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Ünalp A, Güzin Y, Ünay B, Tosun A, Çavuşoğlu D, Tekin HG, Kurul SH, Arhan E, Edizer S, Öztürk G, Yiş U, Yılmaz Ü. Retracted: Clinical and genetic evaluations of rare childhood epilepsies in Turkey's national cohort. Epileptic Disord 2023; 25:924. [PMID: 37584621 DOI: 10.1002/epd2.20150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 12/25/2022] [Accepted: 08/10/2023] [Indexed: 08/17/2023]
Abstract
Aycan Ünalp, Yiğithan Güzin, Bülent Ünay, Ayşe Tosun, Dilek Çavuşoğlu, Hande Gazeteci Tekin, Semra Hız Kurul, Ebru Arhan, Selvinaz Edizer, Gülten Öztürk, Uluç Yiş, Ünsal Yılmaz, Turkish Rare Epilepsies Study Group, Clinical and genetic evaluations of rare childhood epilepsies in Turkey's national cohort, Epileptic Disorders, 2023, (https://doi.org/10.1002/epd2.20150) The above article, published online on 16 August 2023 on Wiley Online Library (www.onlinelibrary.wiley.com), has been retracted by agreement between the authors, the Editor-in-Chief, Sándor Beniczky, and John Wiley & Sons Ltd. The authors asked for a retraction based on an experimental error which would alter the results of the study if corrected.
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2
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Hadzsiev K, Hegyi M, Fogarasi A, Bodó-Baltavári T, Zsigmond A, Maász A, Szabó A, Till Á. Observation of a Possible Successful Treatment of DEPDC5-Related Epilepsy with mTOR Inhibitor. Neuropediatrics 2023; 54:344-346. [PMID: 37263295 PMCID: PMC10506865 DOI: 10.1055/a-2104-1614] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 04/18/2023] [Indexed: 06/03/2023]
Abstract
The mechanistic target of the rapamycin signaling pathway serves as a central regulator of cell metabolism, growth, proliferation, and survival. In its regulation, the GTPase-activating protein activity toward Rags1 complex has an inhibitory effect. Mutations in genes encoding this complex protein are among the most common abnormalities in focal epilepsies. Within these mutations, the mutations affecting the DEPDC5 gene have been associated with different autosomal dominantly inherited epilepsy types. Due to the limited data available on mTOR inhibitor therapy in nontuberous sclerosis complex epileptic patients, here we present the clinical management of a patient with intractable epilepsy, skin hypopigmentation, and a DEPDC5 variant. The patient's phenotype is compatible with a nonlesional DEPDC5-related epileptic encephalopathy. We initiated compassionate, off-label everolimus treatment as the patient's condition continuously deteriorated. Due to bilateral pneumonia occurring at the beginning of the treatment, it was temporarily discontinued, and resumed in half the dose. Follow-up examination after 18 months showed a 90% reduction in seizure frequency with moderate improvement in attention function and nutritional status. Our case report emphasizes the importance of early genetic testing in patients with epileptic encephalopathy. Clinical consequences of mammalian target of rapamycin complex 1 (mTORC1) upregulation may be amenable to tailored treatment with mTOR inhibitors. A clinical trial on an international scale would be needed to draw conclusions.
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Affiliation(s)
- Kinga Hadzsiev
- Department of Medical Genetics, Medical School, Clinical Center, University of Pécs, Pécs, Hungary
| | - Márta Hegyi
- Bethesda Children's Hospital, Epilepsy Center, Budapest, Hungary
| | - András Fogarasi
- Bethesda Children's Hospital, Epilepsy Center, Budapest, Hungary
| | | | - Anna Zsigmond
- Department of Medical Genetics, Medical School, Clinical Center, University of Pécs, Pécs, Hungary
| | - Anita Maász
- Department of Medical Genetics, Medical School, Clinical Center, University of Pécs, Pécs, Hungary
| | - András Szabó
- Department of Medical Genetics, Medical School, Clinical Center, University of Pécs, Pécs, Hungary
| | - Ágnes Till
- Department of Medical Genetics, Medical School, Clinical Center, University of Pécs, Pécs, Hungary
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3
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Nissenkorn A, Kluger G, Schubert-Bast S, Bayat A, Bobylova M, Bonanni P, Ceulemans B, Coppola A, Di Bonaventura C, Feucht M, Fuchs A, Gröppel G, Heimer G, Herdt B, Kulikova S, Mukhin K, Nicassio S, Orsini A, Panagiotou M, Pringsheim M, Puest B, Pylaeva O, Ramantani G, Tsekoura M, Ricciardelli P, Lerman Sagie T, Stark B, Striano P, van Baalen A, De Wachter M, Cerulli Irelli E, Cuccurullo C, von Stülpnagel C, Russo A. Perampanel as precision therapy in rare genetic epilepsies. Epilepsia 2023; 64:866-874. [PMID: 36734057 DOI: 10.1111/epi.17530] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Perampanel, an antiseizure drug with α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antagonist properties, may have a targeted effect in genetic epilepsies with overwhelming glutamate receptor activation. Epilepsies with loss of γ-aminobutyric acid inhibition (e.g., SCN1A), overactive excitatory neurons (e.g., SCN2A, SCN8A), and variants in glutamate receptors (e.g., GRIN2A) hold special interest. We aimed to collect data from a large rare genetic epilepsy cohort treated with perampanel, to detect possible subgroups with high efficacy. METHODS This multicenter project was based on the framework of NETRE (Network for Therapy in Rare Epilepsies), a web of pediatric neurologists treating rare epilepsies. Retrospective data from patients with genetic epilepsies treated with perampanel were collected. Outcome measures were responder rate (50% seizure reduction), and percentage of seizure reduction after 3 months of treatment. Subgroups of etiologies with high efficacy were identified. RESULTS A total of 137 patients with 79 different etiologies, aged 2 months to 61 years (mean = 15.48 ± 9.9 years), were enrolled. The mean dosage was 6.45 ± 2.47 mg, and treatment period was 2.0 ± 1.78 years (1.5 months-8 years). Sixty-two patients (44.9%) were treated for >2 years. Ninety-eight patients (71%) were responders, and 93 (67.4%) chose to continue therapy. The mean reduction in seizure frequency was 56.61% ± 34.36%. Sixty patients (43.5%) sustained >75% reduction in seizure frequency, including 38 (27.5%) with >90% reduction in seizure frequency. The following genes showed high treatment efficacy: SCN1A, GNAO1, PIGA, PCDH19, SYNGAP1, POLG1, POLG2, and NEU1. Eleven of 17 (64.7%) patients with Dravet syndrome due to an SCN1A pathogenic variant were responders to perampanel treatment; 35.3% of them had >90% seizure reduction. Other etiologies remarkable for >90% reduction in seizures were GNAO1 and PIGA. Fourteen patients had a continuous spike and wave during sleep electroencephalographic pattern, and in six subjects perampanel reduced epileptiform activity. SIGNIFICANCE Perampanel demonstrated high safety and efficacy in patients with rare genetic epilepsies, especially in SCN1A, GNAO1, PIGA, PCDH19, SYNGAP1, CDKL5, NEU1, and POLG, suggesting a targeted effect related to glutamate transmission.
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Affiliation(s)
- Andreea Nissenkorn
- Pediatric Neurology Unit, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gerhard Kluger
- Epilepsy Center for Children and Adolescents, Schön Clinic Vogtareuth, Vogtareuth, Germany
- Research Institute for Rehabilitation, Transition, and Palliation, PMU Salzburg, Salzburg, Austria
| | | | - Allan Bayat
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Filadelfia, Dianalund, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Marya Bobylova
- Svt. Lucka's Institute of Child Neurology and Epilepsy, Moscow, Russian Federation
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, Eugenio Medea, Scientific Institute for Research and Health Care, Treviso, Italy
| | - Berten Ceulemans
- Pediatric Neurology, Antwerp University and Antwerp University Hospital, Edegem, Belgium
| | - Antonietta Coppola
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University Naples, Naples, Italy
| | | | - Martha Feucht
- Center for Rare and Complex Epilepsies, full member of EpiCARE, Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - Anne Fuchs
- SPZ Suhl SRH Central Clinic Suhl, Pediatric Clinic, Suhl, Germany
| | - Gudrun Gröppel
- Department of Pediatrics and Adolescent Medicine, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Gali Heimer
- Pediatric Neurology Unit, Sheba Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Sviatlana Kulikova
- Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus
| | - Konstantin Mukhin
- Svt. Lucka's Institute of Child Neurology and Epilepsy, Moscow, Russian Federation
| | - Stefania Nicassio
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'età pediatrica, Bologna, Italy
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric Department, Pisa University Hospital, University Hospital of Pisa, Pisa, Italy
| | | | - Milka Pringsheim
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schön Clinic Vogtareuth, Vogtareuth, Germany
| | - Burkhard Puest
- Department of Neuropediatrics, Wilhelmstift Catholic Children's Hospital, Hamburg, Germany
| | - Olga Pylaeva
- Svt. Lucka's Institute of Child Neurology and Epilepsy, Moscow, Russian Federation
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
| | - Maria Tsekoura
- Department of Neuropediatrics, University Children's Hospital Zurich, Zurich, Switzerland
| | - Paolo Ricciardelli
- Neurology Service of the Pediatric Unit, Ravenna Hospital, Ravenna, Italy
| | - Tally Lerman Sagie
- Pediatric Neurology Unit, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Brigit Stark
- Department of Pediatrics and Adolescent Medicine, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Pasquale Striano
- Giannina Gaslini Institute, Scientific Institute for Research and Health Care, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Andreas van Baalen
- Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Kiel University (CAU), Kiel, Germany
| | - Matthias De Wachter
- Pediatric Neurology, Antwerp University and Antwerp University Hospital, Edegem, Belgium
| | | | - Claudia Cuccurullo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University Naples, Naples, Italy
| | - Celina von Stülpnagel
- Research Institute for Rehabilitation, Transition, and Palliation, PMU Salzburg, Salzburg, Austria
- Pediatric Office Dr. Brückmann, Brannenburg, Germany
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics Department of Pediatrics and Epilepsy Center, Dr. von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany
| | - Angelo Russo
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'età pediatrica, Bologna, Italy
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Oates S, Absoud M, Goyal S, Bayley S, Baulcomb J, Sims A, Riddett A, Allis K, Brasch-Andersen C, Balasubramanian M, Bai R, Callewaert B, Hüffmeier U, Le Duc D, Radtke M, Korff C, Kennedy J, Low K, Møller RS, Nielsen JEK, Popp B, Quteineh L, Rønde G, Schönewolf-Greulich B, Shillington A, Taylor MR, Todd E, Torring PM, Tümer Z, Vasileiou G, Yates TM, Zweier C, Rosch R, Basson MA, Pal DK. ZMYND11 variants are a novel cause of centrotemporal and generalised epilepsies with neurodevelopmental disorder. Clin Genet 2021; 100:412-429. [PMID: 34216016 DOI: 10.1111/cge.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 12/15/2022]
Abstract
ZMYND11 is the critical gene in chromosome 10p15.3 microdeletion syndrome, a syndromic cause of intellectual disability. The phenotype of ZMYND11 variants has recently been extended to autism and seizures. We expand on the epilepsy phenotype of 20 individuals with pathogenic variants in ZMYND11. We obtained clinical descriptions of 16 new and nine published individuals, plus detailed case history of two children. New individuals were identified through GeneMatcher, ClinVar and the European Network for Therapies in Rare Epilepsy (NETRE). Genetic evaluation was performed using gene panels or exome sequencing; variants were classified using American College of Medical Genetics (ACMG) criteria. Individuals with ZMYND11 associated epilepsy fell into three groups: (i) atypical benign partial epilepsy or idiopathic focal epilepsy (n = 8); (ii) generalised epilepsies/infantile epileptic encephalopathy (n = 4); (iii) unclassified (n = 8). Seizure prognosis ranged from spontaneous remission to drug resistant. Neurodevelopmental deficits were invariable. Dysmorphic features were variable. Variants were distributed across the gene and mostly de novo with no precise genotype-phenotype correlation. ZMYND11 is one of a small group of chromatin reader genes associated in the pathogenesis of epilepsy, and specifically ABPE. More detailed epilepsy descriptions of larger cohorts and functional studies might reveal genotype-phenotype correlation. The epileptogenic mechanism may be linked to interaction with histone H3.3.
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Affiliation(s)
- Stephanie Oates
- Department of Paediatric Neuroscience, King's College Hospital, London, UK
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Michael Absoud
- Newcomen Children's Neurosciences Centre, Evelina London Children's Hospital, London, UK
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Sushma Goyal
- Newcomen Children's Neurosciences Centre, Evelina London Children's Hospital, London, UK
| | - Sophie Bayley
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Jennifer Baulcomb
- Newcomen Children's Neurosciences Centre, Evelina London Children's Hospital, London, UK
| | - Annemarie Sims
- Newcomen Children's Neurosciences Centre, Evelina London Children's Hospital, London, UK
| | - Amy Riddett
- Newcomen Children's Neurosciences Centre, Evelina London Children's Hospital, London, UK
| | - Katrina Allis
- Genetic Counselor, Mitochondrial and Metabolic Genetics, GeneDx, Gaithersburg, Maryland, USA
| | - Charlotte Brasch-Andersen
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
- Human Genetics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Meena Balasubramanian
- Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
- Academic Unit of Child Health, Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - Renkui Bai
- Genetic Counselor, Mitochondrial and Metabolic Genetics, GeneDx, Gaithersburg, Maryland, USA
| | - Bert Callewaert
- Centre for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Ulrike Hüffmeier
- Institute of Human Genetics, Friedrich-Alexander Universitat of Erlangen-Nurnberg, Erlangen, Germany
| | - Diana Le Duc
- Institute of Human Genetics, University of Leipzig Medical Centre, Leipzig, Germany
| | - Maximilian Radtke
- Institute of Human Genetics, University of Leipzig Medical Centre, Leipzig, Germany
| | - Christian Korff
- Pediatric Neurology Unit, University Hospitals, Geneva, Switzerland
| | - Joanna Kennedy
- Department of Genetics, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Karen Low
- Department of Genetics, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rikke S Møller
- Department of Epilepsy Genetics and Personalized Treatment, The Danish Epilepsy Centre, Dianalund, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jens Erik Klint Nielsen
- Department of Clinical Genetics, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Bernt Popp
- Institute of Human Genetics, Friedrich-Alexander Universitat of Erlangen-Nurnberg, Erlangen, Germany
| | - Lina Quteineh
- Pediatric Neurology Unit, University Hospitals, Geneva, Switzerland
- Service of Genetic Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Gitte Rønde
- Department of Clinical Genetics, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | | | - Matthew Rg Taylor
- University of Colorado Anschutz Medical Campus, Adult Medical Genetics Program, Aurora, Colorado, USA
| | - Emily Todd
- University of Colorado Anschutz Medical Campus, Adult Medical Genetics Program, Aurora, Colorado, USA
| | - Pernille M Torring
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Zeynep Tümer
- Department of Genetics, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Georgia Vasileiou
- Institute of Human Genetics, Friedrich-Alexander Universitat of Erlangen-Nurnberg, Erlangen, Germany
| | - T Michael Yates
- Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
- Academic Unit of Child Health, Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - Christiane Zweier
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Richard Rosch
- Department of Human Genetics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M Albert Basson
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
- Centre for Craniofacial and Regenerative Biology, King's College London, London, UK
| | - Deb K Pal
- Department of Paediatric Neuroscience, King's College Hospital, London, UK
- Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
- Newcomen Children's Neurosciences Centre, Evelina London Children's Hospital, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
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5
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Abstract
Zusammenfassung
Hintergrund
Aktuell werden in der Epileptologie fast ausschließlich Medikamente eingesetzt, die gegen Anfälle wirken („Antikonvulsiva“). Diese beeinflussen die Pathophysiologie der individuell zugrunde liegenden Epilepsie wenig spezifisch im Sinne von „Antiepileptika“. Darauf zielt aber der Begriff „molekulare Pädiatrie“ ab.
Methodik
Ein großes internationales Netzwerk zum einfachen Erfahrungsaustausch von Klinikern über die Therapie von Kindern mit sehr seltenen genetischen Epilepsien ist das Network for Therapy of Rare Epilepsies (NETRE).
Ergebnisse
NETRE besteht seit 15 Jahren und ist in > 320 Gruppen gegliedert, die mit anderen Forschungsgruppen und Selbsthilfevereinigungen kooperieren. Einige Beispiele für klinische Charakteristika neuer Epilepsiegene werden vorgestellt (z. B. Kauanfälle bei SYNGAP1). Eine genetische Untersuchung kann helfen, eine diagnostische Odyssee, auch eine Fehl- oder Überbehandlung eines Patienten zu vermeiden. Aus den genetischen Befunden ergeben sich bislang nur in Einzelfällen gezielte Therapiemöglichkeiten, und diese bisher meist nur mit geringer Evidenz: z. B. Natriumkanalblocker bei SCN2A-Mutationen mit einer „gain of function“ oder Statine bei SYNGAP1-Mutationen. Epigenetische Faktoren wie „early neuroimpaired twin entity“ (ENITE) sind auch bei genetischen Epilepsien bedeutsam.
Diskussion
Der rasante Fortschritt in der genetischen Grundlagenforschung kommt einem Paradigmenwechsel im Verständnis von Pathophysiologie und klinischen Zeichen v. a. bei im frühen Kindesalter beginnenden Epilepsien gleich. Individualisierte Therapieansätze sind aktuell noch selten. Anamnese, klinische Untersuchung und Erfahrung bleiben wichtig. Ethische, psychologische und wirtschaftliche Aspekte einer breiten genetischen Diagnostik sind zu berücksichtigen.
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