Abstract
Phenotypic and Genetic Spectrum of Epilepsy With Myoclonic Atonic
Seizures
Tang S, Addis L, Smith A, Topp SD, Pendziwiat M, Mei D, Parker A, Agrawal S, Hughes
E, Lascelles K, Williams RE, Fallon P, Robinson R, Cross HJ, Hedderly T, Eltze C, Kerr
T, Desurkar A, Hussain N, Kinali M, Bagnasco I, Vassallo G, Whitehouse W, Goyal S,
Absoud M, EuroEPINOMICS-RES Consortium, Møller RS, Helbig I, Weber, YG, Marini C,
Guerrini R, Simpson MA, Pal DK. Epilepsia. 2020;61(5):995-1007. doi:
10.1111/epi.16508
Objective:
We aimed to describe the extent of neurodevelopmental impairments and identify the
genetic etiologies in a large cohort of patients with epilepsy with myoclonic atonic
seizures (MAEs).
Methods:
We deeply phenotyped patients with MAE for epilepsy features, intellectual
disability, autism spectrum disorder, and attention-deficit/hyperactivity disorder
using standardized neuropsychological instruments. We performed exome analysis
(whole exome sequencing) filtered on epilepsy and neuropsychiatric gene sets to
identify genetic etiologies.
Results:
We analyzed 101 patients with MAE (70% male). The median age of seizure onset was
34 months (range = 6-72 months). The main seizure types were myoclonic atonic or
atonic in 100%, generalized tonic-clonic in 72%, myoclonic in 69%, absence in 60%,
and tonic seizures in 19% of patients. We observed intellectual disability in 62% of
patients, with extremely low adaptive behavioral scores in 69%. In addition, 24%
exhibited symptoms of autism and 37% exhibited attention-deficit/hyperactivity
symptoms. We discovered pathogenic variants in 12 (14%) of 85 patients, including 5
previously published patients. These were pathogenic genetic variants in SYNGAP1 (n
= 3), KIAA2022 (n = 2), and SLC6A1 (n = 2), as well as KCNA2, SCN2A, STX1B, KCNB1,
and MECP2 (n = 1 each). We also identified 3 new candidate genes, ASH1L, CHD4, and
SMARCA2 in 1 patient each.
Significance:
MAE is associated with significant neurodevelopmental impairment. MAE is
genetically heterogeneous, and we identified a pathogenic genetic etiology in 14% of
this cohort by exome analysis. These findings suggest that MAE is a manifestation of
several etiologies rather than a discrete syndromic entity.
Collapse