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The Parasomnias and Sleep Related Movement Disorders—A Look Back at Six Decades of Scientific Studies. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2022. [DOI: 10.3390/ctn6010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective of this article is to provide a comprehensive personal survey of all the major parasomnias with coverage of their clinical presentation, investigation, physiopathogenesis and treatment. These include the four major members of the slow-wave sleep arousal parasomnias which are enuresis nocturna (bedwetting), somnambulism (sleepwalking), sleep terrors (pavor nocturnus in children, incubus attacks in adults) and confusional arousals (sleep drunkenness). Other parasomnias covered are sleep-related aggression, hypnagogic and hypnopompic terrifying hallucinations, REM sleep terrifying dreams, nocturnal anxiety attacks, sleep paralysis, sleep talking (somniloquy), sexsomnia, REM sleep behavior disorder (RBD), nocturnal paroxysmal dystonia, sleep starts (hypnic jerks), jactatio capitis nocturna (head and total body rocking), periodic limb movement disorder (PLMs), hypnagogic foot tremor, restless leg syndrome (Ekbom syndrome), exploding head syndrome, excessive fragmentary myoclonus, nocturnal cramps, and sleep-related epileptic seizures. There is interest in the possibility of relationships between sleep/wake states and creativity.
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Shi XY, Wang G, Li T, Li Z, Leo P, Liu Z, Wu G, Zhu H, Zhang Y, Li D, Gao L, Yang L, Wang W, Liao J, Wang J, Zhou S, Wang H, Li X, Gao J, Zhang L, Shu X, Li D, Li Y, Chen C, Zhang X, Partida GC, Lundberg M, Reutens D, Bartlett P, Brown MA, Zou LP, Xu H. Identification of susceptibility variants to benign childhood epilepsy with centro-temporal spikes (BECTS) in Chinese Han population. EBioMedicine 2020; 57:102840. [PMID: 32580138 PMCID: PMC7317238 DOI: 10.1016/j.ebiom.2020.102840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/11/2020] [Accepted: 06/02/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Benign Childhood Epilepsy with Centro-temporal Spikes (BECTS) is the most common form of idiopathic epilepsy in children, accounting for up to 23% of pediatric epilepsy. The pathogenesis of BECTS is unknown, but it is thought that genetic factors play a role in susceptibility to the disease. METHODS To investigate the role of common genetic variants in BECTS pathogenesis, a 2-stage genome-wide association study (GWAS) was performed in 1,800 Chinese Han BECTS patients, and 7,090 healthy controls. Genetic findings were used in a Mendelian Randomization study in the UK Biobank dataset to investigate the potential role of smoking in BECTS. FINDINGS Definitive evidence of a role for common-variant heritability was demonstrated, with heritability of BECTS of >10% observed even with conservative disease prevalence assumptions. Although no individual locus achieved genome-wide significance, twelve loci achieved suggestive evidence of association (5 × 10-8<P<10-5). Using combined genetic and brain tissue gene expression data analyzed by Summary-data-based Mendelian Randomization (SMR), causative association of BECTS was demonstrated with SNP rs1948 and the CHRNA5 t3603436 transcript (Peqtl = 2·10 × 10-12, Psmr = 7·9 × 10-5). This finding indicates rs1948 is significantly associated with BECTS through effects on expression of CHRNA5 in brain tissue. The identification of novel loci suggests involvements of KALRN and the CHRNA5-A3-B4 cluster in BECTS. Using a generalized SMR approach we demonstrate that maternal smoking around birth is significantly associated with increased risk of BECTS (odds ratio = 3·90, P = 0·0099). INTERPRETATION This study shows that BECTS risk is at least partially heritable and due to common genetic variants. Additionally, we demonstrate that BECTS risk is substantially increased by maternal smoking around birth.
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Affiliation(s)
- Xiu-Yu Shi
- Department of Pediatrics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian district, Beijing, China
| | - Geng Wang
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China; University of Queensland Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Ting Li
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhixiu Li
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Brisbane, Australia
| | - Paul Leo
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Translational Research Institute, Brisbane, Australia
| | - Zhisheng Liu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology Wuhan, Hubei, China
| | - Gefei Wu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology Wuhan, Hubei, China
| | - Hongmin Zhu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology Wuhan, Hubei, China
| | - Yuqin Zhang
- Department of Neurology, Tian Jin Children's hospital, 238 Longyan road, Beichen district, Tianjin, China
| | - Dong Li
- Department of Neurology, Tian Jin Children's hospital, 238 Longyan road, Beichen district, Tianjin, China
| | - Li Gao
- Department of Pediatrics, Henan Provincial People's Hospital, 7 Weiwu Road, Jinshui District, Zhengzhou, Henan Province, China
| | - Liu Yang
- Department of Pediatrics, Henan Provincial People's Hospital, 7 Weiwu Road, Jinshui District, Zhengzhou, Henan Province, China
| | - Wei Wang
- Department of Neurology, Harbin Children's Hospital, 57 YouYi Road, DaoLi District, Harbin, Heilongjiang Province, China
| | - Jianxiang Liao
- Department of Neurology, Shenzhen Children's Hospital, 7019 Yitian Road Futian, Shenzhen, Guangdong Province, China
| | - Jiwen Wang
- Department of Neurology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, New Pudong district, Shanghai, China
| | - Shuizhen Zhou
- Department of Neurology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, China
| | - Hua Wang
- Department of Pediatric Neurology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning Province, China
| | - Xiaojing Li
- Department of Neurology, Guangzhou Women and Children's Medical Center, 9 Jinsui Road, Tianhe district, Guangzhou, Guangdong Province, China
| | - Jingyun Gao
- Department of Pediatric Neurology, Hebei Tangshan City maternal and child health care hospital,14 South Jianhe Road, Tangshan, Hebei Province, China
| | - Li Zhang
- Department of Pediatrics, Linyi People's Hospital, 130 Yizhou Road, Lanshan, Linyi, Shandong Province, China
| | - Xiaomei Shu
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical College, 149 Dalian Road, Zunyi, Guizhou Province, China
| | - Dan Li
- Department of Pediatrics, the Second affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, Shaanxi Province, China
| | - Yan Li
- Department of Neurology, Children's Hospital Affiliated to Soochow University, 92 Zhongnan Street, Suzhou, Jiangsu Province, China
| | - Chunhong Chen
- Department of Neurology, Beijing Children's Hospital, 56 South Lishi Road, Xicheng District, Beijing, China
| | - Xiuju Zhang
- Department of Pediatrics, Xingtai People's Hospital,16 Hongxing Street, Xingtai, Hebei Province, China
| | - Gabriel Cuellar Partida
- University of Queensland Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Mischa Lundberg
- University of Queensland Diamantina Institute, University of Queensland, Brisbane, Australia
| | - David Reutens
- Centre for Advanced Imaging, University of Queensland, Brisbane, Australia
| | - Perry Bartlett
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia
| | - Matthew A Brown
- Guy's & St Thomas' NHS Foundation Trust and King's College London, NIHR Biomedical Research Centre, London, England United Kingdom.
| | - Li-Ping Zou
- Department of Pediatrics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian district, Beijing, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China.
| | - Huji Xu
- Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China; Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China; Peking-Tsinghua Center for Life Sciences, Tsinghua University, Beijing 100084, China.
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Dixit AB, Sharma D, Tripathi M, Srivastava A, Paul D, Prakash D, Sarkar C, Kumar K, Banerjee J, Chandra PS. Genome-wide DNA Methylation and RNAseq Analyses Identify Aberrant Signalling Pathways in Focal Cortical Dysplasia (FCD) Type II. Sci Rep 2018; 8:17976. [PMID: 30568293 PMCID: PMC6299275 DOI: 10.1038/s41598-018-35892-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/01/2018] [Indexed: 01/26/2023] Open
Abstract
Focal cortical dysplasia (FCD) is one of the most common pathologies associated with drug-resistant epilepsy (DRE). The pharmacological targets remain obscured, as the molecular mechanisms underlying FCD are unclear. Implications of epigenetically modulated aberrant gene expression in disease progression are reported in various DRE pathologies except FCD. Here we performed genome-wide CpG-DNA methylation profiling by methylated DNA immunoprecipitation (MeDIP) microarray and RNA sequencing (RNAseq) on cortical tissues resected from FCD type II patients. A total of 19088 sites showed altered DNA methylation in all the CpG islands. Of these, 5725 sites were present in the promoter regions, of which 176 genes showed an inverse correlation between methylation and gene expression. Many of these 176 genes were found to belong to a cohesive network of physically interacting proteins linked to several cellular functions. Pathway analysis revealed significant enrichment of receptor tyrosine kinases (RTK), EGFR, PDGFRA, NTRK3, and mTOR signalling pathways. This is the first study that investigates the epigenetic signature associated with FCD type II pathology. The candidate genes and pathways identified in this study may play a crucial role in the regulation of the pathogenic mechanisms of epileptogenesis associated with FCD type II pathologies.
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Affiliation(s)
- Aparna Banerjee Dixit
- Center of Excellence for Epilepsy, A joint NBRC-AIIMS collaboration, NBRC, Manesar, India. .,Dr. B R Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India.
| | - Devina Sharma
- Center of Excellence for Epilepsy, A joint NBRC-AIIMS collaboration, NBRC, Manesar, India.,Department of Neurosurgery, AIIMS, New Delhi, India
| | - Manjari Tripathi
- Center of Excellence for Epilepsy, A joint NBRC-AIIMS collaboration, NBRC, Manesar, India.,Department of Neurology, AIIMS, New Delhi, India
| | | | - Debasmita Paul
- Center of Excellence for Epilepsy, A joint NBRC-AIIMS collaboration, NBRC, Manesar, India.,Department of Neurosurgery, AIIMS, New Delhi, India
| | - Deepak Prakash
- Department of Forensic Medicine and Toxicology, AIIMS, New Delhi, India
| | | | - Krishan Kumar
- Center of Excellence for Epilepsy, A joint NBRC-AIIMS collaboration, NBRC, Manesar, India.,Department of Neurosurgery, AIIMS, New Delhi, India
| | - Jyotirmoy Banerjee
- Center of Excellence for Epilepsy, A joint NBRC-AIIMS collaboration, NBRC, Manesar, India.,Department of Biophysics, AIIMS, New Delhi, India
| | - P Sarat Chandra
- Center of Excellence for Epilepsy, A joint NBRC-AIIMS collaboration, NBRC, Manesar, India. .,Department of Neurosurgery, AIIMS, New Delhi, India.
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Samarasekera SR, Berkovic SF, Scheffer IE. A case series of lacosamide as adjunctive therapy in refractory sleep-related hypermotor epilepsy (previously nocturnal frontal lobe epilepsy). J Sleep Res 2018; 27:e12669. [DOI: 10.1111/jsr.12669] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/19/2017] [Accepted: 01/02/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Shanika R. Samarasekera
- Epilepsy Research Centre; Department of Medicine; University of Melbourne; Melbourne Vic. Australia
| | - Samuel F. Berkovic
- Epilepsy Research Centre; Department of Medicine; University of Melbourne; Melbourne Vic. Australia
| | - Ingrid E. Scheffer
- Epilepsy Research Centre; Department of Medicine; University of Melbourne; Melbourne Vic. Australia
- Department of Paediatrics; University of Melbourne; Melbourne Vic. Australia
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Puligheddu M, Melis M, Pillolla G, Milioli G, Parrino L, Terzano GM, Aroni S, Sagheddu C, Marrosu F, Pistis M, Muntoni AL. Rationale for an adjunctive therapy with fenofibrate in pharmacoresistant nocturnal frontal lobe epilepsy. Epilepsia 2017; 58:1762-1770. [DOI: 10.1111/epi.13863] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Monica Puligheddu
- Sleep Disorder Research Center; Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Italy
| | - Miriam Melis
- Department of Biomedical Sciences; University of Cagliari; Monserrato Italy
| | - Giuliano Pillolla
- Department of Biomedical Sciences; University of Cagliari; Monserrato Italy
| | - Giulia Milioli
- Department of Neurosciences; Sleep Disorder Center; University of Parma; Parma Italy
| | - Liborio Parrino
- Department of Neurosciences; Sleep Disorder Center; University of Parma; Parma Italy
| | | | - Sonia Aroni
- Department of Biomedical Sciences; University of Cagliari; Monserrato Italy
| | - Claudia Sagheddu
- Department of Biomedical Sciences; University of Cagliari; Monserrato Italy
| | - Francesco Marrosu
- Sleep Disorder Research Center; Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Italy
- Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Italy
| | - Marco Pistis
- Department of Biomedical Sciences; University of Cagliari; Monserrato Italy
- Neuroscience Institute; National Research Council of Italy; Cagliari Italy
| | - Anna Lisa Muntoni
- Neuroscience Institute; National Research Council of Italy; Cagliari Italy
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Avanzini G, Mantegazza M, Terragni B, Canafoglia L, Scalmani P, Franceschetti S. The impact of genetic and experimental studies on classification and therapy of the epilepsies. Neurosci Lett 2017; 667:17-26. [PMID: 28522348 DOI: 10.1016/j.neulet.2017.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/12/2017] [Accepted: 05/13/2017] [Indexed: 10/19/2022]
Abstract
Different types of epilepsy are associated with gene mutations, in which seizures can be the only symptom (genetic epilepsies) or be one of the elements of complex clinical pictures that are often progressive over time (epileptic or epileptogenic encephalopathies). In epileptogenic encephalopathies, epileptic seizures and other neurological and cognitive signs are symptoms of genetically determined neuropathological or neurochemical disorders. In epileptic encephalopathies, epileptic activity itself is thought to contribute to severe cognitive and behavioral impairments above and beyond what might be expected from the underlying pathology alone. The distinction is conceptually clear and clinically relevant, as the different categories have a different prognosis in terms of both epilepsy and associated neurological and cognitive picture, but the boundaries are sometimes difficult to define in the clinical practice. Here we review the genetic epilepsies from the clinician perspective. A monogenic inheritance has been defined only in a minority of idiopathic epilepsies making improper to rename genetic the category of idiopathic epilepsies, until the presumptive multigenic mechanism will be demonstrated. A search for gene mutations must be done in any patient with candidate genetic types of epilepsy or epileptic/epileptogenic encephalopathy (e.g. familial forms) to complete the diagnostic process, define the prognosis and optimize the therapy. Advanced methods are available to express the gene variant in experimental model systems and test its effect on the properties of the affected protein, on neuronal excitability and on phenotypes in model organisms, and may help in identifying treatments with compatible action mechanisms. The influence of genetic studies on epilepsy taxonomy is now a matter of discussion: their impact on the international classification of the epilepsies will hopefully be defined soon.
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Affiliation(s)
- Giuliano Avanzini
- Dept. of Neurophysiology and Diagnostic Epileptology, Foundation IRCCS Neurological Institute C. Besta, 20133 Milan, Italy.
| | - Massimo Mantegazza
- Institute of Molecular and Cellular Pharmacology (IPMC), CNRS UMR7275, 06560, Valbonne-Sophia, Antipolis, France; University Côte d'Azur (UCA), 06560, Valbonne-Sophia, Antipolis, France
| | - Benedetta Terragni
- Dept. of Neurophysiology and Diagnostic Epileptology, Foundation IRCCS Neurological Institute C. Besta, 20133 Milan, Italy
| | - Laura Canafoglia
- Dept. of Neurophysiology and Diagnostic Epileptology, Foundation IRCCS Neurological Institute C. Besta, 20133 Milan, Italy
| | - Paolo Scalmani
- Dept. of Neurophysiology and Diagnostic Epileptology, Foundation IRCCS Neurological Institute C. Besta, 20133 Milan, Italy
| | - Silvana Franceschetti
- Dept. of Neurophysiology and Diagnostic Epileptology, Foundation IRCCS Neurological Institute C. Besta, 20133 Milan, Italy
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7
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Villa C, Combi R. Potassium Channels and Human Epileptic Phenotypes: An Updated Overview. Front Cell Neurosci 2016; 10:81. [PMID: 27064559 PMCID: PMC4811893 DOI: 10.3389/fncel.2016.00081] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 03/15/2016] [Indexed: 12/03/2022] Open
Abstract
Potassium (K+) channels are expressed in almost every cells and are ubiquitous in neuronal and glial cell membranes. These channels have been implicated in different disorders, in particular in epilepsy. K+ channel diversity depends on the presence in the human genome of a large number of genes either encoding pore-forming or accessory subunits. More than 80 genes encoding the K+ channels were cloned and they represent the largest group of ion channels regulating the electrical activity of cells in different tissues, including the brain. It is therefore not surprising that mutations in these genes lead to K+ channels dysfunctions linked to inherited epilepsy in humans and non-human model animals. This article reviews genetic and molecular progresses in exploring the pathogenesis of different human epilepsies, with special emphasis on the role of K+ channels in monogenic forms.
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Affiliation(s)
- Chiara Villa
- School of Medicine and Surgery, University of Milano-Bicocca Monza, Italy
| | - Romina Combi
- School of Medicine and Surgery, University of Milano-Bicocca Monza, Italy
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8
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Wang MY, Liu XZ, Wang J, Wu LW. A novel mutation of the nicotinic acetylcholine receptor gene CHRNA4 in a Chinese patient with non-familial nocturnal frontal lobe epilepsy. Epilepsy Res 2014; 108:1927-31. [DOI: 10.1016/j.eplepsyres.2014.08.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/24/2014] [Accepted: 08/31/2014] [Indexed: 11/24/2022]
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10
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Kim GE, Kaczmarek LK. Emerging role of the KCNT1 Slack channel in intellectual disability. Front Cell Neurosci 2014; 8:209. [PMID: 25120433 PMCID: PMC4112808 DOI: 10.3389/fncel.2014.00209] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 07/10/2014] [Indexed: 01/15/2023] Open
Abstract
The sodium-activated potassium KNa channels Slack and Slick are encoded by KCNT1 and KCNT2, respectively. These channels are found in neurons throughout the brain, and are responsible for a delayed outward current termed I KNa. These currents integrate into shaping neuronal excitability, as well as adaptation in response to maintained stimulation. Abnormal Slack channel activity may play a role in Fragile X syndrome, the most common cause for intellectual disability and inherited autism. Slack channels interact directly with the fragile X mental retardation protein (FMRP) and I KNa is reduced in animal models of Fragile X syndrome that lack FMRP. Human Slack mutations that alter channel activity can also lead to intellectual disability, as has been found for several childhood epileptic disorders. Ongoing research is elucidating the relationship between mutant Slack channel activity, development of early onset epilepsies and intellectual impairment. This review describes the emerging role of Slack channels in intellectual disability, coupled with an overview of the physiological role of neuronal I KNa currents.
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Affiliation(s)
- Grace E Kim
- Departments of Pharmacology and Cellular & Molecular Physiology, Yale University School of Medicine New Haven, CT, USA
| | - Leonard K Kaczmarek
- Departments of Pharmacology and Cellular & Molecular Physiology, Yale University School of Medicine New Haven, CT, USA
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Guerrini R, Marini C, Mantegazza M. Genetic epilepsy syndromes without structural brain abnormalities: clinical features and experimental models. Neurotherapeutics 2014; 11:269-85. [PMID: 24664660 PMCID: PMC3996114 DOI: 10.1007/s13311-014-0267-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Research in genetics of epilepsy represents an area of great interest both for clinical purposes and for understanding the basic mechanisms of epilepsy. Most mutations in epilepsies without structural brain abnormalities have been identified in ion channel genes, but an increasing number of genes involved in a diversity of functional and developmental processes are being recognized through whole exome or genome sequencing. Targeted molecular diagnosis is now available for different forms of epilepsy. The identification of epileptogenic mutations in patients before epilepsy onset and the possibility of developing therapeutic strategies tested in experimental models may facilitate experimental approaches that prevent epilepsy or decrease its severity. Functional analysis is essential for better understanding pathogenic mechanisms and gene interactions. In vitro experimental systems are either cells that usually do not express the protein of interest or neurons in primary cultures. In vivo/ex vivo systems are organisms or preparations obtained from them (e.g., brain slices), which should better model the complexity of brain circuits and actual pathophysiological conditions. Neurons differentiated from induced pluripotent stem cells generated from the skin fibroblasts of patients have recently allowed the study of mutations in human neurons having the genetic background of a given patient. However, there is remarkable complexity underlying epileptogenesis in the clinical dimension, as reflected by the fact that experimental models have not provided yet results having clinical translation and that, with a few exceptions concerning rare conditions, no new curative treatment has emerged from any genetic finding in epilepsy.
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Affiliation(s)
- Renzo Guerrini
- Pediatric Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Viale Pieraccini 24, 50139, Florence, Italy,
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12
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Abstract
Epilepsy affects almost 1% of the population, and yet the pathophysiology of this disorder is unknown in the majority of the cases. Recently, a number of mutations in different genes were identified, mostly in cases of familial epilepsy with a Mendelian mode of inheritance. The majority of these genes code for voltage- or ligand-gated ion channels. Interestingly, not only generalized epilepsies, but also focal epilepsies were shown to be caused by mutated genes, which in some cases are expressed ubiquitously in the brain. This review will focus on the monogenic familial epilepsies and the clinical and molecular aspects of these diseases.
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Affiliation(s)
- Danielle M Andrade
- University of Toronto, Division of Neurology, Krembil Neuroscience Centre, Toronto Western Hospital, Toronto, Canada.
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14
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Abstract
BACKGROUND Nocturnal frontal lobe epilepsy (NFLE) is an idiopathic partial epilepsy characterized by a wide spectrum of stereotyped motor manifestations, mostly occurring during non rapid eye movements sleep. NFLE is underdiagnosed since semiological similarities make it difficult to distinguish NFLE from parasomnias. In 1994, authors reported families with NFLE inherited as an autosomal dominant trait and they introduced the term of autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE). A family history of possible NFLE is found in about 25% of cases. The genetic bases of the disease have been detected in a minority of cases. Mutations causing a gain of function of the neuronal nicotinic acetylcholine receptors were reported in 3 different subunits. REVIEW SUMMARY This review discusses the clinical aspects of NFLE and the diagnostic procedures. Furthermore, the genetic aspects are outlined. The main differentiating features characterizing NFLE are: (a) several attacks per night at any time during the night; (b) brief duration of the attacks; (c) stereotyped motor pattern. Nocturnal video-polysomnography is crucial for the diagnosis. Neurological examination in NFLE/ADNFLE is normal. About 30% of NFLE cases are resistant to antiepileptic drugs. Concerning the genetics, putative susceptibility nucleotide variations affecting the promoter of the CRH gene and altering the corticotrophin-releasing hormone levels have been reported in some NFLE patients. CONCLUSIONS Distinguishing NFLE seizures from paroxysmal nonepileptic sleep disorders is often difficult and sometimes impossible on clinical grounds alone. Nocturnal video-polysomnography is mandatory. Further genetic studies could help the diagnosis and treatment in NFLE patients.
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Abstract
One of the most exciting areas in epilepsy has been the explosion in our understanding of the genetics of the epilepsies over the last decade. Built on a long history of careful clinical genetic studies of the epilepsies, the relatively recent discovery of epilepsy genes has enabled insights into pathways causing seizure disorders. A variety of mutational mechanisms can cause epilepsy resulting from different, and sometimes surprising, molecular processes such as copy number variation within the genome. The majority of known epilepsy genes encode ion channel subunits leading many of the genetic epilepsies to be regarded as channelopathies. Understanding how dysfunction of a mutant protein leads to hyperexcitability is key to understanding the pathophysiology of this group of serious and common childhood disorders. The architecture of the common genetic epilepsies following complex inheritance, where multiple genes are involved, is also beginning to be unraveled. The clinical approach to understanding the genetics of the epilepsies has matured and requires a detailed family history of seizures together with delineation of the child's epilepsy syndrome. Recognition of specific genetic epilepsy syndromes enables optimal treatment and prognostic and genetic counseling.
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Affiliation(s)
- Rima Nabbout
- Department of Pediatric Neurology, Hôpital Necker-Enfants Malades; Centre de référence épilepsies rares; INSERM U663, Paris, France.
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Naldi I, Bisulli F, Vignatelli L, Licchetta L, Pittau F, Di Vito L, Mostacci B, Menghi V, Provini F, Montagna P, Tinuper P. Tobacco habits in nocturnal frontal lobe epilepsy. Epilepsy Behav 2013; 26:114-7. [PMID: 23246147 DOI: 10.1016/j.yebeh.2012.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 09/27/2012] [Accepted: 10/11/2012] [Indexed: 11/20/2022]
Abstract
The beneficial effect of nicotine has been reported in autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) patients, but not tested in sporadic cases. Recently, a nicotine defect in the arousal pathway has been hypothesized even in sporadic NFLE patients and their relatives. This case-control family study was designed to test whether NFLE subjects were more likely to use tobacco than controls, as an indirect marker of cholinergic arousal system dysregulation. At least four relatives were included for each NFLE proband and control. Each subject was questioned about tobacco habits; 434 individuals were recruited. Moreover, we compared NFLE patients with age- and sex-matched controls to determine whether they are more likely to use tobacco. We found a slightly higher trend of tobacco use in NFLE probands compared to that in control subjects; we did not find any significant difference in the distribution of tobacco use among NFLE group compared to that in the control group.
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Affiliation(s)
- Ilaria Naldi
- IRCCS Istituto delle Scienze Neurologiche Bologna, and Dipartimento di ScienzeBiomediche e NeuroMotorie, Alma Mater Studiorum Università di Bologna, Bologna, Italy
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Becchetti A. Neuronal nicotinic receptors in sleep-related epilepsy: studies in integrative biology. ISRN BIOCHEMISTRY 2012; 2012:262941. [PMID: 25969754 PMCID: PMC4392997 DOI: 10.5402/2012/262941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 10/21/2012] [Indexed: 11/23/2022]
Abstract
Although Mendelian diseases are rare, when considered one by one, overall they constitute a significant social burden. Besides the medical aspects, they propose us one of the most general biological problems. Given the simplest physiological perturbation of an organism, that is, a single gene mutation, how do its effects percolate through the hierarchical biological levels to determine the pathogenesis? And how robust is the physiological system to this perturbation? To solve these problems, the study of genetic epilepsies caused by mutant ion channels presents special advantages, as it can exploit the full range of modern experimental methods. These allow to extend the functional analysis from single channels to whole brains. An instructive example is autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE), which can be caused by mutations in neuronal nicotinic acetylcholine receptors. In vitro, such mutations often produce hyperfunctional receptors, at least in heterozygous condition. However, understanding how this leads to sleep-related frontal epilepsy is all but straightforward. Several available animal models are helping us to determine the effects of ADNFLE mutations on the mammalian brain. Because of the complexity of the cholinergic regulation in both developing and mature brains, several pathogenic mechanisms are possible, which also present different therapeutic implications.
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Affiliation(s)
- Andrea Becchetti
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, Piazza della Scienza 2, 20126 Milan, Italy
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Gourfinkel-An I, Baulac S, Brice A, Leguern E, Baulac M. Genetics of inherited human epilepsies. DIALOGUES IN CLINICAL NEUROSCIENCE 2012. [PMID: 22034131 PMCID: PMC3181638 DOI: 10.31887/dcns.2001.3.1/igourfinkelan] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Major advances have recently been made in our understanding of the genetic basis of monogenic inherited epilepsies. Progress has been particularly spectacular with respect to idiopathic epilepsies, with the discovery that mutations in ion channel subunits are implicated. However, important advances have also been made in many inherited symptomatic epilepsies, for which direct molecular diagnosis is now possible, simplifying previously complex investigations, it is expected that identification of the genes implicated in familial forms of epilepsies will lead to a better understanding of the underlying pathophysiological mechanisms of these disorders and to the development of experimental models and new therapeutic strategies, in this article, we review the clinical and genetic data concerning most of the inherited human epilepsies.
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Affiliation(s)
- I Gourfinkel-An
- Unité d'Epileptologie, Hôpital Pitié-Salpêtrière, Paris, France; Service d'Electrophysiologie, Hôpital Pitié-Salpêtrière, Paris, France
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Parasomnias and nocturnal frontal lobe epilepsy (NFLE): lights and shadows--controversial points in the differential diagnosis. Sleep Med 2012; 12 Suppl 2:S27-32. [PMID: 22136895 DOI: 10.1016/j.sleep.2011.10.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 11/20/2022]
Abstract
Nocturnal frontal lobe epilepsy (NFLE) is characterized by seizures with complex, often bizarre, violent behaviour arising only or mainly during sleep. These unusual seizures and their occurrence during sleep are often accompanied by normal EEG tracings and neuroradiological findings, making it difficult to distinguish NFLE seizures from other non-epileptic nocturnal paroxysmal events, namely parasomnias. NFLE was described for the first time in 1981, but, as its epileptic origin was controversial, the condition was called nocturnal paroxysmal dystonia. Even though many aspects of parasomnias and NFLE have been clarified in the last two decades, the problem of differential diagnosis remains a challenge for clinicians. This paper discusses some controversial points still under debate. The difficulties in distinguishing nocturnal epileptic seizures from parasomnias reflect just one aspect of the intriguing issue of the pathophysiological relationships between all types of paroxysmal motor behaviours during sleep.
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The epilepsies. Neurogenetics 2012. [DOI: 10.1017/cbo9781139087711.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Nocturnal Frontal Epilepsies: Diagnostic and Therapeutic Challenges for Sleep Specialists. Sleep Med Clin 2012. [DOI: 10.1016/j.jsmc.2011.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stewart AM, Desmond D, Kyzar E, Gaikwad S, Roth A, Riehl R, Collins C, Monnig L, Green J, Kalueff AV. Perspectives of zebrafish models of epilepsy: What, how and where next? Brain Res Bull 2012; 87:135-43. [DOI: 10.1016/j.brainresbull.2011.11.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 11/20/2011] [Accepted: 11/25/2011] [Indexed: 10/14/2022]
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Poza JJ. The genetics of focal epilepsies. HANDBOOK OF CLINICAL NEUROLOGY 2012; 107:153-161. [PMID: 22938969 DOI: 10.1016/b978-0-444-52898-8.00009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Juan José Poza
- Department of Neurology, Hospital Donostia, San Sebastian, Spain.
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Nocturnal Frontal Lobe Epilepsy: New pathophysiological interpretations. Sleep Med 2011; 12 Suppl 2:S39-42. [DOI: 10.1016/j.sleep.2011.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/11/2011] [Accepted: 10/12/2011] [Indexed: 11/22/2022]
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Unterberger I, Trinka E. Diagnosis and treatment of paroxysmal dyskinesias revisited. Ther Adv Neurol Disord 2011; 1:4-11. [PMID: 21180566 DOI: 10.1177/1756285608095119] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Paroxysmal dyskinesias (PDs) are a rare group of hyperkinetic movement disorders mainly characterized by their episodic nature. Neurological examination may be entirely normal between the attacks. Three main types of PDs can be distinguished based on their precipitating events - (i) paroxysmal kinesigenic dyskinesias (PKD), (ii) paroxysmal non-kinesigenic dyskinesias (PNKD) and (iii) paroxysmal exercise-induced (exertion-induced) dyskinesias (PED). The diagnosis of PDs is based on their clinical presentation and precipitating events. Substantial progress has been made in the field of genetics and PDs. Treatment options mainly include anticonvulsants and benefit of treatment is depending on the type of PD. Most important differential diagnosis are non-epileptic psychogenic, non-epileptic organic and epileptic attack disorders, especially nocturnal frontal lobe epilepsy.
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Affiliation(s)
- Iris Unterberger
- Medizinische Universität Innsbruck, Universitätsklinik für Neurologie, Anichstrasse 35, 6020 Innsbruck, Austria.
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Affiliation(s)
- Marco Zucconi
- Department of Clinical Neurosciences, Vita-Salute San Raffaele University, Milan, Italy.
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Si Y, Liu L, Li Q, Mu J, Tian LY, Chen JN, Zhou D. Features of the K-complex waves in refractory nocturnal frontal lobe epilepsy. Epilepsy Res 2010; 92:219-25. [DOI: 10.1016/j.eplepsyres.2010.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 09/29/2010] [Accepted: 10/03/2010] [Indexed: 11/25/2022]
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Mantegazza M, Rusconi R, Scalmani P, Avanzini G, Franceschetti S. Epileptogenic ion channel mutations: from bedside to bench and, hopefully, back again. Epilepsy Res 2010; 92:1-29. [PMID: 20828990 DOI: 10.1016/j.eplepsyres.2010.08.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 07/30/2010] [Accepted: 08/08/2010] [Indexed: 01/21/2023]
Abstract
Mutations of genes coding for ion channels cause several genetically determined human epileptic syndromes. The identification of a gene variant linked to a particular disease gives important information, but it is usually necessary to perform functional studies in order to completely disclose the pathogenic mechanisms. The functional consequences of epileptogenic mutations have been studied both in vitro and in vivo with several experimental systems, studies that have provided significant knowledge on the pathogenic mechanisms that leads to inherited human epilepsies, and possibly also on the pathogenic mechanisms of non-genetic human epilepsies due to "acquired channelopathies". However, several open issues remain and difficulties in the interpretation of the experimental data have arisen that limit translational applications. We will highlight the value and the limits of different approaches to the study of epileptogenic channelopathies, focussing on the importance of the experimental systems in the assessment of the functional effects of the mutations and on the possible applications of the obtained results to the clinical practice.
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Affiliation(s)
- Massimo Mantegazza
- Institut de Pharmacologie Moléculaire et Cellulaire, CNRS UMR6097 and University of Nice-Sophia Antipolis, 660 route des Lucioles, 06560 Valbonne, France.
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Tinuper P, Bisulli F, Provini F, Lugaresi E. Familial frontal lobe epilepsy and its relationship with other nocturnal paroxysmal events. Epilepsia 2010; 51 Suppl 1:51-3. [PMID: 20331716 DOI: 10.1111/j.1528-1167.2009.02446.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Paolo Tinuper
- Department of Neurological Sciences, University of Bologna, Bologna, Italy.
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Abstract
Genetic factors play an increasingly recognized role in idiopathic epilepsies. Since 1995, positional cloning strategies in multi-generational families with autosomal dominant transmission have revealed 11 genes (KCNQ2, KCNQ3, CHRNA4, CHRNA2, CHRNB2, SCN1B, SCN1A, SCN2A, GABRG2, GABRA1, and LGI1) and numerous loci for febrile seizures and epilepsies. To date, all genes with the exception of LGI1 (leucine-rich glioma inactivated 1), encode neuronal ion channel or neurotransmitter receptor subunits. Molecular approaches have revealed great genetic heterogeneity, with the vast majority of genes remaining to be identified. One of the major challenges is now to understand phenotype-genotype correlations. This review focuses on the current knowledge on the molecular basis of these rare Mendelian autosomal dominant forms of idiopathic epilepsies.
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Affiliation(s)
- Stéphanie Baulac
- UPMC/Inserm, UMR_S975, Cricm, F-75013, Bâtiment Pharmacie, Hôpital de la Pitié-Salpêtrière, 47 boulevard de l'hôpital, 75013 Paris, France.
| | - Michel Baulac
- UPMC/Inserm, UMR_S975, Cricm, F-75013, Bâtiment Pharmacie, Hôpital de la Pitié-Salpêtrière, 47 boulevard de l'hôpital, 75013 Paris, France; Center for Epilepsy, AP-HP, Bâtiment Paul Casteigne Hôpital de la Pitié-Salpêtrière, 47 boulevard de l'hôpital, 75013 Paris, France
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Anderson CME, Berkovic S, Dulac O, Gardiner M, Jain S, Friis ML, Lindhout D, Noebels J, Ottman R, Scaramelli A, Serratosa J, Steinlein O. ILAE Genetics Commission Conference Report: Molecular Analysis of Complex Genetic Epilepsies. Epilepsia 2009. [DOI: 10.1046/j.1528-1157.2002.t01-1-04312.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Genetic basis in epilepsies caused by malformations of cortical development and in those with structurally normal brain. Hum Genet 2009; 126:173-93. [PMID: 19536565 DOI: 10.1007/s00439-009-0702-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 06/02/2009] [Indexed: 01/10/2023]
Abstract
Epilepsy is the most common neurological disorder affecting young people. The etiologies are multiple and most cases are sporadic. However, some rare families with Mendelian inheritance have provided evidence of genes' important role in epilepsy. Two important but apparently different groups of disorders have been extensively studied: epilepsies associated with malformations of cortical development (MCDs) and epilepsies associated with a structurally normal brain (or with minimal abnormalities only). This review is focused on clinical and molecular aspects of focal cortical dysplasia, polymicrogyria, periventricular nodular heterotopia, subcortical band heterotopia, lissencephaly and schizencephaly as examples of MCDs. Juvenile myoclonic epilepsy, childhood absence epilepsy, some familial forms of focal epilepsy and epilepsies associated with febrile seizures are discussed as examples of epileptic conditions in (apparently) structurally normal brains.
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Cortical hyperexcitability and epileptogenesis: Understanding the mechanisms of epilepsy – Part 1. J Clin Neurosci 2009; 16:355-65. [DOI: 10.1016/j.jocn.2008.08.026] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 08/12/2008] [Indexed: 11/22/2022]
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Chen Y, Wu L, Fang Y, He Z, Peng B, Shen Y, Xu Q. A novel mutation of the nicotinic acetylcholine receptor gene CHRNA4 in sporadic nocturnal frontal lobe epilepsy. Epilepsy Res 2009; 83:152-6. [DOI: 10.1016/j.eplepsyres.2008.10.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 09/29/2008] [Accepted: 10/22/2008] [Indexed: 10/21/2022]
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Combi R, Ferini-Strambi L, Luisa Tenchini M. CHRNA2 mutations are rare in the NFLE population: Evaluation of a large cohort of Italian patients. Sleep Med 2009; 10:139-42. [DOI: 10.1016/j.sleep.2007.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Revised: 11/07/2007] [Accepted: 11/13/2007] [Indexed: 10/22/2022]
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Affiliation(s)
- Ruth Ottman
- Gertrude H. Sergievsky Center and Mailman School of Public Health (Department of Epidemiology) Columbia University, New York, New York, U.S.A
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Affiliation(s)
- Samuel F. Berkovic
- Epilepsy Research Institute, The University of Melbourne, Austin and Repatriation Medical Centre,
West Heidelberg, Victoria, Australia
| | - Ingrid E. Scheffer
- Epilepsy Research Institute, The University of Melbourne, Austin and Repatriation Medical Centre,
West Heidelberg, Victoria, Australia
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Derry CP, Heron SE, Phillips F, Howell S, MacMahon J, Phillips HA, Duncan JS, Mulley JC, Berkovic SF, Scheffer IE. Severe autosomal dominant nocturnal frontal lobe epilepsy associated with psychiatric disorders and intellectual disability. Epilepsia 2008; 49:2125-9. [PMID: 18479385 DOI: 10.1111/j.1528-1167.2008.01652.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is a relatively benign epilepsy syndrome with few comorbidities. Here we describe two families with unusually severe ADNFLE, with associated psychiatric, behavioral, and cognitive features. Detailed clinical data on 17 affected individuals were obtained, and genotyping of microsatellite markers, linkage analysis, and sequencing of candidate genes was performed. The severe ADNFLE phenotype in these families was often refractory to treatment, with status epilepticus occurring in 24% of subjects. Psychiatric or behavioral disorders occurred in 53%, with intellectual disability in 24%, and developmental regression in two individuals. No mutations were identified in alpha4, alpha2, or beta2 nAChR subunits. In one family there was evidence of linkage to a region of 15q24 without nAChR subunit genes. In conclusion, severe ADNFLE has significant medical, psychiatric, and intellectual morbidity. The molecular basis of severe ADNFLE is unknown but may involve non-nAChR-related mechanisms.
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Affiliation(s)
- Christopher P Derry
- Department of Medicine (Neurology), Epilepsy Research Centre, University of Melbourne, Victoria, Australia
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Díaz-Otero F, Quesada M, Morales-Corraliza J, Martínez-Parra C, Gómez-Garre P, Serratosa JM. Autosomal dominant nocturnal frontal lobe epilepsy with a mutation in theCHRNB2gene. Epilepsia 2008; 49:516-20. [PMID: 17900292 DOI: 10.1111/j.1528-1167.2007.01328.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE; MIM 600513) has been associated with mutations in the genes coding for the alfa-4 (CHRNA4), beta-2 (CHRNB2), and alpha-2 (CHRNA2) subunits of the neuronal nicotinic acetylcholine receptor (nAChR) and for the corticotropin-releasing hormone (CRH). A four-generation ADNFLE family with six affected members was identified. All affected members presented the clinical characteristics of ADNFLE. Interictal awake and sleep EEG recordings showed no epileptiform abnormalities. Ictal video-EEG recordings showed focal seizures with frontal lobe semiology. Mutation analysis of the CHRNB2 gene revealed a c.859G>A transition (Val287Met) within the second transmembrane domain, identical to that previously described in a Scottish ADNFLE family. To our knowledge, this is the third family reported presenting a mutation in CHRNB2. The clinical phenotype appears similar to that described with mutations in CHRNA4, suggesting that mutations in these two subunits lead to similar functional alterations of the nAChR.
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Grill MF, Losey TE, Ng YT. The Hitchhiker's guide to the child neurologist's genetic evaluation of epilepsy. Semin Pediatr Neurol 2008; 15:32-40. [PMID: 18342259 DOI: 10.1016/j.spen.2008.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Over the past several decades, familial aggregation studies as well as twin studies have supported a genetic component to seizures. The recent advent of the genome project has served as a catalyst in the search for elucidating the hereditary influences of various epilepsies. Overlapping seizure features may lead to ambiguity when attempting to isolate a single phenotype. Conversely, the phenomenon of genetic heterogeneity implies that multiple genetic mutations may give rise to a similar phenotype. Despite valiant attempts at strictly defining epilepsy phenotype and mode of penetrance, one must also consider the role of environment in gene expression. Genetics (testing) in epilepsy is no longer limited to the idiopathic epilepsies but may have an equally significant role in the symptomatic epilepsies. This article guides the reader through the genetics of epilepsy via discussion of the phenotypic description of known genetic childhood epilepsy syndromes, illustration of the associated gene mutations identified thus far, and the implications of genetic testing in clinical practice.
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Affiliation(s)
- Marie F Grill
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA
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Montagna P, Provini F, Bisulli F, Tinuper P. Nocturnal epileptic seizures versus the arousal parasomnias. SOMNOLOGIE 2008. [DOI: 10.1007/s11818-008-0333-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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45
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Bernard G, Shevell MI. Channelopathies: a review. Pediatr Neurol 2008; 38:73-85. [PMID: 18206787 DOI: 10.1016/j.pediatrneurol.2007.09.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 07/05/2007] [Accepted: 09/13/2007] [Indexed: 10/22/2022]
Abstract
Channelopathies are a recently delineated, emerging group of neurologic disorders united by genetically determined defects in ion-channel function. These disorders are characterized by a prominent genetic and phenotypic heterogeneity that can make them challenging and bewildering to understand. This systematic review attempts to categorize these disorders according to their predominant clinical manifestations (i.e., myotonia, weakness, migraine, ataxia, epilepsy, and movement disorders) within the context of what is presently known about the molecular basis of recognized clinical syndromes. Areas of both genetic and phenotypic overlap are highlighted. The review is intended to assist clinicians in enhancing their diagnostic acumen and in targeting specific genetic tests.
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Affiliation(s)
- Genevieve Bernard
- Department of Neurology/Neurosurgery, McGill University, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada
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Teper Y, Whyte D, Cahir E, Lester HA, Grady SR, Marks MJ, Cohen BN, Fonck C, McClure-Begley T, McIntosh JM, Labarca C, Lawrence A, Chen F, Gantois I, Davies PJ, Petrou S, Murphy M, Waddington J, Horne MK, Berkovic SF, Drago J. Nicotine-induced dystonic arousal complex in a mouse line harboring a human autosomal-dominant nocturnal frontal lobe epilepsy mutation. J Neurosci 2007; 27:10128-42. [PMID: 17881519 PMCID: PMC6672658 DOI: 10.1523/jneurosci.3042-07.2007] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We generated a mouse line harboring an autosomal-dominant nocturnal frontal lobe epilepsy (ADNFLE) mutation: the alpha4 nicotinic receptor S248F knock-in strain. In this mouse, modest nicotine doses (1-2 mg/kg) elicit a novel behavior termed the dystonic arousal complex (DAC). The DAC includes stereotypical head movements, body jerking, and forelimb dystonia; these behaviors resemble some core features of ADNFLE. A marked Straub tail is an additional component of the DAC. Similar to attacks in ADNFLE, the DAC can be partially suppressed by the sodium channel blocker carbamazepine or by pre-exposure to a very low dose of nicotine (0.1 mg/kg). The DAC is centrally mediated, genetically highly penetrant, and, surprisingly, not associated with overt ictal electrical activity as assessed by (1) epidural or frontal lobe depth-electrode electroencephalography or (2) hippocampal c-fos-regulated gene expression. Heterozygous knock-in mice are partially protected from nicotine-induced seizures. The noncompetitive antagonist mecamylamine does not suppress the DAC, although it suppresses high-dose nicotine-induced wild-type-like seizures. Experiments on agonist-induced 86Rb+ and neurotransmitter efflux from synaptosomes and on alpha4S248Fbeta2 receptors expressed in oocytes confirm that the S248F mutation confers resistance to mecamylamine blockade. Genetic background, gender, and mutant gene expression levels modulate expression of the DAC phenotype in mice. The S248F mouse thus appears to provide a model for the paroxysmal dystonic element of ADNFLE semiology. Our model complements what is seen in other ADNFLE animal models. Together, these mice cover the spectrum of behavioral and electrographic events seen in the human condition.
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Affiliation(s)
| | | | | | - Henry A. Lester
- Division of Biology, California Institute of Technology, Pasadena, California 91125
| | - Sharon R. Grady
- Institute of Behavioral Genetics, University of Colorado, Boulder, Colorado 80309
| | - Michael J. Marks
- Institute of Behavioral Genetics, University of Colorado, Boulder, Colorado 80309
| | - Bruce N. Cohen
- Division of Biology, California Institute of Technology, Pasadena, California 91125
| | - Carlos Fonck
- Division of Biology, California Institute of Technology, Pasadena, California 91125
| | | | - J. Michael McIntosh
- Departments of Biology and Psychiatry, University of Utah, Salt Lake City, Utah 84112-0840
| | - Cesar Labarca
- Division of Biology, California Institute of Technology, Pasadena, California 91125
| | | | | | | | | | | | - Mark Murphy
- Department of Anatomy and Cell Biology, The University of Melbourne, Victoria 3010, Australia
| | - John Waddington
- Royal College of Surgeons in Ireland, Dublin 2, Ireland, and
| | | | - Samuel F. Berkovic
- Department of Medicine and Epilepsy Research Centre, University of Melbourne, Austin Health, Heidelberg West, Victoria 3081, Australia
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Marini C, Guerrini R. The role of the nicotinic acetylcholine receptors in sleep-related epilepsy. Biochem Pharmacol 2007; 74:1308-14. [PMID: 17662253 DOI: 10.1016/j.bcp.2007.06.030] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2007] [Revised: 06/18/2007] [Accepted: 06/19/2007] [Indexed: 12/01/2022]
Abstract
The role of neuronal acetylcholine receptors (nAChRs) in epilepsy has been clearly established by the finding of mutations in a subset of genes coding for subunits of the nAChRs in a form of sleep-related epilepsy with familial occurrence in about 30% of probands and dominant inheritance, named autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE). Sporadic and familial forms have similar clinical and EEG features. Seizures begin in middle childhood as clusters of sleep-related attacks with prominent motor activity, and sustained dystonic posturing. In addition to nocturnal seizures, psychosis or schizophrenia, behavioral disorders, memory deficits and mental retardation were described in some individuals. Although over hundred families are on record, only a minority of them have been linked to mutations in the genes coding for the alpha4, alpha2 and beta2 (CHRNA4, CHRNA2, and CHRNB2) subunits of the nAChRs, indicating that ADNFLE is genetically heterogeneous despite a relatively homogeneous clinical picture. Functional characterization of some mutations suggests that gain of the receptor function might be the basis for epileptogenesis. In vitro and in vivo studies have shown high density of nAChRs in the thalamus, over activated brainstem ascending cholinergic pathway and enhanced GABAergic function, reinforcing the hypothesis that cortico-subcortical networks, regulating arousal from sleep, play a central role in seizure precipitation in ADNFLE.
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Affiliation(s)
- Carla Marini
- Epilepsy, Neurophysiology and Neurogenetics Unit, Department of Child Neurology and Psychiatry, IRCCS Stella Maris Foundation, Pisa, Italy.
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De Marco EV, Gambardella A, Annesi F, Labate A, Carrideo S, Forabosco P, Civitelli D, Candiano ICC, Tarantino P, Annesi G, Quattrone A. Further evidence of genetic heterogeneity in families with autosomal dominant nocturnal frontal lobe epilepsy. Epilepsy Res 2007; 74:70-3. [PMID: 17324557 DOI: 10.1016/j.eplepsyres.2006.12.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 12/05/2006] [Accepted: 12/23/2006] [Indexed: 11/23/2022]
Abstract
PURPOSE Mutations in the genes encoding the alfa(2), alfa(4) and beta(2) subunits of the neuronal nicotinic acetylcholine receptor (nAChR) play a causative role in autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE). Moreover, variations in the promoter of the corticotropic-releasing hormone gene (CRH) were also associated with ADNFLE. Here, we investigated whether nine brain-expressed genes (CHRNA2, CHRNA3, CHRNA4, CHRNA5, CHRNA6, CHRNA7, CHRNB2, CHRNB3, CHRNB4), encoding distinct nAChR subunits, and CRH are associated with the disease in three distinct ADNFLE families from Southern Italy. METHODS There were 14 living affected individuals (9 women), ranging in age from 14 to 57 years, pertaining to three unrelated families. Age at onset of seizures clustered around 9 years of age (range from 7 and 16 years, mean: 9.1 years+/-3.8). All affected individuals manifested nocturnal partial seizures of frontal lobe origin, which were well controlled by medications. Exon 5 of CHRNA4 and CHRNB2 genes, harboring all the known mutations, was sequenced in the probands. Then, we performed a linkage study on 13 affected and 26 non-affected individuals belonging to the three families with microsatellite markers and an intragenic polymorphisms encompassing the chromosome localization of the nAChR subunit genes and of the CRH gene. RESULTS Mutational and linkage analyses allowed us to exclude the involvement of all known nAChR subunit genes and of the CRH gene in ADNFLE in our families. CONCLUSION Our results further illustrate the considerable genetic heterogeneity for such a syndrome, despite the quite homogeneous clinical picture. It is therefore reasonable to hypothesize that at least another gene not belonging to the nAChR gene family, in addition to CRH, is involved in the pathogenesis of ADNFLE.
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Affiliation(s)
- Elvira V De Marco
- Institute of Neurological Sciences, National Research Council, Mangone (CS), Italy
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Abstract
Nocturnal frontal lobe epilepsy (NFLE) is a condition primarily characterized by seizures occurring exclusively or predominantly during sleep, the semiology of which suggest a frontal lobe origin and, more specifically, the involvement of the orbitofrontal or mesial frontal regions. It is usually considered as a relatively benign and homogeneous epileptic syndrome, the neuropsychological impact of which should be minimal. However, several issues complicate this view. 1. NFLE is rather a heterogeneous disorder which includes both sporadic and familial forms, various seizure types, and drug resistance in about 30% of patients. 2. The frontal origin of seizures has rarely been demonstrated, and mainly relies on the presence of ictal signs suggestive of frontal lobe epilepsy, but which might only reflect the propagation of ictal discharges of extrafrontal origin. 3. NFLE-like seizures were recently found to be associated with temporobasal cortical dysplasia, or an insular epileptogenic zone, including one patient with autosomal dominant frontal lobe epilepsy (ADNFLE). 4. No study has yet specifically evaluated the neuropsychological profile of patients with NFLE. Available data suggest that behavioral problems and mental retardation might be associated with ADNFLE, especially when it is related to a mutation of the nicotinic receptor subunits. Conversely, the majority of NFLE patients does not seem to present with gross cognitive disturbance, even though many of these patients complain of chronically disrupted sleep and daytime sleepiness. Further research is warranted in this field, keeping in mind that the neural networks underlying NFLE remain poorly known and might primarily involve extrafrontal brain regions in some patients.
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Affiliation(s)
- Philippe Ryvlin
- CTRS-IDEE and Department of Functional Neurology and Epileptology, Neurological Hospital, Hospices Civiles de Lyon and Université Claude Bernard Lyon1, Lyon, France.
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Hirose S. A new paradigm of channelopathy in epilepsy syndromes: Intracellular trafficking abnormality of channel molecules. Epilepsy Res 2006; 70 Suppl 1:S206-17. [PMID: 16860540 DOI: 10.1016/j.eplepsyres.2005.12.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Revised: 12/01/2005] [Accepted: 12/01/2005] [Indexed: 10/24/2022]
Abstract
Mutations in genes encoding ion channels in brain neurons have been identified in various epilepsy syndromes. In neuronal networks, "gain-of-function" of channels in excitatory neurotransmission could lead to hyper-excitation while "loss-of-function" in inhibitory transmission impairs neuronal inhibitory system, both of which can result in epilepsy. A working hypothesis to view epilepsy as a disorder of channel or "channelopathy" seems rational to explore the pathogenesis of epilepsy. However, the imbalance resulting from channel dysfunction is not sufficient to delineate the pathogenesis of all epilepsy syndromes of which the underlying channel abnormalities have been verified. Mutations identified in epilepsy, mainly in genes encoding subunits of GABA(A) receptors, undermine intracellular trafficking, thus leading to retention of channel molecules in the endoplasmic reticulum (ER). This process may cause ER stress followed by apoptosis, which is a known pathomechanism of certain neurodegenerative disorders. Thus, the pathomechanism of "channel trafficking abnormality" may provide a new paradigm to channelopathy to unsolved questions underlying epilepsy, such as differences between generalized epilepsy with febrile seizures plus and severe myoclonic epilepsy in infancy, which share the causative genetic abnormalities in the same genes and hence are so far considered to be within the spectrum of one disease entity or allelic variants.
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Affiliation(s)
- Shinichi Hirose
- Department of Pediatrics, Fukuoka University, 45-1,7-chome Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
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