- Center for Development, Behavior and Genetics, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Tugce B. Balci
- Division of Genetics, Department of Paediatrics, London Health Sciences Centre, London, Ontario, Canada
| | - Raymond Louie
- Greenwood Genetic Center, Greenwood, South Carolina, USA
| | - Michael Lyons
- Greenwood Genetic Center, Greenwood, South Carolina, USA
| | - Jessica Douglas
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Catherine Nowak
- Division of Genetics and Metabolism, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Alexandra Afenjar
- APHP. SU, Reference Center for Intellectual Disabilities Caused by Rare Causes, Department of Genetics and Medical Embryology, Hôpital Trousseau, Paris, France
| | - Juliane Hoyer
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Boris Keren
- Department of Genetics, Hospital Pitié-Salpêtrière, Paris, France
| | - Saskia M. Maas
- Department of Human Genetics, Academic Medical Center, and
| | - Mahdi M. Motazacker
- Laboratory of Genome Diagnostics, Department of Human Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Ahna M. Rabani
- Division of Medical Genetics, Department of Pediatrics, UCLA, Los Angeles, California, USA
| | - Elizabeth M. McCormick
- Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics
| | - Marni J. Falk
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics
| | - Sarah M. Ruggiero
- Division of Neurology, and
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ingo Helbig
- Division of Neurology, and
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rikke S. Møller
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Centre, Dianalund, Denmark
| | - Lino Tessarollo
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute (NCI), Frederick, Maryland, USA
| | - Francesco Tomassoni Ardori
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute (NCI), Frederick, Maryland, USA
| | - Mary Ellen Palko
- Mouse Cancer Genetics Program, Center for Cancer Research, National Cancer Institute (NCI), Frederick, Maryland, USA
| | - Tzung-Chien Hsieh
- Institute for Genomic Statistics and Bioinformatics, 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
| | - Mythily Ganapathi
- New York Genome Center, New York, New York, USA
- Department of Pathology, Columbia University Irving Medical Center, New York, New York, USA
| | - Bruce D. Gelb
- Mindich Child Health and Development Institute and the Departments of Pediatrics and Genetics and Genomic Sciences, Icahn School of Medicine, New York, New York, USA
| | - Vaidehi Jobanputra
- New York Genome Center, New York, New York, USA
- Department of Pathology, Columbia University Irving Medical Center, New York, New York, USA
| | | | - John Greally
- Department of Genetics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sébastien Jacquemont
- Division of Genetics and Genomics, CHU Ste-Justine Hospital and CHU Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Khadijé Jizi
- Division of Genetics and Genomics, CHU Ste-Justine Hospital and CHU Sainte-Justine Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Ange-Line Bruel
- INSERM UMR 1231, Genetics of Developmental Anomalies, Université de Bourgogne Franche-Comté, Dijon, France
- UF Innovation en Diagnostic Génomique des Maladies Rares, CHU Dijon Bourgogne, Dijon, France
- FHU-TRANSLAD, Fédération Hospitalo-Universitaire Translational Medicine in Developmental Anomalies, CHU Dijon Bourgogne, Dijon, France
| | - Chloé Quelin
- Medical Genetics Department, Centre de Référence Maladies Rares CLAD-Ouest, CHU Hôpital Sud, Rennes, France
| | - Vinod K. Misra
- Division of Genetic, Genomic, and Metabolic Disorders, Children’s Hospital of Michigan, Detroit, Michigan, USA
- Central Michigan University College of Medicine, Discipline of Pediatrics, Mount Pleasant, Michigan, USA
| | - Erika Chick
- Division of Genetic, Genomic, and Metabolic Disorders, Children’s Hospital of Michigan, Detroit, Michigan, USA
| | - Corrado Romano
- Research Unit of Rare Diseases and Neurodevelopmental Disorders, Oasi Research Institute-IRCCS, Troina, Italy
- Medical Genetics, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | | | | - Manuela Morleo
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Naples, Italy
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Vincenzo Nigro
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Naples, Italy
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Rie Seyama
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Obstetrics and Gynecology, Juntendo University, Tokyo, Japan
| | - Yuri Uchiyama
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Rare Disease Genomics, Yokohama City University Hospital, Yokohama, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryoji Taira
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsuya Tashiro
- Department of Pediatrics, Karatsu Red Cross Hospital, Saga, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Gökhan Yigit
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Bernd Wollnik
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
- Cluster of Excellence “Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells” (MBExC), University of Göttingen, Göttingen, Germany
| | - Michael Wagner
- Kinderzentrum Oldenburg, Sozialpädiatrisches Zentrum, Diakonisches Werk Oldenburg, Oldenburg, Germany
| | - Barbara Kutsche
- Kinderzentrum Oldenburg, Sozialpädiatrisches Zentrum, Diakonisches Werk Oldenburg, Oldenburg, Germany
| | - Anna C.E. Hurst
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Ryan Schmidt
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, California, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Linda Randolph
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
- Division of Medical Genetics, Children’s Hospital Los Angeles, California, USA
| | - Rebecca C. Spillmann
- Department of Pediatrics–Medical Genetics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Vandana Shashi
- Department of Pediatrics–Medical Genetics, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Dawn Cordeiro
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amanda Carnevale
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gregory Costain
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tayyaba Khan
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Benoît Funalot
- Department of Genetics, Hôpital Henri-Mondor APHP and CHI Creteil, University Paris Est Creteil, IMRB, Inserm U.955, Creteil, France
| | - Frederic Tran Mau-Them
- INSERM UMR 1231, Genetics of Developmental Anomalies, Université de Bourgogne Franche-Comté, Dijon, France
- UF Innovation en Diagnostic Génomique des Maladies Rares, CHU Dijon Bourgogne, Dijon, France
| | | | - Sixto García-Miñaúr
- Institute of Medical and Molecular Genetics (INGEMM), Hospital Universitario La Paz, Madrid, Spain
| | - Matthew Osmond
- Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Lauren Chad
- Department of Pediatrics, Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nada Quercia
- Department of Genetic Counselling, Division of Clinical and Metabolic Genetics, Hospital for Sick Children, Ottawa, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Diana Carrasco
- Department of Clinical Genetics, Cook Children’s Hospital, Fort Worth, Texas, USA
| | - Chumei Li
- Division of Genetics, Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Amarilis Sanchez-Valle
- Division of Genetics and Metabolism, Department of Pediatrics, University of South Florida, Tampa, Florida, USA
| | - Meghan Kelley
- Division of Genetics and Metabolism, Department of Pediatrics, University of South Florida, Tampa, Florida, USA
| | - Mathilde Nizon
- Nantes Université, CHU Nantes, Medical Genetics Department, Nantes, France
- Nantes Université, CNRS, INSERM, l’Institut du Thorax, Nantes, France
| | | | | | - Kari Stefansson
- deCODE genetics/Amgen Inc., Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Svetlana Gorokhova
- Aix Marseille University, Inserm, U1251-MMG, Marseille Medical Genetics, Marseille, France
- Department of Medical Genetics, Timone Hospital, APHM, Marseille, France
| | - Tiffany Busa
- Department of Medical Genetics, Timone Hospital, APHM, Marseille, France
| | - Marlène Rio
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Hamza Hadj Habdallah
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Marion Lesieur-Sebellin
- Department of Genomic Medicine of Rare Disorders, Necker Hospital, APHP Center, University Paris Cité, Paris, France
| | - Jeanne Amiel
- Rare Disease Genetics Department, APHP, Hôpital Necker, Paris, France
- Université Paris Cité, Inserm, Institut Imagine, Embryology and Genetics of Malformations Laboratory, Paris, France
| | - Véronique Pingault
- Rare Disease Genetics Department, APHP, Hôpital Necker, Paris, France
- Université Paris Cité, Inserm, Institut Imagine, Embryology and Genetics of Malformations Laboratory, Paris, France
- Laboratoire de Biologie Médicale Multi-Sites SeqOIA (laboratoire-seqoia.fr), Paris, France
| | - Sandra Mercier
- Nantes Université, CHU Nantes, Medical Genetics Department, Nantes, France
- Nantes Université, CNRS, INSERM, l’Institut du Thorax, Nantes, France
| | - Marie Vincent
- Nantes Université, CHU Nantes, Medical Genetics Department, Nantes, France
- Nantes Université, CNRS, INSERM, l’Institut du Thorax, Nantes, France
| | - Christophe Philippe
- INSERM UMR 1231, Genetics of Developmental Anomalies, Université de Bourgogne Franche-Comté, Dijon, France
| | | | - Kathryn Friend
- Genetics and Molecular Pathology, SA Pathology, Adelaide, South Australia, Australia
| | | | | | - Jane Rosser
- Department of General Medicine, Women’s and Children’s Hospital, Adelaide, South Australia, Australia
| | - Cheryl Shoubridge
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, South Australia, Australia
| | - Mark Corbett
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, South Australia, Australia
| | - Christopher Barnett
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, South Australia, Australia
- Pediatric and Reproductive Genetics Unit, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia
| | - Jozef Gecz
- Adelaide Medical School and Robinson Research Institute, The University of Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Kathleen Leppig
- Genetic Services, Kaiser Permenante of Washington, Seattle, Washington, USA
| | - Anne Slavotinek
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Carlo Marcelis
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rolph Pfundt
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bert B.A. de Vries
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Alice S. Brooks
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Benjamin Cogne
- Nantes Université, CHU Nantes, Medical Genetics Department, Nantes, France
- Nantes Université, CNRS, INSERM, l’Institut du Thorax, Nantes, France
- Laboratoire de Biologie Médicale Multi-Sites SeqOIA (laboratoire-seqoia.fr), Paris, France
| | - Thomas Rambaud
- Laboratoire de Biologie Médicale Multi-Sites SeqOIA (laboratoire-seqoia.fr), Paris, France
| | - Zeynep Tümer
- Kennedy Center, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Elaine H. Zackai
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Naiara Akizu
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yuanquan Song
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hakon Hakonarson
- Center for Applied Genomics, and
- Division of Human Genetics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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10
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Scala M, Bradley CA, Howe JL, Trost B, Salazar NB, Shum C, Reuter MS, MacDonald JR, Ko SY, Frankland PW, Granger L, Anadiotis G, Pullano V, Brusco A, Keller R, Parisotto S, Pedro HF, Lusk L, McDonnell PP, Helbig I, Mullegama SV, Douine ED, Russell BE, Nelson SF, Zara F, Scherer SW. Genetic variants in DDX53 contribute to Autism Spectrum Disorder associated with the Xp22.11 locus. medRxiv 2023:2023.12.21.23300383. [PMID: 38234782 PMCID: PMC10793518 DOI: 10.1101/2023.12.21.23300383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Autism Spectrum Disorder (ASD) exhibits an ~4:1 male-to-female sex bias and is characterized by early-onset impairment of social/communication skills, restricted interests, and stereotyped behaviors. Disruption of the Xp22.11 locus has been associated with ASD in males. This locus includes the three-exon PTCHD1 gene, an adjacent multi-isoform long noncoding RNA (lncRNA) named PTCHD1-AS (spanning ~1Mb), and a poorly characterized single-exon RNA helicase named DDX53 that is intronic to PTCHD1-AS. While the relationship between PTCHD1/PTCHD1-AS and ASD is being studied, the role of DDX53 has not been examined, in part because there is no apparent functional murine orthologue. Through clinical testing, here, we identified 6 males and 1 female with ASD from 6 unrelated families carrying rare, predicted-damaging or loss-of-function variants in DDX53. Then, we examined databases, including the Autism Speaks MSSNG and Simons Foundation Autism Research Initiative, as well as population controls. We identified 24 additional individuals with ASD harboring rare, damaging DDX53 variations, including the same variants detected in two families from the original clinical analysis. In this extended cohort of 31 participants with ASD (28 male, 3 female), we identified 25 mostly maternally-inherited variations in DDX53, including 18 missense changes, 2 truncating variants, 2 in-frame variants, 2 deletions in the 3' UTR and 1 copy number deletion. Our findings in humans support a direct link between DDX53 and ASD, which will be important in clinical genetic testing. These same autism-related findings, coupled with the observation that a functional orthologous gene is not found in mouse, may also influence the design and interpretation of murine-modelling of ASD.
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Affiliation(s)
- Marcello Scala
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- UOC Genetica Medica, IRCCS Giannina Gaslini, Genoa, Italy
| | - Clarrisa A. Bradley
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Program in Neurosciences and Mental Health, The Hospital for Sick Children and Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer L. Howe
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Brett Trost
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Nelson Bautista Salazar
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Carole Shum
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Miriam S. Reuter
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Jeffrey R. MacDonald
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Sangyoon Y. Ko
- Program in Neurosciences and Mental Health, The Hospital for Sick Children and Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Paul W. Frankland
- Program in Neurosciences and Mental Health, The Hospital for Sick Children and Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Leslie Granger
- Department of Genetics and Metabolism, Randall Children’s Hospital, Portland, OR 97227, USA
| | - George Anadiotis
- Department of Genetics and Metabolism, Randall Children’s Hospital, Portland, OR 97227, USA
| | - Verdiana Pullano
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Alfredo Brusco
- Department of Neurosciences Rita Levi-Montalcini, University of Turin, 10126 Turin, Italy
- Medical Genetics Unit, Città della Salute e della Scienza University Hospital, Torino, Italy
| | - Roberto Keller
- Adult Autism Centre DSM ASL Città di Torino, 10138 Turin, Italy
| | - Sarah Parisotto
- Center for Genetic and Genomic Medicine, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Helio F. Pedro
- Center for Genetic and Genomic Medicine, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Laina Lusk
- Epilepsy Neurogenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Pamela Pojomovsky McDonnell
- Epilepsy Neurogenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ingo Helbig
- Epilepsy Neurogenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | - Emilie D. Douine
- Department of Human Genetics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Bianca E. Russell
- Department of Human Genetics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Stanley F. Nelson
- Department of Human Genetics, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Federico Zara
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- UOC Genetica Medica, IRCCS Giannina Gaslini, Genoa, Italy
| | - Stephen W. Scherer
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada
- McLaughlin Centre, Toronto, ON M5G 0A4, Canada
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11
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Morgan AT, Scerri TS, Vogel AP, Reid CA, Quach M, Jackson VE, McKenzie C, Burrows EL, Bennett MF, Turner SJ, Reilly S, Horton SE, Block S, Kefalianos E, Frigerio-Domingues C, Sainz E, Rigbye KA, Featherby TJ, Richards KL, Kueh A, Herold MJ, Corbett MA, Gecz J, Helbig I, Thompson-Lake DGY, Liégeois FJ, Morell RJ, Hung A, Drayna D, Scheffer IE, Wright DK, Bahlo M, Hildebrand MS. Stuttering associated with a pathogenic variant in the chaperone protein cyclophilin 40. Brain 2023; 146:5086-5097. [PMID: 37977818 PMCID: PMC10689913 DOI: 10.1093/brain/awad314] [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: 05/12/2023] [Revised: 07/26/2023] [Accepted: 08/10/2023] [Indexed: 11/19/2023] Open
Abstract
Stuttering is a common speech disorder that interrupts speech fluency and tends to cluster in families. Typically, stuttering is characterized by speech sounds, words or syllables which may be repeated or prolonged and speech that may be further interrupted by hesitations or 'blocks'. Rare variants in a small number of genes encoding lysosomal pathway proteins have been linked to stuttering. We studied a large four-generation family in which persistent stuttering was inherited in an autosomal dominant manner with disruption of the cortico-basal-ganglia-thalamo-cortical network found on imaging. Exome sequencing of three affected family members revealed the PPID c.808C>T (p.Pro270Ser) variant that segregated with stuttering in the family. We generated a Ppid p.Pro270Ser knock-in mouse model and performed ex vivo imaging to assess for brain changes. Diffusion-weighted MRI in the mouse revealed significant microstructural changes in the left corticospinal tract, as previously implicated in stuttering. Quantitative susceptibility mapping also detected changes in cortico-striatal-thalamo-cortical loop tissue composition, consistent with findings in affected family members. This is the first report to implicate a chaperone protein in the pathogenesis of stuttering. The humanized Ppid murine model recapitulates network findings observed in affected family members.
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Affiliation(s)
- Angela T Morgan
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville 3052, Australia
| | - Thomas S Scerri
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
| | - Adam P Vogel
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville 3052, Australia
- Centre for Neuroscience of Speech, The University of Melbourne, Parkville 3053, Australia
- Clinical Trials, Redenlab Inc., Melbourne 3000, Australia
| | - Christopher A Reid
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Heidelberg 3084, Australia
| | - Mara Quach
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3004, Australia
| | - Victoria E Jackson
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
| | - Chaseley McKenzie
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
| | - Emma L Burrows
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
| | - Mark F Bennett
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Heidelberg 3084, Australia
| | | | - Sheena Reilly
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Menzies Health Institute Queensland, Griffith University, 4215 Southport, Australia
| | - Sarah E Horton
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville 3052, Australia
| | - Susan Block
- Discipline of Speech Pathology, School of Allied Health, La Trobe University, Bundoora 3086, Australia
| | - Elaina Kefalianos
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Parkville 3052, Australia
| | - Carlos Frigerio-Domingues
- Laboratory of Communication Disorders, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892-2320, USA
| | - Eduardo Sainz
- Laboratory of Communication Disorders, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892-2320, USA
| | - Kristin A Rigbye
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Heidelberg 3084, Australia
| | - Travis J Featherby
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
| | - Kay L Richards
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
| | - Andrew Kueh
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
| | - Marco J Herold
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
| | - Mark A Corbett
- Adelaide Medical School, The University of Adelaide, Adelaide 5000, Australia
- Neurogenetics Research Program, South Australian Health and Medical Research Institute, Adelaide 5000, Australia
| | - Jozef Gecz
- Adelaide Medical School, The University of Adelaide, Adelaide 5000, Australia
- Neurogenetics Research Program, South Australian Health and Medical Research Institute, Adelaide 5000, Australia
| | - Ingo Helbig
- Department of Neurology, Children’s Hospital, Philadelphia, PA 19104, USA
| | - Daisy G Y Thompson-Lake
- Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Frédérique J Liégeois
- Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Robert J Morell
- Laboratory of Molecular Genetics, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
- Genomics and Computational Biology Core, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
| | - Andrew Hung
- School of Science, STEM College, RMIT University, Melbourne 3001, Australia
| | - Dennis Drayna
- Laboratory of Communication Disorders, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892-2320, USA
| | - Ingrid E Scheffer
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, 3052, Parkville 3052, Australia
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Heidelberg 3084, Australia
- Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville 3052, Australia
| | - David K Wright
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne 3004, Australia
| | - Melanie Bahlo
- The Walter and Eliza Hall Institute of Medical Research, Parkville 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville 3052, Australia
- School of Mathematics and Statistics, University of Melbourne, 3010 Parkville, Australia
| | - Michael S Hildebrand
- Murdoch Children’s Research Institute, Parkville 3052, Australia
- Department of Medicine, Epilepsy Research Centre, University of Melbourne, Heidelberg 3084, Australia
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12
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Xian J, Thalwitzer KM, McKee J, Sullivan KR, Brimble E, Fitch E, Toib J, Kaufman MC, deCampo D, Cunningham K, Pierce SR, Goss J, Rigby CS, Syrbe S, Boland M, Prosser B, Fitter N, Ruggiero SM, Helbig I. Delineating clinical and developmental outcomes in STXBP1-related disorders. Brain 2023; 146:5182-5197. [PMID: 38015929 PMCID: PMC10689925 DOI: 10.1093/brain/awad287] [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: 05/10/2023] [Revised: 07/31/2023] [Accepted: 08/18/2023] [Indexed: 11/30/2023] Open
Abstract
STXBP1-related disorders are among the most common genetic epilepsies and neurodevelopmental disorders. However, the longitudinal epilepsy course and developmental end points, have not yet been described in detail, which is a critical prerequisite for clinical trial readiness. Here, we assessed 1281 cumulative patient-years of seizure and developmental histories in 162 individuals with STXBP1-related disorders and established a natural history framework. STXBP1-related disorders are characterized by a dynamic pattern of seizures in the first year of life and high variability in neurodevelopmental trajectories in early childhood. Epilepsy onset differed across seizure types, with 90% cumulative onset for infantile spasms by 6 months and focal-onset seizures by 27 months of life. Epilepsy histories diverged between variant subgroups in the first 2 years of life, when individuals with protein-truncating variants and deletions in STXBP1 (n = 39) were more likely to have infantile spasms between 5 and 6 months followed by seizure remission, while individuals with missense variants (n = 30) had an increased risk for focal seizures and ongoing seizures after the first year. Developmental outcomes were mapped using milestone acquisition data in addition to standardized assessments including the Gross Motor Function Measure-66 Item Set and the Grasping and Visual-Motor Integration subsets of the Peabody Developmental Motor Scales. Quantification of end points revealed high variability during the first 5 years of life, with emerging stratification between clinical subgroups. An earlier epilepsy onset was associated with lower developmental abilities, most prominently when assessing gross motor development and expressive communication. We found that individuals with neonatal seizures or early infantile seizures followed by seizure offset by 12 months of life had more predictable seizure trajectories in early to late childhood compared to individuals with more severe seizure presentations, including individuals with refractory epilepsy throughout the first year. Characterization of anti-seizure medication response revealed age-dependent response over time, with phenobarbital, levetiracetam, topiramate and adrenocorticotropic hormone effective in reducing seizures in the first year of life, while clobazam and the ketogenic diet were effective in long-term seizure management. Virtual clinical trials using seizure frequency as the primary outcome resulted in wide range of trial success probabilities across the age span, with the highest probability in early childhood between 1 year and 3.5 years. In summary, we delineated epilepsy and developmental trajectories in STXBP1-related disorders using standardized measures, providing a foundation to interpret future therapeutic strategies and inform rational trial design.
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Affiliation(s)
- Julie Xian
- 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 19146, USA
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Kim Marie Thalwitzer
- 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 19146, USA
- Division of Pediatric Epileptology, Centre for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Jillian McKee
- 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 19146, USA
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Katie Rose Sullivan
- 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 19146, USA
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Elise Brimble
- Ciitizen Natural History Registry, Invitae, San Francisco, CA 94017, USA
| | - Eryn Fitch
- 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
| | - Jonathan Toib
- 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
| | - Michael C Kaufman
- 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 19146, USA
| | - Danielle deCampo
- 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
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Kristin Cunningham
- 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
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Samuel R Pierce
- 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
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | | | | | - Steffen Syrbe
- Division of Pediatric Epileptology, Centre for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Michael Boland
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Institute for Genomic Medicine, Columbia University, New York, NY 10032, USA
| | - Benjamin Prosser
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Department of Physiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Nasha Fitter
- Ciitizen Natural History Registry, Invitae, San Francisco, CA 94017, USA
| | - Sarah M Ruggiero
- 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
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 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 19146, USA
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
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13
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Vanoye CG, Abramova TV, DeKeyser JM, Ghabra NF, Oudin MJ, Burge CB, Helbig I, Thompson CH, George AL. Molecular and Cellular Context Influences SCN8A Variant Function. bioRxiv 2023:2023.11.11.566702. [PMID: 38014225 PMCID: PMC10680676 DOI: 10.1101/2023.11.11.566702] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Pathogenic variants in SCN8A , which encodes the voltage-gated sodium (Na V ) channel Na V 1.6, are associated with neurodevelopmental disorders including epileptic encephalopathy. Previous approaches to determine SCN8A variant function may be confounded by the use of a neonatal-expressed alternatively spliced isoform of Na V 1.6 (Na V 1.6N), and engineered mutations to render the channel tetrodotoxin (TTX) resistant. In this study, we investigated the impact of SCN8A alternative splicing on variant function by comparing the functional attributes of 15 variants expressed in two developmentally regulated splice isoforms (Na V 1.6N, Na V 1.6A). We employed automated patch clamp recording to enhance throughput, and developed a novel neuronal cell line (ND7/LoNav) with low levels of endogenous Na V current to obviate the need for TTX-resistance mutations. Expression of Na V 1.6N or Na V 1.6A in ND7/LoNav cells generated Na V currents that differed significantly in voltage-dependence of activation and inactivation. TTX-resistant versions of both isoforms exhibited significant functional differences compared to the corresponding wild-type (WT) channels. We demonstrated that many of the 15 disease-associated variants studied exhibited isoform-dependent functional effects, and that many of the studied SCN8A variants exhibited functional properties that were not easily classified as either gain- or loss-of-function. Our work illustrates the value of considering molecular and cellular context when investigating SCN8A variants.
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14
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Jacobwitz M, Mulvihill C, Kaufman MC, Gonzalez AK, Resendiz K, Francoeur C, Helbig I, Topjian AA, Abend NS. A Comparison of Ketamine and Midazolam as First-Line Anesthetic Infusions for Pediatric Status Epilepticus. Neurocrit Care 2023:10.1007/s12028-023-01859-2. [PMID: 37783824 DOI: 10.1007/s12028-023-01859-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/08/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Pediatric refractory status epilepticus (RSE) often requires management with anesthetic infusions, but few data compare first-line anesthetics. This study aimed to compare the efficacy and adverse effects of midazolam and ketamine infusions as first-line anesthetics for pediatric RSE. METHODS Retrospective single-center study of consecutive study participants treated with ketamine or midazolam as the first-line anesthetic infusions for RSE at a quaternary care children's hospital from December 1, 2017, until September 15, 2021. RESULTS We identified 117 study participants (28 neonates), including 79 (68%) who received midazolam and 38 (32%) who received ketamine as the first-line anesthetic infusions. Seizures terminated more often in study participants administered ketamine (61%, 23/38) than midazolam (28%, 22/79; odds ratio [OR] 3.97, 95% confidence interval [CI] 1.76-8.98; P < 0.01). Adverse effects occurred more often in study participants administered midazolam (24%, 20/79) than ketamine (3%, 1/38; OR 12.54, 95% CI 1.61-97.43; P = 0.016). Study participants administered ketamine were younger, ketamine was used more often for children with acute symptomatic seizures, and midazolam was used more often for children with epilepsy. Multivariable logistic regression of seizure termination by first-line anesthetic infusion (ketamine or midazolam) including age at SE onset, SE etiology category, and individual seizure duration at anesthetic infusion initiation indicated seizures were more likely to terminate following ketamine than midazolam (OR 4.00, 95% CI 1.69-9.49; P = 0.002) and adverse effects were more likely following midazolam than ketamine (OR 13.41, 95% CI 1.61-111.04; P = 0.016). Survival to discharge was higher among study participants who received midazolam (82%, 65/79) than ketamine (55%, 21/38; P = 0.002), although treating clinicians did not attribute any deaths to ketamine or midazolam. CONCLUSIONS Among children and neonates with RSE, ketamine was more often followed by seizure termination and less often associated with adverse effects than midazolam when administered as the first-line anesthetic infusion. Further prospective data are needed to compare first-line anesthetics for RSE.
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Affiliation(s)
- Marin Jacobwitz
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Caitlyn Mulvihill
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Michael C Kaufman
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alexander K Gonzalez
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Karla Resendiz
- Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Conall Francoeur
- Division of Critical Care, Québec, QC, Canada
- Department of Pediatrics, Centre Hospitalier Universitaire de Québec-University of Laval Research Center, Québec, QC, Canada
| | - Ingo Helbig
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alexis A Topjian
- Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesia and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nicholas S Abend
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Anesthesia and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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15
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Molisani SE, Parikh D, DiGiovine M, Dlugos D, Fitzgerald MP, Fried L, Helbig I, Kessler SK, McDonnell PP, Melamed S, Prelack MS, Sharif U, Tefft S, Tencer J, Witzman S, Shaw K, Abend NS. A quality improvement initiative to improve folic acid supplementation counseling for adolescent females with epilepsy. Epilepsia 2023; 64:2818-2826. [PMID: 37496463 DOI: 10.1111/epi.17723] [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: 06/05/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE We designed a quality improvement (QI) project to improve rates of documented folic acid supplementation counseling for adolescent females with epilepsy, consistent with a quality measure from the American Academy of Neurology and American Epilepsy Society. Our SMART aim was to increase the percentage of visits at which folic acid counseling was addressed from our baseline rate of 23% to 50% by July 1, 2020. METHODS This initiative was conducted in female patients ≥12 years old with epilepsy who were prescribed daily antiseizure medication and were seen by the 13 providers in our Neurology QI Program. Using provider interviews, we undertook a root cause analysis of low counseling rates and identified the following main factors: insufficient time during clinic visit to counsel, lack of provider knowledge, and forgetting to counsel. Countermeasures were designed to address these main root causes and were implemented through iterative plan-do-study-act (PDSA) cycles. Interventions included provider education and features within the electronic health record, which were introduced sequentially, culminating in the creation of a best practice advisory (BPA). We performed biweekly chart reviews of visits for applicable patients to establish baseline performance rate and track progress over time. We used a statistical process control p-chart to analyze the outcome measure of documented counseling. As a balancing measure, clinicians were surveyed using the Technology Adoption Model survey to assess acceptance of the BPA. RESULTS From September 2019 to August 2022, the QI team improved rates of documented folic acid counseling from 23% to 73% through several PDSA cycles. This level of performance has been sustained over time. The most successful and sustainable intervention was the BPA. Provider acceptance of the BPA was overall positive. SIGNIFICANCE We successfully used QI methodology to improve and sustain our rates of documented folic acid supplementation counseling for adolescent females with epilepsy.
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Affiliation(s)
- Sara E Molisani
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Darshana Parikh
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Marissa DiGiovine
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Dennis Dlugos
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mark P Fitzgerald
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Epilepsy Neurogenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy and Neurodevelopmental Disorders Center, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lawrence Fried
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ingo Helbig
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Epilepsy Neurogenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy and Neurodevelopmental Disorders Center, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sudha Kilaru Kessler
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Pamela Pojomovsky McDonnell
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Epilepsy Neurogenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Susan Melamed
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Marisa S Prelack
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Uzma Sharif
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sarah Tefft
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy Neurogenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy and Neurodevelopmental Disorders Center, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jaclyn Tencer
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Stephanie Witzman
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kathy Shaw
- Department of Pediatrics (Division of Emergency Medicine), Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicholas S Abend
- Department of Pediatrics (Division of Neurology), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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16
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Wang R, Helbig I, Edmondson AC, Lin L, Xing Y. Splicing defects in rare diseases: transcriptomics and machine learning strategies towards genetic diagnosis. Brief Bioinform 2023; 24:bbad284. [PMID: 37580177 PMCID: PMC10516351 DOI: 10.1093/bib/bbad284] [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: 03/14/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/16/2023] Open
Abstract
Genomic variants affecting pre-messenger RNA splicing and its regulation are known to underlie many rare genetic diseases. However, common workflows for genetic diagnosis and clinical variant interpretation frequently overlook splice-altering variants. To better serve patient populations and advance biomedical knowledge, it has become increasingly important to develop and refine approaches for detecting and interpreting pathogenic splicing variants. In this review, we will summarize a few recent developments and challenges in using RNA sequencing technologies for rare disease investigation. Moreover, we will discuss how recent computational splicing prediction tools have emerged as complementary approaches for revealing disease-causing variants underlying splicing defects. We speculate that continuous improvements to sequencing technologies and predictive modeling will not only expand our understanding of splicing regulation but also bring us closer to filling the diagnostic gap for rare disease patients.
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Affiliation(s)
- Robert Wang
- Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Genomics and Computational Biology Graduate Program, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ingo Helbig
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Andrew C Edmondson
- Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Lan Lin
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Raymond G. Perelman Center for Cellular and Molecular Therapeutics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Yi Xing
- Center for Computational and Genomic Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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17
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Camp CR, Vlachos A, Klöckner C, Krey I, Banke TG, Shariatzadeh N, Ruggiero SM, Galer P, Park KL, Caccavano A, Kimmel S, Yuan X, Yuan H, Helbig I, Benke TA, Lemke JR, Pelkey KA, McBain CJ, Traynelis SF. Loss of Grin2a causes a transient delay in the electrophysiological maturation of hippocampal parvalbumin interneurons. Commun Biol 2023; 6:952. [PMID: 37723282 PMCID: PMC10507040 DOI: 10.1038/s42003-023-05298-9] [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: 03/23/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023] Open
Abstract
N-methyl-D-aspartate receptors (NMDARs) are ligand-gated ionotropic glutamate receptors that mediate a calcium-permeable component to fast excitatory neurotransmission. NMDARs are heterotetrameric assemblies of two obligate GluN1 subunits (GRIN1) and two GluN2 subunits (GRIN2A-GRIN2D). Sequencing data shows that 43% (297/679) of all currently known NMDAR disease-associated genetic variants are within the GRIN2A gene, which encodes the GluN2A subunit. Here, we show that unlike missense GRIN2A variants, individuals affected with disease-associated null GRIN2A variants demonstrate a transient period of seizure susceptibility that begins during infancy and diminishes near adolescence. We show increased circuit excitability and CA1 pyramidal cell output in juvenile mice of both Grin2a+/- and Grin2a-/- mice. These alterations in somatic spiking are not due to global upregulation of most Grin genes (including Grin2b). Deeper evaluation of the developing CA1 circuit led us to uncover age- and Grin2a gene dosing-dependent transient delays in the electrophysiological maturation programs of parvalbumin (PV) interneurons. We report that Grin2a+/+ mice reach PV cell electrophysiological maturation between the neonatal and juvenile neurodevelopmental timepoints, with Grin2a+/- mice not reaching PV cell electrophysiological maturation until preadolescence, and Grin2a-/- mice not reaching PV cell electrophysiological maturation until adulthood. Overall, these data may represent a molecular mechanism describing the transient nature of seizure susceptibility in disease-associated null GRIN2A patients.
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Affiliation(s)
- Chad R Camp
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Anna Vlachos
- Section on Cellular and Synaptic Physiology, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Chiara Klöckner
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Ilona Krey
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Tue G Banke
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Nima Shariatzadeh
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Sarah M Ruggiero
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Peter Galer
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, 19146, USA
| | - Kristen L Park
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - Adam Caccavano
- Section on Cellular and Synaptic Physiology, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Sarah Kimmel
- Section on Cellular and Synaptic Physiology, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Xiaoqing Yuan
- Section on Cellular and Synaptic Physiology, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Hongjie Yuan
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Center for Functional Evaluation of Rare Variants, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ingo Helbig
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, 19146, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Tim A Benke
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, 80045, 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
| | - Kenneth A Pelkey
- Section on Cellular and Synaptic Physiology, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Chris J McBain
- Section on Cellular and Synaptic Physiology, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Stephen F Traynelis
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA.
- Center for Functional Evaluation of Rare Variants, Emory University School of Medicine, Atlanta, GA, 30322, USA.
- Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, 30322, USA.
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18
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Stevelink R, Campbell C, Chen S, Abou-Khalil B, Adesoji OM, Afawi Z, Amadori E, Anderson A, Anderson J, Andrade DM, Annesi G, Auce P, Avbersek A, Bahlo M, Baker MD, Balagura G, Balestrini S, Barba C, Barboza K, Bartolomei F, Bast T, Baum L, Baumgartner T, Baykan B, Bebek N, Becker AJ, Becker F, Bennett CA, Berghuis B, Berkovic SF, Beydoun A, Bianchini C, Bisulli F, Blatt I, Bobbili DR, Borggraefe I, Bosselmann C, Braatz V, Bradfield JP, Brockmann K, Brody LC, Buono RJ, Busch RM, Caglayan H, Campbell E, Canafoglia L, Canavati C, Cascino GD, Castellotti B, Catarino CB, Cavalleri GL, Cerrato F, Chassoux F, Cherny SS, Cheung CL, Chinthapalli K, Chou IJ, Chung SK, Churchhouse C, Clark PO, Cole AJ, Compston A, Coppola A, Cosico M, Cossette P, Craig JJ, Cusick C, Daly MJ, Davis LK, de Haan GJ, Delanty N, Depondt C, Derambure P, Devinsky O, Di Vito L, Dlugos DJ, Doccini V, Doherty CP, El-Naggar H, Elger CE, Ellis CA, Eriksson JG, Faucon A, Feng YCA, Ferguson L, Ferraro TN, Ferri L, Feucht M, Fitzgerald M, Fonferko-Shadrach B, Fortunato F, Franceschetti S, Franke A, French JA, Freri E, Gagliardi M, Gambardella A, Geller EB, Giangregorio T, Gjerstad L, Glauser T, Goldberg E, Goldman A, Granata T, Greenberg DA, Guerrini R, Gupta N, Haas KF, Hakonarson H, Hallmann K, Hassanin E, Hegde M, Heinzen EL, Helbig I, Hengsbach C, Heyne HO, Hirose S, Hirsch E, Hjalgrim H, Howrigan DP, Hucks D, Hung PC, Iacomino M, Imbach LL, Inoue Y, Ishii A, Jamnadas-Khoda J, Jehi L, Johnson MR, Kälviäinen R, Kamatani Y, Kanaan M, Kanai M, Kantanen AM, Kara B, Kariuki SM, Kasperavičiūte D, Kasteleijn-Nolst Trenite D, Kato M, Kegele J, Kesim Y, Khoueiry-Zgheib N, King C, Kirsch HE, Klein KM, Kluger G, Knake S, Knowlton RC, Koeleman BPC, Korczyn AD, Koupparis A, Kousiappa I, Krause R, Krenn M, Krestel H, Krey I, Kunz WS, Kurki MI, Kurlemann G, Kuzniecky R, Kwan P, Labate A, Lacey A, Lal D, Landoulsi Z, Lau YL, Lauxmann S, Leech SL, Lehesjoki AE, Lemke JR, Lerche H, Lesca G, Leu C, Lewin N, Lewis-Smith D, Li GHY, Li QS, Licchetta L, Lin KL, Lindhout D, Linnankivi T, Lopes-Cendes I, Lowenstein DH, Lui CHT, Madia F, Magnusson S, Marson AG, May P, McGraw CM, Mei D, Mills JL, Minardi R, Mirza N, Møller RS, Molloy AM, Montomoli M, Mostacci B, Muccioli L, Muhle H, Müller-Schlüter K, Najm IM, Nasreddine W, Neale BM, Neubauer B, Newton CRJC, Nöthen MM, Nothnagel M, Nürnberg P, O’Brien TJ, Okada Y, Ólafsson E, Oliver KL, Özkara C, Palotie A, Pangilinan F, Papacostas SS, Parrini E, Pato CN, Pato MT, Pendziwiat M, Petrovski S, Pickrell WO, Pinsky R, Pippucci T, Poduri A, Pondrelli F, Powell RHW, Privitera M, Rademacher A, Radtke R, Ragona F, Rau S, Rees MI, Regan BM, Reif PS, Rhelms S, Riva A, Rosenow F, Ryvlin P, Saarela A, Sadleir LG, Sander JW, Sander T, Scala M, Scattergood T, Schachter SC, Schankin CJ, Scheffer IE, Schmitz B, Schoch S, Schubert-Bast S, Schulze-Bonhage A, Scudieri P, Sham P, Sheidley BR, Shih JJ, Sills GJ, Sisodiya SM, Smith MC, Smith PE, Sonsma ACM, Speed D, Sperling MR, Stefansson H, Stefansson K, Steinhoff BJ, Stephani U, Stewart WC, Stipa C, Striano P, Stroink H, Strzelczyk A, Surges R, Suzuki T, Tan KM, Taneja RS, Tanteles GA, Taubøll E, Thio LL, Thomas GN, Thomas RH, Timonen O, Tinuper P, Todaro M, Topaloğlu P, Tozzi R, Tsai MH, Tumiene B, Turkdogan D, Unnsteinsdóttir U, Utkus A, Vaidiswaran P, Valton L, van Baalen A, Vetro A, Vining EPG, Visscher F, von Brauchitsch S, von Wrede R, Wagner RG, Weber YG, Weckhuysen S, Weisenberg J, Weller M, Widdess-Walsh P, Wolff M, Wolking S, Wu D, Yamakawa K, Yang W, Yapıcı Z, Yücesan E, Zagaglia S, Zahnert F, Zara F, Zhou W, Zimprich F, Zsurka G, Zulfiqar Ali Q. GWAS meta-analysis of over 29,000 people with epilepsy identifies 26 risk loci and subtype-specific genetic architecture. Nat Genet 2023; 55:1471-1482. [PMID: 37653029 PMCID: PMC10484785 DOI: 10.1038/s41588-023-01485-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/21/2023] [Indexed: 09/02/2023]
Abstract
Epilepsy is a highly heritable disorder affecting over 50 million people worldwide, of which about one-third are resistant to current treatments. Here we report a multi-ancestry genome-wide association study including 29,944 cases, stratified into three broad categories and seven subtypes of epilepsy, and 52,538 controls. We identify 26 genome-wide significant loci, 19 of which are specific to genetic generalized epilepsy (GGE). We implicate 29 likely causal genes underlying these 26 loci. SNP-based heritability analyses show that common variants explain between 39.6% and 90% of genetic risk for GGE and its subtypes. Subtype analysis revealed markedly different genetic architectures between focal and generalized epilepsies. Gene-set analyses of GGE signals implicate synaptic processes in both excitatory and inhibitory neurons in the brain. Prioritized candidate genes overlap with monogenic epilepsy genes and with targets of current antiseizure medications. Finally, we leverage our results to identify alternate drugs with predicted efficacy if repurposed for epilepsy treatment.
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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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Montanucci L, Lewis-Smith D, Collins RL, Niestroj LM, Parthasarathy S, Xian J, Ganesan S, Macnee M, Brünger T, Thomas RH, Talkowski M, Helbig I, Leu C, Lal D. Genome-wide identification and phenotypic characterization of seizure-associated copy number variations in 741,075 individuals. Nat Commun 2023; 14:4392. [PMID: 37474567 PMCID: PMC10359300 DOI: 10.1038/s41467-023-39539-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 06/16/2023] [Indexed: 07/22/2023] Open
Abstract
Copy number variants (CNV) are established risk factors for neurodevelopmental disorders with seizures or epilepsy. With the hypothesis that seizure disorders share genetic risk factors, we pooled CNV data from 10,590 individuals with seizure disorders, 16,109 individuals with clinically validated epilepsy, and 492,324 population controls and identified 25 genome-wide significant loci, 22 of which are novel for seizure disorders, such as deletions at 1p36.33, 1q44, 2p21-p16.3, 3q29, 8p23.3-p23.2, 9p24.3, 10q26.3, 15q11.2, 15q12-q13.1, 16p12.2, 17q21.31, duplications at 2q13, 9q34.3, 16p13.3, 17q12, 19p13.3, 20q13.33, and reciprocal CNVs at 16p11.2, and 22q11.21. Using genetic data from additional 248,751 individuals with 23 neuropsychiatric phenotypes, we explored the pleiotropy of these 25 loci. Finally, in a subset of individuals with epilepsy and detailed clinical data available, we performed phenome-wide association analyses between individual CNVs and clinical annotations categorized through the Human Phenotype Ontology (HPO). For six CNVs, we identified 19 significant associations with specific HPO terms and generated, for all CNVs, phenotype signatures across 17 clinical categories relevant for epileptologists. This is the most comprehensive investigation of CNVs in epilepsy and related seizure disorders, with potential implications for clinical practice.
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Affiliation(s)
- Ludovica Montanucci
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, USA
| | - David Lewis-Smith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Clinical Neurosciences, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ryan L Collins
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, USA
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology (M.I.T.) and Harvard, Cambridge, USA
| | | | - Shridhar Parthasarathy
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Julie Xian
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shiva Ganesan
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marie Macnee
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Tobias Brünger
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Rhys H Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Clinical Neurosciences, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Michael Talkowski
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, USA
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology (M.I.T.) and Harvard, Cambridge, USA
| | - Ingo Helbig
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Costin Leu
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, USA.
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK.
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, USA.
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, US.
| | - Dennis Lal
- Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, USA.
- Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology (M.I.T.) and Harvard, Cambridge, USA.
- Stanley Center for Psychiatric Research, Broad Institute of Harvard and M.I.T, Cambridge, MA, USA.
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, US.
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McKee JL, Karlin A, deCampo D, Helbig I. GLUT1, GGE, and the resilient fallacy of refuted epilepsy genes. Seizure 2023; 109:97-98. [PMID: 37331727 DOI: 10.1016/j.seizure.2023.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 03/31/2023] [Indexed: 06/20/2023] Open
Affiliation(s)
- Jillian L McKee
- 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 Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Alexis Karlin
- 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 Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Danielle deCampo
- 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 Neurology, University of Pennsylvania Perelman School of Medicine, 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 19146, USA; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA.
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22
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Thalwitzer KM, Xian J, deCampo D, Parthasarathy S, Magielski J, Sullivan KR, Goss J, Rigby CS, Boland M, Prosser B, Ruggiero SM, Syrbe S, Helbig I. Early life seizures and epileptic spasms in STXBP1-related disorders. medRxiv 2023:2023.06.26.23291892. [PMID: 37425705 PMCID: PMC10327252 DOI: 10.1101/2023.06.26.23291892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background and Objectives Individuals with disease-causing variants in STXBP1 frequently have epilepsy onset in the first year of life with a variety of seizure types, including epileptic spasms. However, the impact of early-onset seizures and anti-seizure medication (ASM) on the risk of developing epileptic spasms and impact on their trajectory is poorly understood, limiting informed and anticipatory treatment, as well as trial design. Methods We retrospectively reconstructed seizure and medication histories in weekly intervals for individuals with STXBP1-related disorders with epilepsy onset in the first year of life and quantitatively analyzed longitudinal seizure histories and medication response. Results We included 61 individuals with early onset seizures, 29 of whom had epileptic spasms. Individuals with neonatal seizures were likely to have continued seizures after the neonatal period (25/26). The risk of developing epileptic spasms was not increased in individuals with neonatal seizures or early infantile seizures (21/41 vs. 8/16; OR 1, 95% CI 0.3-3.9, p = 1). We did not find any ASM associated with the development of epileptic spasms following prior seizures. Individuals with prior seizures (n = 16/21, 76%) had a higher risk to develop refractory epileptic spasms (n = 5/8, 63%, OR =1.9, 95% CI 0.2-14.6, p = 0.6). Individuals with refractory epileptic spasms had a later onset of epileptic spasms (n = 20, median 20 weeks) compared to individuals with non-refractory epileptic spasms (n = 8, median 13 weeks; p = 0.08). When assessing treatment response, we found that clonazepam (n = 3, OR 12.6, 95% CI 2.2-509.4; p < 0.01), clobazam (n=7, OR 3, 95% CI 1.6-6.2; p < 0.01), topiramate (n=9, OR 2.3, 95% CI 1.4-3.9; p < 0.01), and levetiracetam (n=16, OR 1.7, 95% CI 1.2-2.4; p < 0.01) were more likely to reduce seizure frequency and/or to maintain seizure freedom with regards to epileptic spasms than other medications. Discussion We provide a comprehensive assessment of early-onset seizures in STXBP1-related disorders and show that the risk of epileptic spasms is not increased following a prior history of early-life seizures, nor by certain ASM. Our study provides baseline information for targeted treatment and prognostication in early-life seizures in STXBP1-related disorders.
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Affiliation(s)
- Kim M Thalwitzer
- Division of Neurology, Children’s Hospital of Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, USA
- Division of Pediatric Epileptology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany
| | - Julie Xian
- Division of Neurology, Children’s Hospital of Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, USA
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, USA
| | - Danielle deCampo
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, USA
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, USA
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, USa
| | - Shridhar Parthasarathy
- Division of Neurology, Children’s Hospital of Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, USA
| | - Jan Magielski
- Division of Neurology, Children’s Hospital of Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, USA
- Neuroscience Program, University of Pennsylvania, Philadelphia, USA
| | - Katie Rose Sullivan
- Division of Neurology, Children’s Hospital of Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, USA
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, USA
| | | | | | - Michael Boland
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, USA
- Institute for Genomic Medicine, Columbia University, USA
| | - Ben Prosser
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, USA
- Department of Physiology, University of Pennsylvania Perelman School of Medicine, USA
| | - Sarah M Ruggiero
- Division of Neurology, Children’s Hospital of Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, USA
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, USA
| | - Steffen Syrbe
- Division of Pediatric Epileptology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Germany
| | - Ingo Helbig
- Division of Neurology, Children’s Hospital of Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, USA
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, USA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, USA
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23
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Seiffert S, Pendziwiat M, Hedrich UBS, Helbig I, Weber Y, Schwarz N. KCNC2 variants of uncertain significance are also associated to various forms of epilepsy. Front Neurol 2023; 14:1212079. [PMID: 37360341 PMCID: PMC10289024 DOI: 10.3389/fneur.2023.1212079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Recently, de novo variants in KCNC2, coding for the potassium channel subunit KV3.2, have been described as causative for various forms of epilepsy including genetic generalized epilepsy (GGE) and developmental and epileptic encephalopathy (DEE). Here, we report the functional characteristics of three additional KCNC2 variants of uncertain significance and one variant classified as pathogenic. Electrophysiological studies were performed in Xenopus laevis oocytes. The data presented here support that KCNC2 variants with uncertain significance may also be causative for various forms of epilepsy, as they show changes in the current amplitude and activation and deactivation kinetics of the channel, depending on the variant. In addition, we investigated the effect of valproic acid on KV3.2, as several patients carrying pathogenic variants in the KCNC2 gene achieved significant seizure reduction or seizure freedom with this drug. However, in our electrophysiological investigations, no change on the behavior of KV3.2 channels could be observed, suggesting that the therapeutic effect of VPA may be explained by other mechanisms.
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Affiliation(s)
- Simone Seiffert
- Department of Human Genetics, University Hospital Ulm, Ulm, Germany
- Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Manuela Pendziwiat
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Ulrike B. S. Hedrich
- Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Ingo Helbig
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Yvonne Weber
- Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Epileptology and Neurology, University of Aachen, Aachen, Germany
| | - Niklas Schwarz
- Department of Neurology and Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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24
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Sullivan KR, Ruggiero SM, Xian J, Thalwitzer KM, Ali R, Stewart S, Cosico M, Steinberg J, Goss J, Pfalzer AC, Horning KJ, Weitzel N, Corey S, Conway L, Rigby CS, Bichell TJ, Helbig I. A disease concept model for STXBP1-related disorders. Epilepsia Open 2023; 8:320-333. [PMID: 36625631 PMCID: PMC10235567 DOI: 10.1002/epi4.12688] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE STXBP1-related disorders are rare genetic epilepsies and neurodevelopmental disorders, but the impact of symptoms across clinical domains is poorly understood. Disease concept models are formal frameworks to assess the lived experience of individuals and their families and provide a basis for generating outcome measures. METHODS We conducted semistructured, qualitative interviews with 19 caregivers of 16 individuals with STXBP1-related disorders and 7 healthcare professionals. We systematically coded themes using NVivo software and grouped concepts into the domains of symptoms, symptom impact, and caregiver impact. We quantified the frequency of concepts throughout the lifespan and across clinical subgroups stratified by seizure history and developmental trajectories. RESULTS Over 25 hours of interviews, we coded a total of 3626 references to 38 distinct concepts. In addition to well-recognized clinical features such as developmental delay (n = 240 references), behavior (n = 201), and seizures (n = 147), we identified previously underrepresented symptoms including gastrointestinal (n = 68) and respiratory symptoms (n = 24) and pain (n = 30). The most frequently referenced symptom impacts were autonomy (n = 96), socialization (n = 64), and schooling (n = 61). Emotional impact (n = 354), support (n = 200), and daily life & activities (n = 108) were highly cited caregiver impacts. We found that seizures were more commonly referenced in infancy than in other age groups, while behavior and socialization were more likely to be referred to in childhood. We found that caregivers of individuals with ongoing seizures were less likely to reference developmental delay, possibly due to the relatively high impact of seizures. SIGNIFICANCE STXBP1-related disorders are complex conditions affecting a wide range of clinical and social domains. We comprehensively mapped symptoms and their impact on families to generate a comprehensive disease model as a foundation for clinical endpoints in future trials.
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Affiliation(s)
- Katie R. Sullivan
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Sarah M. Ruggiero
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Julie Xian
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Biomedical and Health Informatics (DBHi)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Kim M. Thalwitzer
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Biomedical and Health Informatics (DBHi)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Rahma Ali
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Sydni Stewart
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Mahgenn Cosico
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Biomedical and Health Informatics (DBHi)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | | | - James Goss
- STXBP1 Foundation, ApexHolly SpringsNorth CarolinaUSA
| | | | - Kyle J. Horning
- Vanderbilt UniversityNashvilleTennesseeUSA
- COMBINEDBrainBrentwoodTennesseeUSA
| | | | | | - Laura Conway
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Terry Jo Bichell
- Vanderbilt UniversityNashvilleTennesseeUSA
- COMBINEDBrainBrentwoodTennesseeUSA
| | - Ingo Helbig
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- The Epilepsy NeuroGenetics Initiative (ENGIN)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of Biomedical and Health Informatics (DBHi)Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of NeurologyUniversity of Pennsylvania, Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
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25
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Hanin A, Cespedes J, Pulluru Y, Gopaul M, Aronica E, Decampo D, Helbig I, Howe CL, Huttner A, Koh S, Navarro V, Taraschenko O, Vezzani A, Wilson MR, Xian J, Gaspard N, Hirsch LJ. Review and standard operating procedures for collection of biospecimens and analysis of biomarkers in new onset refractory status epilepticus. Epilepsia 2023; 64:1444-1457. [PMID: 37039049 PMCID: PMC10756682 DOI: 10.1111/epi.17600] [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: 01/06/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
New onset refractory status epilepticus (NORSE), including its subtype with a preceding febrile illness known as febrile infection-related epilepsy syndrome (FIRES), is one of the most severe forms of status epilepticus. The exact causes of NORSE are currently unknown, and there is so far no disease-specific therapy. Identifying the underlying pathophysiology and discovering specific biomarkers, whether immunologic, infectious, genetic, or other, may help physicians in the management of patients with NORSE. A broad spectrum of biomarkers has been proposed for status epilepticus patients, some of which were evaluated for patients with NORSE. Nonetheless, none has been validated, due to significant variabilities in study cohorts, collected biospecimens, applied analytical methods, and defined outcome endpoints, and to small sample sizes. The NORSE Institute established an open NORSE/FIRES biorepository for health-related data and biological samples allowing the collection of biospecimens worldwide, promoting multicenter research and sharing of data and specimens. Here, we suggest standard operating procedures for biospecimen collection and biobanking in this rare condition. We also propose criteria for the appropriate use of previously collected biospecimens. We predict that the widespread use of standardized procedures will reduce heterogeneity, facilitate the future identification of validated biomarkers for NORSE, and provide a better understanding of the pathophysiology and best clinical management for these patients.
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Affiliation(s)
- Aurélie Hanin
- Department of Neurology and Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
- Sorbonne Université, Institut du Cerveau ICM, Paris Brain Institute, Inserm, CNRS, Assistance Publique -Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, DMU Neurosciences 6, Paris, France
- Assistance Publique -Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, DMU Neurosciences 6, Epilepsy Unit and Department of Clinical Neurophysiology, Paris, France
| | - Jorge Cespedes
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
- Universidad Autonoma de Centro America, School of Medicine, San Jose, Costa Rica
| | - Yashwanth Pulluru
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
- Nebraska Medical Center, Omaha, Nebraska, USA
| | - Margaret Gopaul
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Eleonora Aronica
- Department of (Neuro) Pathology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Danielle Decampo
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy NeuroGenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ingo Helbig
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy NeuroGenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Charles L. Howe
- Division of Experimental Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anita Huttner
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sookyong Koh
- Department of Pediatrics, Children’s Hospital Medical Center, University of Nebraska, Omaha, Nebraska, USA
| | - Vincent Navarro
- Sorbonne Université, Institut du Cerveau ICM, Paris Brain Institute, Inserm, CNRS, Assistance Publique -Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, DMU Neurosciences 6, Paris, France
- Assistance Publique -Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, DMU Neurosciences 6, Epilepsy Unit and Department of Clinical Neurophysiology, Paris, France
| | - Olga Taraschenko
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Annamaria Vezzani
- Department of Acute Brain Injury, Istituto di Recerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Michael R. Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, California, San Francisco, USA
| | - Julie Xian
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Epilepsy NeuroGenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nicolas Gaspard
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
- Université Libre de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Lawrence J. Hirsch
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
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26
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Xian J, Thalwitzer KM, McKee J, Sullivan KR, Brimble E, Fitch E, Toib J, Kaufman MC, deCampo D, Cunningham K, Pierce SR, Goss J, Rigby CS, Syrbe S, Boland M, Prosser B, Fitter N, Ruggiero SM, Helbig I. Delineating clinical and developmental outcomes in STXBP1-related disorders. medRxiv 2023:2023.05.10.23289776. [PMID: 37215006 PMCID: PMC10197795 DOI: 10.1101/2023.05.10.23289776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
STXBP1-related disorders are among the most common genetic epilepsies and neurodevelopmental disorders. However, the longitudinal epilepsy course and developmental endpoints have not yet been described in detail, which is a critical prerequisite for clinical trial readiness. Here, we assessed 1,281 cumulative patient-years of seizure and developmental histories in 162 individuals with STXBP1-related disorders and established a natural history framework. STXBP1-related disorders are characterized by a dynamic pattern of seizures in the first year of life and high variability in neurodevelopmental trajectories in early childhood. Epilepsy onset differed across seizure types, with 90% cumulative onset for infantile spasms by 6 months and focal-onset seizures by 27 months of life. Epilepsy histories diverged between variant subgroups in the first 2 years of life, when individuals with protein-truncating variants and deletions in STXBP1 (n=39) were more likely to have infantile spasms between 5 and 6 months followed by seizure remission, while individuals with missense variants (n=30) had an increased risk for focal seizures and ongoing seizures after the first year. Developmental outcomes were mapped using milestone acquisition data in addition to standardized assessments including the Gross Motor Function Measure-66 Item Set and the Grasping and Visual-Motor Integration subsets of the Peabody Developmental Motor Scales. Quantification of endpoints revealed high variability during the first five years of life, with emerging stratification between clinical subgroups, most prominently between individuals with and without infantile spasms. We found that individuals with neonatal seizures or early infantile seizures followed by seizure offset by 12 months of life had more predictable seizure trajectories in early to late childhood than compared to individuals with more severe seizure presentations, including individuals with refractory epilepsy throughout the first year. Characterization of anti-seizure medication response revealed age-dependent response over time, with phenobarbital, levetiracetam, topiramate, and adrenocorticotropic hormone effective in reducing seizures in the first year of life, while clobazam and the ketogenic diet were effective in long-term seizure management. Virtual clinical trials using seizure frequency as the primary outcome resulted in wide range of trial success probabilities across the age span, with the highest probability in early childhood between 1 year and 3.5 years. In summary, we delineated epilepsy and developmental trajectories in STXBP1-related disorders using standardized measures, providing a foundation to interpret future therapeutic strategies and inform rational trial design.
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Affiliation(s)
- Julie Xian
- 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 19146, USA
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Kim Marie Thalwitzer
- 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 19146, USA
- Division of Pediatric Epileptology, Centre for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Jillian McKee
- 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 19146, USA
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Katie Rose Sullivan
- 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 19146, USA
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | | | - Eryn Fitch
- 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
| | - Jonathan Toib
- 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
| | - Michael C. Kaufman
- 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 19146, USA
| | - Danielle deCampo
- 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
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Kristin Cunningham
- 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
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Samuel R. Pierce
- 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
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | | | | | - Steffen Syrbe
- Division of Pediatric Epileptology, Centre for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Michael Boland
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Institute for Genomic Medicine, Columbia University, New York, NY 10032, USA
| | - Ben Prosser
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Department of Physiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | | | - Sarah M. Ruggiero
- 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
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, 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 19146, USA
- Epilepsy and Neurodevelopmental Disorders Center (ENDD), Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
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Daniali M, Galer PD, Lewis-Smith D, Parthasarathy S, Kim E, Salvucci DD, Miller JM, Haag S, Helbig I. Enriching representation learning using 53 million patient notes through human phenotype ontology embedding. Artif Intell Med 2023; 139:102523. [PMID: 37100502 PMCID: PMC10782859 DOI: 10.1016/j.artmed.2023.102523] [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: 07/01/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
The Human Phenotype Ontology (HPO) is a dictionary of >15,000 clinical phenotypic terms with defined semantic relationships, developed to standardize phenotypic analysis. Over the last decade, the HPO has been used to accelerate the implementation of precision medicine into clinical practice. In addition, recent research in representation learning, specifically in graph embedding, has led to notable progress in automated prediction via learned features. Here, we present a novel approach to phenotype representation by incorporating phenotypic frequencies based on 53 million full-text health care notes from >1.5 million individuals. We demonstrate the efficacy of our proposed phenotype embedding technique by comparing our work to existing phenotypic similarity-measuring methods. Using phenotype frequencies in our embedding technique, we are able to identify phenotypic similarities that surpass current computational models. Furthermore, our embedding technique exhibits a high degree of agreement with domain experts' judgment. By transforming complex and multidimensional phenotypes from the HPO format into vectors, our proposed method enables efficient representation of these phenotypes for downstream tasks that require deep phenotyping. This is demonstrated in a patient similarity analysis and can further be applied to disease trajectory and risk prediction.
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Affiliation(s)
- Maryam Daniali
- Department of Computer Science, Drexel University, Philadelphia, PA, USA; Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Peter D Galer
- Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; The Epilepsy Neuro Genetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | - David Lewis-Smith
- Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; The Epilepsy Neuro Genetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK; Department of Clinical Neurosciences, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - Shridhar Parthasarathy
- Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; The Epilepsy Neuro Genetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Edward Kim
- Department of Computer Science, Drexel University, Philadelphia, PA, USA
| | - Dario D Salvucci
- Department of Computer Science, Drexel University, Philadelphia, PA, USA
| | - Jeffrey M Miller
- Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott Haag
- Department of Computer Science, Drexel University, Philadelphia, PA, USA; Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ingo Helbig
- Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; The Epilepsy Neuro Genetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
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Clatot J, Parthasarathy S, Cohen S, McKee J, Massey S, Somarowthu A, Goldberg EM, Helbig I. SCN1A gain-of-function mutation causing an early onset epileptic encephalopathy. Epilepsia 2023; 64:1318-1330. [PMID: 36287100 PMCID: PMC10130239 DOI: 10.1111/epi.17444] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 06/29/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Loss-of-function variants in SCN1A cause Dravet syndrome, the most common genetic developmental and epileptic encephalopathy (DEE). However, emerging evidence suggests separate entities of SCN1A-related disorders due to gain-of-function variants. Here, we aim to refine the clinical, genetic, and functional electrophysiological features of a recurrent p.R1636Q gain-of-function variant, identified in four individuals at a single center. METHODS Individuals carrying the recurrent SCN1A p.R1636Q variant were identified through diagnostic testing. Whole cell voltage-clamp electrophysiological recording in HEK-293 T cells was performed to compare the properties of sodium channels containing wild-type Nav 1.1 or Nav 1.1-R1636Q along with both Nav β1 and Nav β2 subunits, including response to oxcarbazepine. To delineate differences from other SCN1A-related epilepsies, we analyzed electronic medical records. RESULTS All four individuals had an early onset DEE characterized by focal tonic seizures and additional seizure types starting in the first few weeks of life. Electrophysiological analysis showed a mixed gain-of-function effect with normal current density, a leftward (hyperpolarized) shift of steady-state inactivation, and slower inactivation kinetics leading to a prominent late sodium current. The observed functional changes closely paralleled effects of pathogenic variants in SCN3A and SCN8A at corresponding positions. Both wild type and variant exhibited sensitivity to block by oxcarbazepine, partially correcting electrophysiological abnormalities of the SCN1A p.R1636Q variant. Clinically, a single individual responded to treatment with oxcarbazepine. Across 51 individuals with SCN1A-related epilepsies, those with the recurrent p.R1636Q variants had the earliest ages at onset. SIGNIFICANCE The recurrent SCN1A p.R1636Q variant causes a clinical entity with a wider clinical spectrum than previously reported, characterized by neonatal onset epilepsy and absence of prominent movement disorder. Functional consequences of this variant lead to mixed loss and gain of function that is partially corrected by oxcarbazepine. The recurrent p.R1636Q variant represents one of the most common causes of early onset SCN1A-related epilepsies with separate treatment and prognosis implications.
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Affiliation(s)
- Jérôme Clatot
- Division of Neurology, Department of Pediatrics
- The Epilepsy NeuroGenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shridhar Parthasarathy
- Division of Neurology, Department of Pediatrics
- Department of Biomedical Health Informatics (DBHi)
- The Epilepsy NeuroGenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stacey Cohen
- Division of Neurology, Department of Pediatrics
- Department of Biomedical Health Informatics (DBHi)
- The Epilepsy NeuroGenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jillian McKee
- Division of Neurology, Department of Pediatrics
- The Epilepsy NeuroGenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shavonne Massey
- Division of Neurology, Department of Pediatrics
- The Epilepsy NeuroGenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Ethan M. Goldberg
- Division of Neurology, Department of Pediatrics
- Department of Biomedical Health Informatics (DBHi)
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Neuroscience, University of Pennsylvania School of Medicine, Philadelphia, USA
| | - Ingo Helbig
- Division of Neurology, Department of Pediatrics
- Department of Biomedical Health Informatics (DBHi)
- The Epilepsy NeuroGenetics Initiative, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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deCampo D, Xian J, Karlin A, Sullivan KR, Ruggiero SM, Galer P, Ramos M, Abend NS, Gonzalez A, Helbig I. Investigating the genetic contribution in febrile infection-related epilepsy syndrome and refractory status epilepticus. Front Neurol 2023; 14:1161161. [PMID: 37077567 PMCID: PMC10106651 DOI: 10.3389/fneur.2023.1161161] [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] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/10/2023] [Indexed: 04/05/2023] Open
Abstract
IntroductionFebrile infection-related epilepsy syndrome (FIRES) is a severe childhood epilepsy with refractory status epilepticus after a typically mild febrile infection. The etiology of FIRES is largely unknown, and outcomes in most individuals with FIRES are poor.MethodsHere, we reviewed the current state-of-the art genetic testing strategies in individuals with FIRES. We performed a systematic computational analysis to identify individuals with FIRES and characterize the clinical landscape using the Electronic Medical Records (EMR). Among 25 individuals with a confirmed FIRES diagnosis over the last decade, we performed a comprehensive review of genetic testing and other diagnostic testing.ResultsManagement included use of steroids and intravenous immunoglobulin (IVIG) in most individuals, with an increased use of immunomodulatory agents, including IVIG, plasma exchange (PLEX) and immunosuppressants such as cytokine inhibitors, and the ketogenic diet after 2014. Genetic testing was performed on a clinical basis in almost all individuals and was non-diagnostic in all patients. We compared FIRES with both status epilepticus (SE) and refractory status epilepticus (RSE) as a broader comparison cohort and identified genetic causes in 36% of patients with RSE. The difference in genetic signatures between FIRES and RSE suggest distinct underlying etiologies. In summary, despite the absence of any identifiable etiologies in FIRES, we performed an unbiased analysis of the clinical landscape, identifying a heterogeneous range of treatment strategies and characterized real-world clinical practice.DiscussionFIRES remains one of the most enigmatic conditions in child neurology without any known etiologies to date despite significant efforts in the field, suggesting a clear need for further studies and novel diagnostic and treatment approaches.
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Affiliation(s)
- Danielle deCampo
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Julie Xian
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Alexis Karlin
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Katie R. Sullivan
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Sarah M. Ruggiero
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Peter Galer
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Mark Ramos
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Nicholas S. Abend
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Alex Gonzalez
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Ingo Helbig
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- *Correspondence: Ingo Helbig,
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McKee JL, Kaufman MC, Gonzalez AK, Fitzgerald MP, Massey SL, Fung F, Kessler SK, Witzman S, Abend NS, Helbig I. Leveraging electronic medical record-embedded standardised electroencephalogram reporting to develop neonatal seizure prediction models: a retrospective cohort study. Lancet Digit Health 2023; 5:e217-e226. [PMID: 36963911 PMCID: PMC10065843 DOI: 10.1016/s2589-7500(23)00004-3] [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] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/09/2022] [Accepted: 01/06/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Accurate prediction of seizures can help to direct resource-intense continuous electroencephalogram (CEEG) monitoring to neonates at high risk of seizures. We aimed to use data from standardised EEG reports to generate seizure prediction models for vulnerable neonates. METHODS In this retrospective cohort study, we included neonates who underwent CEEG during the first 30 days of life at the Children's Hospital of Philadelphia (Philadelphia, PA, USA). The hypoxic ischaemic encephalopathy subgroup included only patients with CEEG data during the first 5 days of life, International Classification of Diseases, revision 10, codes for hypoxic ischaemic encephalopathy, and documented therapeutic hypothermia. In January, 2018, we implemented a novel CEEG reporting system within the electronic medical record (EMR) using common data elements that incorporated standardised terminology. All neonatal CEEG data from Jan 10, 2018, to Feb 15, 2022, were extracted from the EMR using age at the time of CEEG. We developed logistic regression, decision tree, and random forest models of neonatal seizure prediction using EEG features on day 1 to predict seizures on future days. FINDINGS We evaluated 1117 neonates, including 150 neonates with hypoxic ischaemic encephalopathy, with CEEG data reported using standardised templates between Jan 10, 2018, and Feb 15, 2022. Implementation of a consistent EEG reporting system that documents discrete and standardised EEG variables resulted in more than 95% reporting of key EEG features. Several EEG features were highly correlated, and patients could be clustered on the basis of specific features. However, no simple combination of features adequately predicted seizure risk. We therefore applied computational models to complement clinical identification of neonates at high risk of seizures. Random forest models incorporating background features performed with classification accuracies of up to 90% (95% CI 83-94) for all neonates and 97% (88-99) for neonates with hypoxic ischaemic encephalopathy; recall (sensitivity) of up to 97% (91-100) for all neonates and 100% (100-100) for neonates with hypoxic ischaemic encephalopathy; and precision (positive predictive value) of up to 92% (84-96) in the overall cohort and 97% (80-99) in neonates with hypoxic ischaemic encephalopathy. INTERPRETATION Using data extracted from the standardised EEG report on the first day of CEEG, we predict the presence or absence of neonatal seizures on subsequent days with classification performances of more than 90%. This information, incorporated into routine care, could guide decisions about the necessity of continuing EEG monitoring beyond the first day, thereby improving the allocation of limited CEEG resources. Additionally, this analysis shows the benefits of standardised clinical data collection, which can drive learning health system approaches to personalised CEEG use. FUNDING Children's Hospital of Philadelphia, the Hartwell Foundation, the National Institute of Neurological Disorders and Stroke, and the Wolfson Foundation.
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Affiliation(s)
- Jillian L McKee
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael C Kaufman
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alexander K Gonzalez
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark P Fitzgerald
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shavonne L Massey
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - France Fung
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sudha K Kessler
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie Witzman
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nicholas S Abend
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ingo Helbig
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Ruggiero SM, Xian J, Helbig I. The current landscape of epilepsy genetics: where are we, and where are we going? Curr Opin Neurol 2023; 36:86-94. [PMID: 36762645 PMCID: PMC10088099 DOI: 10.1097/wco.0000000000001141] [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] [Indexed: 02/11/2023]
Abstract
PURPOSE OF REVIEW In this review, we aim to analyse the progress in understanding the genetic basis of the epilepsies, as well as ongoing efforts to define the increasingly diverse and novel presentations, phenotypes and divergences from the expected that have continually characterized the field. RECENT FINDINGS A genetic workup is now considered to be standard of care for individuals with an unexplained epilepsy, due to mounting evidence that genetic diagnoses significantly influence treatment choices, prognostication, community support, and increasingly, access to clinical trials. As more individuals with epilepsy are tested, novel presentations of known epilepsy genes are being discovered, and more individuals with self-limited epilepsy are able to attain genetic diagnoses. In addition, new genes causative of epilepsy are being uncovered through both traditional and novel methods, including large international data-sharing collaborations and massive sequencing efforts as well as computational methods and analyses driven by the Human Phenotype Ontology (HPO). SUMMARY New approaches to gene discovery and characterization are advancing rapidly our understanding of the genetic and phenotypic architecture of the epilepsies. This review highlights relevant and groundbreaking studies published recently that have pushed forward the field of epilepsy genetics.
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Affiliation(s)
- Sarah M Ruggiero
- 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, 19146, USA
| | - Julie Xian
- 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, 19146, 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, 19146, USA
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
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Kaufman MC, Xian J, Galer PD, Parthasarathy S, Gonzalez AK, McKee JL, Prelack MS, Fitzgerald MP, Helbig I. Child neurology telemedicine: Analyzing 14 820 patient encounters during the first year of the COVID-19 pandemic. Dev Med Child Neurol 2023; 65:406-415. [PMID: 38767061 DOI: 10.1111/dmcn.15406] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022]
Abstract
AIM To determine the long-term impact of telemedicine in child neurology care during the COVID-19 pandemic and with the reopening of outpatient clinics. METHOD We performed an observational cohort study of 34 837 in-person visits and 14 820 telemedicine outpatient visits across 26 399 individuals. We assessed differences in care across visit types, time-period observed, time between follow-ups, patient portal activation rates, and demographic factors. RESULTS We observed a higher proportion of telemedicine for epilepsy (International Classification of Diseases, 10th Revision G40: odds ratio [OR] 1.4, 95% confidence interval [CI] 1.3-1.5) and a lower proportion for movement disorders (G25: OR 0.7, 95% CI 0.6-0.8; R25: OR 0.7, 95% CI 0.6-0.9) relative to in-person visits. Infants were more likely to be seen in-person after reopening clinics than by telemedicine (OR 1.6, 95% CI 1.5-1.8) as were individuals with neuromuscular disorders (OR 1.6, 95% CI 1.5-1.7). Self-reported racial and ethnic minority populations and those with highest social vulnerability had lower telemedicine participation rates (OR 0.8, 95% CI 0.8-0.8; OR 0.7, 95% CI 0.7-0.8). INTERPRETATION Telemedicine continued to be utilized even once in-person clinics were available. Pediatric epilepsy care can often be performed using telemedicine while young patients with neuromuscular disorders often require in-person assessment. Prominent barriers for socially vulnerable families and racial and ethnic minorities persist.
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Affiliation(s)
- Michael C Kaufman
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Julie Xian
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Peter D Galer
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, USA
| | - Shridhar Parthasarathy
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Alexander K Gonzalez
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Jillian L McKee
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Marisa S Prelack
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Mark P Fitzgerald
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Ingo Helbig
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
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Schaare D, Sarasua SM, Lusk L, Parthasarathy S, Wang L, Helbig I, Boccuto L. Concomitant Calcium Channelopathies Involving CACNA1A and CACNA1F: A Case Report and Review of the Literature. Genes (Basel) 2023; 14:400. [PMID: 36833327 PMCID: PMC9956337 DOI: 10.3390/genes14020400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Calcium channels are an integral component in maintaining cellular function. Alterations may lead to channelopathies, primarily manifested in the central nervous system. This study describes the clinical and genetic features of a unique 12-year-old boy harboring two congenital calcium channelopathies, involving the CACNA1A and CACNA1F genes, and provides an unadulterated view of the natural history of sporadic hemiplegic migraine type 1 (SHM1) due to the patient's inability to tolerate any preventative medication. The patient presents with episodes of vomiting, hemiplegia, cerebral edema, seizure, fever, transient blindness, and encephalopathy. He is nonverbal, nonambulatory, and forced to have a very limited diet due to abnormal immune responses. The SHM1 manifestations apparent in the subject are consistent with the phenotype described in the 48 patients identified as part of a systematic literature review. The ocular symptoms of CACNA1F align with the family history of the subject. The presence of multiple pathogenic variants make it difficult to identify a clear phenotype-genotype correlation in the present case. Moreover, the detailed case description and natural history along with the comprehensive review of the literature contribute to the understanding of this complex disorder and point to the need for comprehensive clinical assessments of SHM1.
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Affiliation(s)
- Donna Schaare
- Ph.D. Program in Healthcare Genetics and Genomics, School of Nursing, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Sara M. Sarasua
- Ph.D. Program in Healthcare Genetics and Genomics, School of Nursing, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC 29634, USA
| | - Laina Lusk
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | | | - Liangjiang Wang
- Department of Genetics and Biochemistry, College of Science, Clemson University, Clemson, SC 29634, USA
| | - Ingo Helbig
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Luigi Boccuto
- Ph.D. Program in Healthcare Genetics and Genomics, School of Nursing, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC 29634, USA
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Burglen L, Van Hoeymissen E, Qebibo L, Barth M, Belnap N, Boschann F, Depienne C, De Clercq K, Douglas AGL, Fitzgerald MP, Foulds N, Garel C, Helbig I, Held K, Horn D, Janssen A, Kaindl AM, Narayanan V, Prager C, Rupin-Mas M, Afenjar A, Zhao S, Ramaekers VT, Ruggiero SM, Thomas S, Valence S, Van Maldergem L, Rohacs T, Rodriguez D, Dyment D, Voets T, Vriens J. Gain-of-function variants in the ion channel gene TRPM3 underlie a spectrum of neurodevelopmental disorders. eLife 2023; 12:81032. [PMID: 36648066 PMCID: PMC9886277 DOI: 10.7554/elife.81032] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 12/07/2022] [Indexed: 01/18/2023] Open
Abstract
TRPM3 is a temperature- and neurosteroid-sensitive plasma membrane cation channel expressed in a variety of neuronal and non-neuronal cells. Recently, rare de novo variants in TRPM3 were identified in individuals with developmental and epileptic encephalopathy, but the link between TRPM3 activity and neuronal disease remains poorly understood. We previously reported that two disease-associated variants in TRPM3 lead to a gain of channel function . Here, we report a further 10 patients carrying one of seven additional heterozygous TRPM3 missense variants. These patients present with a broad spectrum of neurodevelopmental symptoms, including global developmental delay, intellectual disability, epilepsy, musculo-skeletal anomalies, and altered pain perception. We describe a cerebellar phenotype with ataxia or severe hypotonia, nystagmus, and cerebellar atrophy in more than half of the patients. All disease-associated variants exhibited a robust gain-of-function phenotype, characterized by increased basal activity leading to cellular calcium overload and by enhanced responses to the neurosteroid ligand pregnenolone sulfate when co-expressed with wild-type TRPM3 in mammalian cells. The antiseizure medication primidone, a known TRPM3 antagonist, reduced the increased basal activity of all mutant channels. These findings establish gain-of-function of TRPM3 as the cause of a spectrum of autosomal dominant neurodevelopmental disorders with frequent cerebellar involvement in humans and provide support for the evaluation of TRPM3 antagonists as a potential therapy.
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Affiliation(s)
- Lydie Burglen
- Centre de référence des malformations et maladies congénitales du cervelet, Départementde Génétique, APHP, Sorbonne UniversityParisFrance
- Developmental Brain Disorders Laboratory, Imagine InstituteParisFrance
| | - Evelien Van Hoeymissen
- Laboratory of Ion Channel Research, Department of cellular and molecular medicine, University of LeuvenLeuvenBelgium
- VIB Center for Brain & Disease ResearchLeuvenBelgium
- Laboratory of Endometrium, Endometriosis & Reproductive Medicine, Department Development & Regeneration, University of LeuvenLeuvenBelgium
| | - Leila Qebibo
- Centre de référence des malformations et maladies congénitales du cervelet, Départementde Génétique, APHP, Sorbonne UniversityParisFrance
| | - Magalie Barth
- Department of Genetics, University Hospital of AngersAngersFrance
| | - Newell Belnap
- Translational Genomics Research Institute (TGen), Neurogenomics Division, Center for Rare Childhood DisordersPhoenixUnited States
| | - Felix Boschann
- Charité – Universitäts medizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Genetics and Human GeneticsBerlinGermany
| | - Christel Depienne
- Institute of Human Genetics, University Hospital Essen, University Duisburg-EssenEssenGermany
| | - Katrien De Clercq
- Laboratory of Ion Channel Research, Department of cellular and molecular medicine, University of LeuvenLeuvenBelgium
- VIB Center for Brain & Disease ResearchLeuvenBelgium
- Laboratory of Endometrium, Endometriosis & Reproductive Medicine, Department Development & Regeneration, University of LeuvenLeuvenBelgium
| | - Andrew GL Douglas
- University Hospital Southampton NHS Foundation TrustSouthamptonUnited Kingdom
| | | | - Nicola Foulds
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation TrustSouthamptonUnited Kingdom
| | - Catherine Garel
- Centre de référence des malformations et maladies congénitales du cervelet, Départementde Génétique, APHP, Sorbonne UniversityParisFrance
- Service de Radiologie Pédiatrique, Hôpital Armand-Trousseau, Médecine Sorbonne UniversitéParisFrance
| | - Ingo Helbig
- Children's Hospital of PhiladelphiaPhiladelphiaUnited States
| | - Katharina Held
- Laboratory of Ion Channel Research, Department of cellular and molecular medicine, University of LeuvenLeuvenBelgium
- VIB Center for Brain & Disease ResearchLeuvenBelgium
- Laboratory of Endometrium, Endometriosis & Reproductive Medicine, Department Development & Regeneration, University of LeuvenLeuvenBelgium
| | - Denise Horn
- Charité – Universitäts medizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Genetics and Human GeneticsBerlinGermany
| | - Annelies Janssen
- Laboratory of Ion Channel Research, Department of cellular and molecular medicine, University of LeuvenLeuvenBelgium
- VIB Center for Brain & Disease ResearchLeuvenBelgium
| | - Angela M Kaindl
- Institute of Cell Biology and Neurobiology, Charité - Universitäts medizin BerlinBerlinGermany
- Department of Pediatric Neurology, Charité - Universitäts medizin BerlinBerlinGermany
- Charité – Universitäts medizin Berlin, Center for Chronically Sick ChildrenBerlinGermany
| | - Vinodh Narayanan
- Translational Genomics Research Institute (TGen), Neurogenomics Division, Center for Rare Childhood DisordersPhoenixUnited States
| | - Christina Prager
- Department of Pediatric Neurology, Charité - Universitäts medizin BerlinBerlinGermany
- Charité – Universitäts medizin Berlin, Center for Chronically Sick ChildrenBerlinGermany
| | - Mailys Rupin-Mas
- Department of Neuropediatrics, University Hospital of AngersAngersFrance
| | - Alexandra Afenjar
- Centre de référence des malformations et maladies congénitales du cervelet, Départementde Génétique, APHP, Sorbonne UniversityParisFrance
| | - Siyuan Zhao
- Department of Pharmacology, Physiology and Neuroscience, Rutgers, The State University of New JerseyNewarkUnited States
| | | | | | - Simon Thomas
- Wessex Regional Genetics Laboratory, Salisbury District HospitalSalisburyUnited Kingdom
| | - Stéphanie Valence
- Centre de référence des malformations et maladies congénitales du cervelet, Départementde Génétique, APHP, Sorbonne UniversityParisFrance
- Sorbonne Université, Service de Neuropédiatrie, Hôpital Trousseau AP-HPParisFrance
| | - Lionel Van Maldergem
- Centre de Génétique Humaine, Université de Franche-Comté BesançonBesanconFrance
- Center of Clinical Investigation 1431, National Institute of Health and Medical ResearchBesanconFrance
| | - Tibor Rohacs
- Department of Pharmacology, Physiology and Neuroscience, Rutgers, The State University of New JerseyNewarkUnited States
| | - Diana Rodriguez
- Centre de référence des malformations et maladies congénitales du cervelet, Départementde Génétique, APHP, Sorbonne UniversityParisFrance
- Sorbonne Université, Service de Neuropédiatrie, Hôpital Trousseau AP-HPParisFrance
| | - David Dyment
- Children's Hospital of Eastern Ontario Research Institute, University of OttawaOttawaCanada
| | - Thomas Voets
- Laboratory of Ion Channel Research, Department of cellular and molecular medicine, University of LeuvenLeuvenBelgium
- VIB Center for Brain & Disease ResearchLeuvenBelgium
| | - Joris Vriens
- Laboratory of Endometrium, Endometriosis & Reproductive Medicine, Department Development & Regeneration, University of LeuvenLeuvenBelgium
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Su Y, Zhou Y, Bennett ML, Li S, Carceles-Cordon M, Lu L, Huh S, Jimenez-Cyrus D, Kennedy BC, Kessler SK, Viaene AN, Helbig I, Gu X, Kleinman JE, Hyde TM, Weinberger DR, Nauen DW, Song H, Ming GL. A single-cell transcriptome atlas of glial diversity in the human hippocampus across the postnatal lifespan. Cell Stem Cell 2023; 30:113. [PMID: 36608676 PMCID: PMC9901278 DOI: 10.1016/j.stem.2022.12.007] [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: 01/07/2023]
Affiliation(s)
- Yijing Su
- Correspondence:
(Y.S.),
(H.S.),
(G.-l.M.)
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Xian J, Helbig I. Guardians of the epilepsy genome. Eur J Paediatr Neurol 2023; 42:A4-A6. [PMID: 36720654 DOI: 10.1016/j.ejpn.2023.01.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Julie Xian
- Epilepsy NeuroGenetics Initiative (ENGIN), Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Ingo Helbig
- Epilepsy NeuroGenetics Initiative (ENGIN), Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
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Priestley JR, Pace LM, Sen K, Aggarwal A, Alves CAP, Campbell IM, Cuddapah SR, Engelhardt NM, Eskandar M, Jolín García PC, Gropman A, Helbig I, Hong X, Gowda VK, Lusk L, Trapane P, Srinivasan VM, Suwannarat P, Ganetzky RD. Malate dehydrogenase 2 deficiency is an emerging cause of pediatric epileptic encephalopathy with a recognizable biochemical signature. Mol Genet Metab Rep 2022; 33:100931. [DOI: 10.1016/j.ymgmr.2022.100931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022] Open
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Parthasarathy S, Ruggiero SM, Gelot A, Soardi FC, Ribeiro BFR, Pires DEV, Ascher DB, Schmitt A, Rambaud C, Represa A, Xie HM, Lusk L, Wilmarth O, McDonnell PP, Juarez OA, Grace AN, Buratti J, Mignot C, Gras D, Nava C, Pierce SR, Keren B, Kennedy BC, Pena SDJ, Helbig I, Cuddapah VA. A recurrent de novo splice site variant involving DNM1 exon 10a causes developmental and epileptic encephalopathy through a dominant-negative mechanism. Am J Hum Genet 2022; 109:2253-2269. [PMID: 36413998 PMCID: PMC9748255 DOI: 10.1016/j.ajhg.2022.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 05/31/2022] [Accepted: 11/01/2022] [Indexed: 11/23/2022] Open
Abstract
Heterozygous pathogenic variants in DNM1 cause developmental and epileptic encephalopathy (DEE) as a result of a dominant-negative mechanism impeding vesicular fission. Thus far, pathogenic variants in DNM1 have been studied with a canonical transcript that includes the alternatively spliced exon 10b. However, after performing RNA sequencing in 39 pediatric brain samples, we find the primary transcript expressed in the brain includes the downstream exon 10a instead. Using this information, we evaluated genotype-phenotype correlations of variants affecting exon 10a and identified a cohort of eleven previously unreported individuals. Eight individuals harbor a recurrent de novo splice site variant, c.1197-8G>A (GenBank: NM_001288739.1), which affects exon 10a and leads to DEE consistent with the classical DNM1 phenotype. We find this splice site variant leads to disease through an unexpected dominant-negative mechanism. Functional testing reveals an in-frame upstream splice acceptor causing insertion of two amino acids predicted to impair oligomerization-dependent activity. This is supported by neuropathological samples showing accumulation of enlarged synaptic vesicles adherent to the plasma membrane consistent with impaired vesicular fission. Two additional individuals with missense variants affecting exon 10a, p.Arg399Trp and p.Gly401Asp, had a similar DEE phenotype. In contrast, one individual with a missense variant affecting exon 10b, p.Pro405Leu, which is less expressed in the brain, had a correspondingly less severe presentation. Thus, we implicate variants affecting exon 10a as causing the severe DEE typically associated with DNM1-related disorders. We highlight the importance of considering relevant isoforms for disease-causing variants as well as the possibility of splice site variants acting through a dominant-negative mechanism.
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Affiliation(s)
- Shridhar Parthasarathy
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Sarah McKeown Ruggiero
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Antoinette Gelot
- AP-HP, Hôpital Armand-Trousseau, Service d'Anatomie Pathologique, 75012 Paris, France; INMED INSERM U 901 Parc Scientifique de Luminy, 13273 Marseille, France; Centre de Recherche Clinique ConCer-LD, Paris, France
| | - Fernanda C Soardi
- GENE - Núcleo de Genética Médica, Belo Horizonte, MG, Brazil; Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Laboratório de Genômica Clínica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Douglas E V Pires
- Computational Biology and Clinical Informatics, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; Systems and Computational Biology, Bio21 Institute, University of Melbourne, 30 Flemington Rd, Parkville, VIC 3052, Australia; School of Computing and Information Systems, University of Melbourne, Melbourne, VIC 3053, Australia
| | - David B Ascher
- Computational Biology and Clinical Informatics, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia; Systems and Computational Biology, Bio21 Institute, University of Melbourne, 30 Flemington Rd, Parkville, VIC 3052, Australia; School of Chemistry and Molecular Biology, University of Queensland, St Lucia, QLD 4072, Australia
| | - Alain Schmitt
- INSERM U 1016, Institut Cochin, Paris, France; CNRS UMR 8104, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Caroline Rambaud
- AP-HP, Hôpital Raymond-Poincaré, Laboratoire Anatomie Pathologique, Garches, France
| | - Alfonso Represa
- INMED, INSERM, Aix-Marseille Université, Campus de Luminy, 13009 Marseille, France
| | - Hongbo M Xie
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Laina Lusk
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Olivia Wilmarth
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Pamela Pojomovsky McDonnell
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Olivia A Juarez
- Baylor College of Medicine Genetics Clinic, Children's Hospital of San Antonio, San Antonio, TX, USA
| | - Alexandra N Grace
- Baylor College of Medicine Genetics Clinic, Children's Hospital of San Antonio, San Antonio, TX, USA
| | - Julien Buratti
- AP-HP, Hôpital de la Pitié Salpêtrière, Département de Génétique, 75013 Paris, France
| | - Cyril Mignot
- AP-HP, Hôpital de la Pitié Salpêtrière, Département de Génétique, 75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, INSERM U 1127, CNRS UMR 7225, ICM, 75013 Paris, France; AP-HP, Hôpital Robert Debré, Service de Neurologie Pediatrique et de Maladies Métaboliques, 75019 Paris, France
| | - Domitille Gras
- AP-HP, Hôpital Robert Debré, Service de Neurologie Pediatrique et de Maladies Métaboliques, 75019 Paris, France
| | - Caroline Nava
- AP-HP, Hôpital de la Pitié Salpêtrière, Département de Génétique, 75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, INSERM U 1127, CNRS UMR 7225, ICM, 75013 Paris, France; AP-HP, Hôpital Robert Debré, Service de Neurologie Pediatrique et de Maladies Métaboliques, 75019 Paris, France
| | - Samuel R Pierce
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Physical Therapy, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Boris Keren
- AP-HP, Hôpital de la Pitié Salpêtrière, Département de Génétique, 75013 Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, INSERM U 1127, CNRS UMR 7225, ICM, 75013 Paris, France; AP-HP, Hôpital Robert Debré, Service de Neurologie Pediatrique et de Maladies Métaboliques, 75019 Paris, France
| | - Benjamin C Kennedy
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA 19146, USA; Department of Neurosurgery, The University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sergio D J Pena
- GENE - Núcleo de Genética Médica, Belo Horizonte, MG, Brazil; Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Laboratório de Genômica Clínica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ingo Helbig
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA 19146, USA; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Vishnu Anand Cuddapah
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Su Y, Zhou Y, Bennett ML, Li S, Carceles-Cordon M, Lu L, Huh S, Jimenez-Cyrus D, Kennedy BC, Kessler SK, Viaene AN, Helbig I, Gu X, Kleinman JE, Hyde TM, Weinberger DR, Nauen DW, Song H, Ming GL. A single-cell transcriptome atlas of glial diversity in the human hippocampus across the postnatal lifespan. Cell Stem Cell 2022; 29:1594-1610.e8. [PMID: 36332572 PMCID: PMC9844262 DOI: 10.1016/j.stem.2022.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/26/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
The molecular diversity of glia in the human hippocampus and their temporal dynamics over the lifespan remain largely unknown. Here, we performed single-nucleus RNA sequencing to generate a transcriptome atlas of the human hippocampus across the postnatal lifespan. Detailed analyses of astrocytes, oligodendrocyte lineages, and microglia identified subpopulations with distinct molecular signatures and revealed their association with specific physiological functions, age-dependent changes in abundance, and disease relevance. We further characterized spatiotemporal heterogeneity of GFAP-enriched astrocyte subpopulations in the hippocampal formation using immunohistology. Leveraging glial subpopulation classifications as a reference map, we revealed the diversity of glia differentiated from human pluripotent stem cells and identified dysregulated genes and pathological processes in specific glial subpopulations in Alzheimer's disease (AD). Together, our study significantly extends our understanding of human glial diversity, population dynamics across the postnatal lifespan, and dysregulation in AD and provides a reference atlas for stem-cell-based glial differentiation.
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Affiliation(s)
- Yijing Su
- Department of Neuroscience and Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Yi Zhou
- Department of Neuroscience and Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mariko L Bennett
- Department of Neuroscience and Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Pediatrics, Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Shiying Li
- Department of Neuroscience and Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu 226001, China
| | - Marc Carceles-Cordon
- Department of Neuroscience and Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Neuroscience Graduate Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Lu Lu
- Department of Neuroscience and Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sooyoung Huh
- Department of Neuroscience and Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dennisse Jimenez-Cyrus
- Department of Neuroscience and Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Benjamin C Kennedy
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sudha K Kessler
- Department of Pediatrics, Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Angela N Viaene
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Ingo Helbig
- Department of Pediatrics, Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 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
| | - Xiaosong Gu
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu 226001, China
| | - Joel E Kleinman
- Lieber Institute for Brain Development, The Solomon H. Snyder Department of Neuroscience, Department of Neurology, and Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Thomas M Hyde
- Lieber Institute for Brain Development, The Solomon H. Snyder Department of Neuroscience, Department of Neurology, and Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Daniel R Weinberger
- Lieber Institute for Brain Development, The Solomon H. Snyder Department of Neuroscience, Department of Neurology, and Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - David W Nauen
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Hongjun Song
- Department of Neuroscience and Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Institute for Regenerative Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; The Epigenetics Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Guo-Li Ming
- Department of Neuroscience and Mahoney Institute for Neurosciences, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Institute for Regenerative Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Lewis-Smith D, Parthasarathy S, Xian J, Kaufman MC, Ganesan S, Galer PD, Thomas RH, Helbig I. Computational analysis of neurodevelopmental phenotypes: Harmonization empowers clinical discovery. Hum Mutat 2022; 43:1642-1658. [PMID: 35460582 PMCID: PMC9560951 DOI: 10.1002/humu.24389] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/23/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022]
Abstract
Making a specific diagnosis in neurodevelopmental disorders is traditionally based on recognizing clinical features of a distinct syndrome, which guides testing of its possible genetic etiologies. Scalable frameworks for genomic diagnostics, however, have struggled to integrate meaningful measurements of clinical phenotypic features. While standardization has enabled generation and interpretation of genomic data for clinical diagnostics at unprecedented scale, making the equivalent breakthrough for clinical data has proven challenging. However, increasingly clinical features are being recorded using controlled dictionaries with machine readable formats such as the Human Phenotype Ontology (HPO), which greatly facilitates their use in the diagnostic space. Improving the tractability of large-scale clinical information will present new opportunities to inform genomic research and diagnostics from a clinical perspective. Here, we describe novel approaches for computational phenotyping to harmonize clinical features, improve data translation through revising domain-specific dictionaries, quantify phenotypic features, and determine clinical relatedness. We demonstrate how these concepts can be applied to longitudinal phenotypic information, which represents a critical element of developmental disorders and pediatric conditions. Finally, we expand our discussion to clinical data derived from electronic medical records, a largely untapped resource of deep clinical information with distinct strengths and weaknesses.
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Affiliation(s)
- David Lewis-Smith
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
- Department of Clinical Neurosciences, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shridhar Parthasarathy
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Julie Xian
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael C. Kaufman
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shiva Ganesan
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Peter D. Galer
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Rhys H. Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK
- Department of Clinical Neurosciences, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - Ingo Helbig
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics (DBHi), Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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Prelack M, Fridinger S, Gonzalez AK, Kaufman MC, Xian J, Galer PD, Craig S, Abend NS, Helbig I. Visits of concern in child neurology telemedicine. Dev Med Child Neurol 2022; 64:1351-1358. [PMID: 35514061 PMCID: PMC9998265 DOI: 10.1111/dmcn.15256] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 01/19/2023]
Abstract
AIM To characterize child neurology telemedicine visits flagged as requiring in-person evaluation during the COVID-19 pandemic. METHOD We analyzed 7130 audio-video telemedicine visits between March and November 2020. Visits of concern (VOCs) were defined as telemedicine visits where the clinical scenario necessitated in-person follow-up evaluation sooner than if the visit had been conducted in-person. RESULTS VOCs occurred in 5% (333/7130) of visits for 292 individuals (148 females, 144 males). Providers noted technical challenges more often in VOCs (40%; 133/333) than visits without concern (non-VOCs) (28%; 1922/6797) (p < 0.05). The median age was younger in VOCs (9 years 3 months, interquartile range [IQR] 2 years 0 months-14 years 3 months) than non-VOCs (11 years 3 months, IQR 5 years 10 months-15 years 10 months) (p < 0.05). Median household income was lower for patients with VOCs ($74 K, IQR $55 K-$97 K) compared to non-VOCs ($80 K, IQR $61 K-$100 K) (p < 0.05). Compared with all other race categories, families who self-identified as Black were more likely to have a VOC (odds ratio 1.53, 95% confidence interval 1.21-2.06). Epilepsy and headache represented the highest percentages of VOCs, while neuromuscular disorders and developmental delay had a higher proportion of VOCs than other neurological disorders. INTERPRETATION These findings suggest that telemedicine is an effective platform for most child neurology visits. Younger children and those with neuromuscular disorders or developmental delays are more likely to require in-person evaluation. WHAT THIS PAPER ADDS It is possible to successfully flag patients who need in-person assessment. Providers can manage issues arising during telemedicine in 95% of visits. Visits flagged as concerning were likely unrelated to modality of patient care. Provider concern was independent of technical difficulties for most telehealth visits. Younger age may be correlated with need for in-person assessment.
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Affiliation(s)
- Marisa Prelack
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Sara Fridinger
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Alexander K Gonzalez
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael C Kaufman
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Julie Xian
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Peter D Galer
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sansanee Craig
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nicholas S Abend
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Anesthesia & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ingo Helbig
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Alves CAPF, Clifford SM, McKeown Ruggiero S, Helbig I, Chadehumbe M, Shekdar K. Teaching NeuroImage: Selectively Bright Inferior Cerebellum in Christianson Syndrome. Neurology 2022; 99:815-816. [PMID: 36096688 DOI: 10.1212/wnl.0000000000201234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/27/2022] [Indexed: 01/19/2023] Open
Affiliation(s)
- Cesar Augusto P F Alves
- From the Division of Neuroradiology (C.A.P.F.A., S.M.C., K.S.), Department of Radiology, the Childrens Hospital of Philadelphia; and Epilepsy Neurogenetics Initiative (S.M.R., I.H., M.C.), Department of Neurology, the Childrens Hospital of Philadelphia, PA.
| | - Simon M Clifford
- From the Division of Neuroradiology (C.A.P.F.A., S.M.C., K.S.), Department of Radiology, the Childrens Hospital of Philadelphia; and Epilepsy Neurogenetics Initiative (S.M.R., I.H., M.C.), Department of Neurology, the Childrens Hospital of Philadelphia, PA
| | - Sarah McKeown Ruggiero
- From the Division of Neuroradiology (C.A.P.F.A., S.M.C., K.S.), Department of Radiology, the Childrens Hospital of Philadelphia; and Epilepsy Neurogenetics Initiative (S.M.R., I.H., M.C.), Department of Neurology, the Childrens Hospital of Philadelphia, PA
| | - Ingo Helbig
- From the Division of Neuroradiology (C.A.P.F.A., S.M.C., K.S.), Department of Radiology, the Childrens Hospital of Philadelphia; and Epilepsy Neurogenetics Initiative (S.M.R., I.H., M.C.), Department of Neurology, the Childrens Hospital of Philadelphia, PA
| | - Madeline Chadehumbe
- From the Division of Neuroradiology (C.A.P.F.A., S.M.C., K.S.), Department of Radiology, the Childrens Hospital of Philadelphia; and Epilepsy Neurogenetics Initiative (S.M.R., I.H., M.C.), Department of Neurology, the Childrens Hospital of Philadelphia, PA
| | - Karuna Shekdar
- From the Division of Neuroradiology (C.A.P.F.A., S.M.C., K.S.), Department of Radiology, the Childrens Hospital of Philadelphia; and Epilepsy Neurogenetics Initiative (S.M.R., I.H., M.C.), Department of Neurology, the Childrens Hospital of Philadelphia, PA
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Hopfner F, Tietz AK, Ruf VC, Ross OA, Koga S, Dickson D, Aguzzi A, Attems J, Beach T, Beller A, Cheshire WP, van Deerlin V, Desplats P, Deuschl G, Duyckaerts C, Ellinghaus D, Evsyukov V, Flanagan ME, Franke A, Frosch MP, Gearing M, Gelpi E, van Gerpen JA, Ghetti B, Glass JD, Grinberg LT, Halliday G, Helbig I, Höllerhage M, Huitinga I, Irwin DJ, Keene DC, Kovacs GG, Lee EB, Levin J, Martí MJ, Mackenzie I, McKeith I, Mclean C, Mollenhauer B, Neumann M, Newell KL, Pantelyat A, Pendziwiat M, Peters A, Porcel LM, Rabano A, Matěj R, Rajput A, Rajput A, Reimann R, Scott WK, Seeley W, Selvackadunco S, Simuni T, Stadelmann C, Svenningsson P, Thomas A, Trenkwalder C, Troakes C, Trojanowski JQ, Uitti RJ, White CL, Wszolek ZK, Xie T, Ximelis T, Justo Y, Müller U, Schellenberg GD, Herms J, Kuhlenbäumer G, Höglinger G. Common Variants Near ZIC1 and ZIC4 in Autopsy-Confirmed Multiple System Atrophy. Mov Disord 2022; 37:2110-2121. [PMID: 35997131 PMCID: PMC10052809 DOI: 10.1002/mds.29164] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/04/2022] [Accepted: 05/02/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Multiple System Atrophy is a rare neurodegenerative disease with alpha-synuclein aggregation in glial cytoplasmic inclusions and either predominant olivopontocerebellar atrophy or striatonigral degeneration, leading to dysautonomia, parkinsonism, and cerebellar ataxia. One prior genome-wide association study in mainly clinically diagnosed patients with Multiple System Atrophy failed to identify genetic variants predisposing for the disease. OBJECTIVE Since the clinical diagnosis of Multiple System Atrophy yields a high rate of misdiagnosis when compared to the neuropathological gold standard, we studied only autopsy-confirmed cases. METHODS We studied common genetic variations in Multiple System Atrophy cases (N = 731) and controls (N = 2898). RESULTS The most strongly disease-associated markers were rs16859966 on chromosome 3, rs7013955 on chromosome 8, and rs116607983 on chromosome 4 with P-values below 5 × 10-6 , all of which were supported by at least one additional genotyped and several imputed single nucleotide polymorphisms. The genes closest to the chromosome 3 locus are ZIC1 and ZIC4 encoding the zinc finger proteins of cerebellum 1 and 4 (ZIC1 and ZIC4). INTERPRETATION Since mutations of ZIC1 and ZIC4 and paraneoplastic autoantibodies directed against ZIC4 are associated with severe cerebellar dysfunction, we conducted immunohistochemical analyses in brain tissue of the frontal cortex and the cerebellum from 24 Multiple System Atrophy patients. Strong immunohistochemical expression of ZIC4 was detected in a subset of neurons of the dentate nucleus in all healthy controls and in patients with striatonigral degeneration, whereas ZIC4-immunoreactive neurons were significantly reduced inpatients with olivopontocerebellar atrophy. These findings point to a potential ZIC4-mediated vulnerability of neurons in Multiple System Atrophy. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Anja K. Tietz
- Department of Neurology, Kiel University, Kiel, Germany
| | - Viktoria C. Ruf
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universität, Munich, Germany
| | - Owen A. Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, USA
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, Florida, USA
| | - Shunsuke Koga
- 6Department of Neuroscience (Neuropathology), Mayo Clinic, Jacksonville, Florida, USA
| | - Dennis Dickson
- 6Department of Neuroscience (Neuropathology), Mayo Clinic, Jacksonville, Florida, USA
| | - Adriano Aguzzi
- Institute of Neuropathology, University Hospital Zürich, Zürich, Switzerland
| | - Johannes Attems
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Thomas Beach
- Banner Sun Health Research Institute, Sun City, Arizona, USA
| | - Allison Beller
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | | | - Vivianna van Deerlin
- Department of Pathology and Laboratory Medicine, Penn Neurodegeneration Genomics Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paula Desplats
- Department of Neurosciences, School of Medicine University of California San Diego, La Jolla, California, USA
- Department of Pathology, School of Medicine University of California San Diego, La Jolla, California, USA
| | | | - Charles Duyckaerts
- Institut du Cerveau, UMR 7225, Sorbonne Université, Paris Brain Institute-ICM, CNRS, AP-HP, Hôpital de la Pitié Salpêtrière, Inserm U1127 DMU Neurosciences, Paris, France
- Brainbank NeuroCEB Neuropathology Network: Plateforme de Ressources Biologiques, Hôpital de La Pitié-Salpêtrière, Bâtiment Roger Baillet, Paris Cedex, France
| | - David Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel & University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Margaret Ellen Flanagan
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pathology, Northwestern University, Chicago, Illinois, USA
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel & University Hospital Schleswig-Holstein, Kiel, Germany
| | - Matthew P. Frosch
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marla Gearing
- Departments of Pathology and Laboratory Medicine and Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ellen Gelpi
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Medical University of Vienna, Austrian Reference Center for Human Prion Diseases (OERPE), Vienna, Austria
| | | | - Bernardino Ghetti
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Lea T. Grinberg
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
- Global Health Institute, University of California, San Francisco, California, USA
- Department of Pathology, University of California, San Francisco, California, USA
- Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Glenda Halliday
- The University of Sydney, School of Medical Sciences, and Brain & Mind Centre, Sydney, New South Wales, Australia
| | - Ingo Helbig
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- The Epilepsy NeuroGenetics Initiative (ENGIN), Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Inge Huitinga
- Department of Neuroimmunology, Netherlands Institute for Neuroscience, Amsterdam, the Netherlands
- Brain Plasticity Group, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - David John Irwin
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Dirk C. Keene
- Department of Pathology, University of Washington, Seattle, Washington, USA
| | - Gabor G. Kovacs
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Department of Laboratory Medicine and Pathobiology and Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
- Laboratory Medicine Program and Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Edward B. Lee
- Department of Pathology and Laboratory Medicine, Translational Neuropathology Research Laboratory Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Johannes Levin
- DZNE – German Center for Neurodegenerative Diseases, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Maria J. Martí
- Parkinson’s Disease and Movement Disorders Unit, Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut de Neurociències, Maeztu Center, University of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigacion Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Ian Mackenzie
- Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ian McKeith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Catriona Mclean
- Department of Anatomical Pathology, Alfred Health, Melbourne, Victoria, Australia
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurology, University Medical Center Goettingen, Gottingen, Germany
| | - Manuela Neumann
- Molecular Neuropathology of Neurodegenerative Diseases, German Center for Neurodegenerative Diseases, Tübingen, Germany
- Department of Neuropathology, University Hospital of Tübingen, Tübingen, Germany
| | - Kathy L. Newell
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alex Pantelyat
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Manuela Pendziwiat
- Department of Neuropediatrics, Children’s Hospital, University Medical Center Schleswig-Holstein, University of Kiel, Kiel, Germany
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | | | - Alberto Rabano
- Neuropathology Department, CIEN Foundation, Alzheimer’s Centre Queen Sofía Foundation, Madrid, Spain
| | - Radoslav Matěj
- Department of Pathology, 3rd Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
- Department of Pathology and Molecular Medicine, 3rd Faculty of Medicine, Charles University, Thomayer University Hospital, Prague, Czech Republic
| | - Alex Rajput
- Division of Neurology, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ali Rajput
- Saskatchewan Movement Disorders Program, Saskatchewan Health Authority/University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Regina Reimann
- Institute of Neuropathology, University Hospital Zürich, Zürich, Switzerland
| | - William K. Scott
- John P. Hussman Institute for Human Genomics and Dr. John T. Macdonald Department of Human Genetics, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - William Seeley
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California, USA
- Global Health Institute, University of California, San Francisco, California, USA
- Department of Pathology, University of California, San Francisco, California, USA
| | - Sashika Selvackadunco
- Basic and Clinical Neuroscience Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Tanya Simuni
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Christine Stadelmann
- Institute for Neuropathology, University Medical Centre Göttingen, Göttingen, Germany
| | - Per Svenningsson
- Section of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Alan Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Claudia Trenkwalder
- Paracelsus-Elena-Klinik, Kassel, Germany
- Department of Neurosurgery, University Medical Center Goettingen, Goettingen, Germany
| | - Claire Troakes
- Basic and Clinical Neuroscience Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - John Q. Trojanowski
- Department of Pathology and Laboratory Medicine, Center for Neurodegenerative Disease Research, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ryan J. Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - Charles L. White
- Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Tao Xie
- Department of Neurology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Teresa Ximelis
- Alzheimer’s Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Yebenes Justo
- Neurological Tissue Bank, Biobanc-Hospital Clínic-IDIBAPS, Barcelona, Spain
- Servicio de Neurología, Hospital Ramón y Cajal de Madrid, Madrid, Spain
| | | | - Ulrich Müller
- Institute of Human Genetics, JLU-Gießen, Giessen, Germany
| | - Gerard D. Schellenberg
- Department of Pathology and Laboratory Medicine, Penn Neurodegeneration Genomics Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jochen Herms
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-Universität, Munich, Germany
- DZNE – German Center for Neurodegenerative Diseases, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | | | - Günter Höglinger
- Department of Neurology Hannover Medical School, Hannover, Germany
- DZNE – German Center for Neurodegenerative Diseases, Munich, Germany
- Zentrum für Systemische Neurowissenschaften, Hannover, Germany
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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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Knowles JK, Helbig I, Metcalf CS, Lubbers LS, Isom LL, Demarest S, Goldberg EM, George AL, Lerche H, Weckhuysen S, Whittemore V, Berkovic SF, Lowenstein DH. Precision medicine for genetic epilepsy on the horizon: Recent advances, present challenges, and suggestions for continued progress. Epilepsia 2022; 63:2461-2475. [PMID: 35716052 PMCID: PMC9561034 DOI: 10.1111/epi.17332] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [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: 01/31/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 01/18/2023]
Abstract
The genetic basis of many epilepsies is increasingly understood, giving rise to the possibility of precision treatments tailored to specific genetic etiologies. Despite this, current medical therapy for most epilepsies remains imprecise, aimed primarily at empirical seizure reduction rather than targeting specific disease processes. Intellectual and technological leaps in diagnosis over the past 10 years have not yet translated to routine changes in clinical practice. However, the epilepsy community is poised to make impressive gains in precision therapy, with continued innovation in gene discovery, diagnostic ability, and bioinformatics; increased access to genetic testing and counseling; fuller understanding of natural histories; agility and rigor in preclinical research, including strategic use of emerging model systems; and engagement of an evolving group of stakeholders (including patient advocates, governmental resources, and clinicians and scientists in academia and industry). In each of these areas, we highlight notable examples of recent progress, new or persistent challenges, and future directions. The future of precision medicine for genetic epilepsy looks bright if key opportunities on the horizon can be pursued with strategic and coordinated effort.
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Affiliation(s)
- Juliet K. Knowles
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, Stanford, California, USA
| | - Ingo Helbig
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA,Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany,Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Cameron S. Metcalf
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
| | - Laura S. Lubbers
- Citizens United for Research in Epilepsy, Chicago, Illinois, USA
| | - Lori L. Isom
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Scott Demarest
- Department of Pediatrics and Neurology, University of Colorado, School of Medicine, Aurora, Colorado, USA
| | - Ethan M. Goldberg
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alfred L. George
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Sarah Weckhuysen
- Division of Neurology, University Hospital Antwerp, Antwerp, Belgium,Applied and Translational Neurogenomics Group, Vlaams Instituut voor Biotechnologie Center for Molecular Neurology, Antwerp, Belgium,Translational Neurosciences, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,μNEURO Research Center of Excellence, University of Antwerp, Antwerp, Belgium
| | - Vicky Whittemore
- Division of Neuroscience, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Rockville, Maryland, USA
| | - Samuel F. Berkovic
- Epilepsy Research Centre, Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Daniel H. Lowenstein
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
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Jacobwitz M, Mulvihill C, Kaufman MC, Gonzalez AK, Resendiz K, MacDonald JM, Francoeur C, Helbig I, Topjian AA, Abend NS. Ketamine for Management of Neonatal and Pediatric Refractory Status Epilepticus. Neurology 2022; 99:e1227-e1238. [PMID: 35817569 PMCID: PMC10499431 DOI: 10.1212/wnl.0000000000200889] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/11/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Few data are available regarding the use of anesthetic infusions for refractory status epilepticus (RSE) in children and neonates, and ketamine use is increasing despite limited data. We aimed to describe the impact of ketamine for RSE in children and neonates. METHODS Retrospective single-center cohort study of consecutive patients admitted to the intensive care units of a quaternary care children's hospital treated with ketamine infusion for RSE. RESULTS Sixty-nine patients were treated with a ketamine infusion for RSE. The median age at onset of RSE was 0.7 years (interquartile range 0.15-7.2), and the cohort included 13 (19%) neonates. Three patients (4%) had adverse events requiring intervention during or within 12 hours of ketamine administration, including hypertension in 2 patients and delirium in 1 patient. Ketamine infusion was followed by seizure termination in 32 patients (46%), seizure reduction in 19 patients (28%), and no change in 18 patients (26%). DISCUSSION Ketamine administration was associated with few adverse events, and seizures often terminated or improved after ketamine administration. Further data are needed comparing first-line and subsequent anesthetic medications for treatment of pediatric and neonatal RSE. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence on the therapeutic utility of ketamine for treatment of RSE in children and neonates.
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Affiliation(s)
- Marin Jacobwitz
- From the Department of Pediatrics (Division of Neurology) (M.J., C.M., M.C.K., A.K.G., I.H., N.S.A.), Children's Hospital of Philadelphia; The Epilepsy NeuroGenetics Initiative (ENGIN) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia; Department of Biomedical and Health Informatics (DBHi) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia, PA; Department of Anesthesia and Critical Care Medicine (K.R., A.A.T., N.S.A.), Children's Hospital of Philadelphia; Department of Pharmacy Services (K.R.), Children's Hospital of Philadelphia, PA; Division of Critical Care (J.M.M.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Critical Care (C.F.), Quebec, Department of Pediatrics, CHU de Québec-University of Laval Research Center; Departments of Neurology and Pediatrics (I.H., N.S.A.), University of Pennsylvania Perelman School of Medicine; and Department of Anesthesia & Critical Care (A.A.T.), University of Pennsylvania Perelman School of Medicine.
| | - Caitlyn Mulvihill
- From the Department of Pediatrics (Division of Neurology) (M.J., C.M., M.C.K., A.K.G., I.H., N.S.A.), Children's Hospital of Philadelphia; The Epilepsy NeuroGenetics Initiative (ENGIN) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia; Department of Biomedical and Health Informatics (DBHi) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia, PA; Department of Anesthesia and Critical Care Medicine (K.R., A.A.T., N.S.A.), Children's Hospital of Philadelphia; Department of Pharmacy Services (K.R.), Children's Hospital of Philadelphia, PA; Division of Critical Care (J.M.M.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Critical Care (C.F.), Quebec, Department of Pediatrics, CHU de Québec-University of Laval Research Center; Departments of Neurology and Pediatrics (I.H., N.S.A.), University of Pennsylvania Perelman School of Medicine; and Department of Anesthesia & Critical Care (A.A.T.), University of Pennsylvania Perelman School of Medicine
| | - Michael C Kaufman
- From the Department of Pediatrics (Division of Neurology) (M.J., C.M., M.C.K., A.K.G., I.H., N.S.A.), Children's Hospital of Philadelphia; The Epilepsy NeuroGenetics Initiative (ENGIN) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia; Department of Biomedical and Health Informatics (DBHi) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia, PA; Department of Anesthesia and Critical Care Medicine (K.R., A.A.T., N.S.A.), Children's Hospital of Philadelphia; Department of Pharmacy Services (K.R.), Children's Hospital of Philadelphia, PA; Division of Critical Care (J.M.M.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Critical Care (C.F.), Quebec, Department of Pediatrics, CHU de Québec-University of Laval Research Center; Departments of Neurology and Pediatrics (I.H., N.S.A.), University of Pennsylvania Perelman School of Medicine; and Department of Anesthesia & Critical Care (A.A.T.), University of Pennsylvania Perelman School of Medicine
| | - Alexander K Gonzalez
- From the Department of Pediatrics (Division of Neurology) (M.J., C.M., M.C.K., A.K.G., I.H., N.S.A.), Children's Hospital of Philadelphia; The Epilepsy NeuroGenetics Initiative (ENGIN) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia; Department of Biomedical and Health Informatics (DBHi) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia, PA; Department of Anesthesia and Critical Care Medicine (K.R., A.A.T., N.S.A.), Children's Hospital of Philadelphia; Department of Pharmacy Services (K.R.), Children's Hospital of Philadelphia, PA; Division of Critical Care (J.M.M.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Critical Care (C.F.), Quebec, Department of Pediatrics, CHU de Québec-University of Laval Research Center; Departments of Neurology and Pediatrics (I.H., N.S.A.), University of Pennsylvania Perelman School of Medicine; and Department of Anesthesia & Critical Care (A.A.T.), University of Pennsylvania Perelman School of Medicine
| | - Karla Resendiz
- From the Department of Pediatrics (Division of Neurology) (M.J., C.M., M.C.K., A.K.G., I.H., N.S.A.), Children's Hospital of Philadelphia; The Epilepsy NeuroGenetics Initiative (ENGIN) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia; Department of Biomedical and Health Informatics (DBHi) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia, PA; Department of Anesthesia and Critical Care Medicine (K.R., A.A.T., N.S.A.), Children's Hospital of Philadelphia; Department of Pharmacy Services (K.R.), Children's Hospital of Philadelphia, PA; Division of Critical Care (J.M.M.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Critical Care (C.F.), Quebec, Department of Pediatrics, CHU de Québec-University of Laval Research Center; Departments of Neurology and Pediatrics (I.H., N.S.A.), University of Pennsylvania Perelman School of Medicine; and Department of Anesthesia & Critical Care (A.A.T.), University of Pennsylvania Perelman School of Medicine
| | - Jennifer M MacDonald
- From the Department of Pediatrics (Division of Neurology) (M.J., C.M., M.C.K., A.K.G., I.H., N.S.A.), Children's Hospital of Philadelphia; The Epilepsy NeuroGenetics Initiative (ENGIN) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia; Department of Biomedical and Health Informatics (DBHi) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia, PA; Department of Anesthesia and Critical Care Medicine (K.R., A.A.T., N.S.A.), Children's Hospital of Philadelphia; Department of Pharmacy Services (K.R.), Children's Hospital of Philadelphia, PA; Division of Critical Care (J.M.M.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Critical Care (C.F.), Quebec, Department of Pediatrics, CHU de Québec-University of Laval Research Center; Departments of Neurology and Pediatrics (I.H., N.S.A.), University of Pennsylvania Perelman School of Medicine; and Department of Anesthesia & Critical Care (A.A.T.), University of Pennsylvania Perelman School of Medicine
| | - Conall Francoeur
- From the Department of Pediatrics (Division of Neurology) (M.J., C.M., M.C.K., A.K.G., I.H., N.S.A.), Children's Hospital of Philadelphia; The Epilepsy NeuroGenetics Initiative (ENGIN) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia; Department of Biomedical and Health Informatics (DBHi) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia, PA; Department of Anesthesia and Critical Care Medicine (K.R., A.A.T., N.S.A.), Children's Hospital of Philadelphia; Department of Pharmacy Services (K.R.), Children's Hospital of Philadelphia, PA; Division of Critical Care (J.M.M.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Critical Care (C.F.), Quebec, Department of Pediatrics, CHU de Québec-University of Laval Research Center; Departments of Neurology and Pediatrics (I.H., N.S.A.), University of Pennsylvania Perelman School of Medicine; and Department of Anesthesia & Critical Care (A.A.T.), University of Pennsylvania Perelman School of Medicine
| | - Ingo Helbig
- From the Department of Pediatrics (Division of Neurology) (M.J., C.M., M.C.K., A.K.G., I.H., N.S.A.), Children's Hospital of Philadelphia; The Epilepsy NeuroGenetics Initiative (ENGIN) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia; Department of Biomedical and Health Informatics (DBHi) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia, PA; Department of Anesthesia and Critical Care Medicine (K.R., A.A.T., N.S.A.), Children's Hospital of Philadelphia; Department of Pharmacy Services (K.R.), Children's Hospital of Philadelphia, PA; Division of Critical Care (J.M.M.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Critical Care (C.F.), Quebec, Department of Pediatrics, CHU de Québec-University of Laval Research Center; Departments of Neurology and Pediatrics (I.H., N.S.A.), University of Pennsylvania Perelman School of Medicine; and Department of Anesthesia & Critical Care (A.A.T.), University of Pennsylvania Perelman School of Medicine
| | - Alexis A Topjian
- From the Department of Pediatrics (Division of Neurology) (M.J., C.M., M.C.K., A.K.G., I.H., N.S.A.), Children's Hospital of Philadelphia; The Epilepsy NeuroGenetics Initiative (ENGIN) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia; Department of Biomedical and Health Informatics (DBHi) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia, PA; Department of Anesthesia and Critical Care Medicine (K.R., A.A.T., N.S.A.), Children's Hospital of Philadelphia; Department of Pharmacy Services (K.R.), Children's Hospital of Philadelphia, PA; Division of Critical Care (J.M.M.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Critical Care (C.F.), Quebec, Department of Pediatrics, CHU de Québec-University of Laval Research Center; Departments of Neurology and Pediatrics (I.H., N.S.A.), University of Pennsylvania Perelman School of Medicine; and Department of Anesthesia & Critical Care (A.A.T.), University of Pennsylvania Perelman School of Medicine
| | - Nicholas S Abend
- From the Department of Pediatrics (Division of Neurology) (M.J., C.M., M.C.K., A.K.G., I.H., N.S.A.), Children's Hospital of Philadelphia; The Epilepsy NeuroGenetics Initiative (ENGIN) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia; Department of Biomedical and Health Informatics (DBHi) (M.C.K., A.K.G., I.H.), Children's Hospital of Philadelphia, PA; Department of Anesthesia and Critical Care Medicine (K.R., A.A.T., N.S.A.), Children's Hospital of Philadelphia; Department of Pharmacy Services (K.R.), Children's Hospital of Philadelphia, PA; Division of Critical Care (J.M.M.), Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; Division of Critical Care (C.F.), Quebec, Department of Pediatrics, CHU de Québec-University of Laval Research Center; Departments of Neurology and Pediatrics (I.H., N.S.A.), University of Pennsylvania Perelman School of Medicine; and Department of Anesthesia & Critical Care (A.A.T.), University of Pennsylvania Perelman School of Medicine
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47
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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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Gavazzi F, Pierce SR, Vithayathil J, Cunningham K, Anderson K, McCann J, Moll A, Muirhead K, Sherbini O, Prange E, Dubbs H, Tochen L, Fraser J, Helbig I, Lewin N, Thakur N, Adang LA. Psychometric outcome measures in beta-propeller protein-associated neurodegeneration (BPAN). Mol Genet Metab 2022; 137:26-32. [PMID: 35878504 PMCID: PMC9613602 DOI: 10.1016/j.ymgme.2022.07.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Beta-propeller protein-associated neurodegeneration (BPAN) is a rare neurodegenerative disorder characterized by iron accumulation in the brain with spectrum of neurodevelopmental and movement phenotypes. In anticipation of future clinical trials and to inform clinical care, there is an unmet need to capture the phenotypic diversity of this rare disorder and better define disease subtypes. METHODS A total of 27 individuals with BPAN were included in our natural history study, from which traditional outcome measures were obtained in 18 subjects. Demographic and diagnostic information, along with acquisition of basic developmental skills and overall neurologic severity were extracted from the medical records. Functional outcome measures were administered at the time of the evaluation or applied retrospectively at the last clinical encounter for patients who were not able to travel for in person. Based on age and functional level, the following assessments were administered: Leiter-3, Gross Motor Function Measure (GMFM)-66 Item Sets, Vineland-3, and Peabody-2. RESULTS Overall, cognitive function was more impaired compared to gross motor function. Onset of symptoms of BPAN within the first 6 months of life was associated with decreased gain of ambulation and gain of spoken language (ambulation: log-rank test p = 0.0015; gain of first word: p = 0.0015). There was no difference in age at seizure onset by age at initial symptom onset (p = 0.8823). Collection of prospective outcome measures was limited by attention and behavior in our patient population, reinforcing the complexity of phenotype assessment and inadequacy of available standardized tests. Overall, gross motor and adaptive behavior assessments were better able to capture the dynamic range of function across the BPAN population than the fine motor and non-verbal cognitive tests. Floor effects were noted across outcome measures in a subset of individuals for cognitive and adaptive behavior tests. CONCLUSION Our data suggest the distinct phenotypes of BPAN: a severe, early onset form and an attenuated form with higher cognitive capabilities. Early age at onset was a key factor in predicting future neurologic impairment.
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Affiliation(s)
- Francesco Gavazzi
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Molecular and Translational Medicine, University of Brescia, Italy
| | - Samuel R Pierce
- Departmen of Physical Therapy, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joseph Vithayathil
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristin Cunningham
- Department of Occupational Therapy, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kim Anderson
- Department of Occupational Therapy, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jacob McCann
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ashley Moll
- Department of Occupational Therapy, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kayla Muirhead
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Omar Sherbini
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erin Prange
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Holly Dubbs
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laura Tochen
- Children's National Medical Center, Department of Neurology, 111 Michigan Ave NW, Washington, DC 20010, USA
| | - Jamie Fraser
- Rare Disease Institute, Division of Genetics and Metabolism, Children's National Hospital, Washington, DC, USA
| | - Ingo Helbig
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Naomi Lewin
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nivedita Thakur
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura A Adang
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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49
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McKee JL, Kaufman MC, Gonzalez AK, Massey SL, Fung FW, Fitzgerald MP, Kessler SK, Witzman S, Abend NS, Helbig I. WE-180. Neonatal seizure prediction algorithms based on EMR-embedded standardized EEG reporting. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.07.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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50
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Cohen SR, Helbig I, Kaufman MC, Schust Myers L, Conway L, Helbig KL. Caregiver assessment of quality of life in individuals with genetic developmental and epileptic encephalopathies. Dev Med Child Neurol 2022; 64:957-964. [PMID: 35229292 PMCID: PMC10305579 DOI: 10.1111/dmcn.15187] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/06/2023]
Abstract
AIM To summarize quality of life (QoL) and its determinants, including disease severity, in individuals with developmental and epileptic encephalopathies (DEEs) through a tailored questionnaire. METHOD A questionnaire containing 89 items addressing demographic characteristics, genetic diagnosis, clinical features, and QoL was distributed to primary caregivers of individuals with DEEs through patient advocacy organizations. Composite scores were generated from the mean values of QoL items, grouped into domain scores. RESULTS Out of 176 received responses, the most common genetic diagnoses reported were SCN2A (n=42/173, 24%), SLC6A1 (n=28/173, 16%), SCN1A (n=22/173, 13%), and KCNQ2 (n=21/173, 12%). Composite QoL scores centered around a mean score of 61.67 of 100 (SD 17.10). QoL scores were strongly associated with the number of days minimally disrupted by seizures, medication side effects, genetic diagnosis, and community type. The mean QoL scores for individuals with DEEs was significantly lower than for individuals with Rett syndrome, cerebral palsy, autism spectrum disorder, and Down syndrome. INTERPRETATION QoL in DEEs can be assessed through a standardized instrument. QoL only partially overlaps with objective measurements of disease severity and may represent an independent outcome measure in precision medicine trials.
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Affiliation(s)
- Stacey R Cohen
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ingo Helbig
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael C Kaufman
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Biomedical and Health Informatics (DBHi), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Laura Conway
- Department of Genetics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Katherine L Helbig
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Epilepsy NeuroGenetics Initiative (ENGIN), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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