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Luiza Benevides M, de Moraes HT, Granados DMM, Bonadia LC, Sauma L, Augusta Montenegro M, Guerreiro MM, Lopes-Cendes Í, Carolina Coan A. Predictors of genetic diagnosis in individuals with developmental and epileptic encephalopathies. Epilepsy Behav 2024; 155:109762. [PMID: 38636144 DOI: 10.1016/j.yebeh.2024.109762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/29/2023] [Accepted: 03/23/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To evaluate the clinical predictors of positive genetic investigation in developmental and epileptic encephalopathies, beyond the influence of Dravet Syndrome. METHODS The study included 98 patients diagnosed with developmental and epileptic encephalopathies. The patients underwent Sanger sequencing of SCN1A, Chromosomal Microarray Analysis, and Whole Exome Sequencing. The association of clinical variables with a positive genetic test was investigated using univariate and multivariate analysis. RESULTS Genetic diagnosis was identified in 47 (48 %) patients with developmental and epileptic encephalopathies. Beyond Dravet Syndrome influence, first seizure in the context of fever (p < 0.01), seizures precipitated by temperature (p = 0.04), cognitive regression (p = 0.04), hypotonia (p < 0.01), and focal seizures (p = 0.03) increased the chances of a positive genetic investigation. In contrast, atonic seizures (p = 0.01) and generalized discharges on electroencephalogram (p = 0.02) decreased the chances. Dravet Syndrome was positively associated with a genetic developmental and epileptic encephalopathies etiology (p < 0.01), whereas epilepsy with myoclonic-atonic seizures (p = 0.01), developmental and epileptic encephalopathies with spike-wave activation in sleep (p = 0.04), and Lennox-Gastaut syndrome (p = 0.03) were negatively associated. In multivariate analysis, the first seizure in the context of fever (p < 0.01) and hypotonia (p = 0.02) were positively, and atonic seizures (p = 0.01) were negatively and independently associated with a genetic etiology. CONCLUSION The predictive variables of genetic investigation in developmental and epileptic encephalopathies are first seizure in the context of fever and hypotonia, whereas atonic seizures decrease the chances of finding a genetic cause for developmental and epileptic encephalopathies. Regarding epileptic syndromes, Dravet Syndrome is highly associated with a positive genetic test, whereas epilepsy with myoclonic-atonic seizures, developmental and epileptic encephalopathies with spike-wave activation in sleep, and Lennox-Gastaut syndrome are rarely associated with a positive genetic investigation.
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Affiliation(s)
- Maria Luiza Benevides
- Child Neurology Service, Department of Neurology, University of Campinas (UNICAMP), Campinas - São Paulo (SP), Brazil.
| | | | | | - Luciana C Bonadia
- Department of Translational Medicine, UNICAMP, Campinas - SP, Brazil.
| | - Letícia Sauma
- Child Neurology Service, Department of Neurology, University of Campinas (UNICAMP), Campinas - São Paulo (SP), Brazil.
| | | | - Marilisa M Guerreiro
- Child Neurology Service, Department of Neurology, University of Campinas (UNICAMP), Campinas - São Paulo (SP), Brazil; Brazilian Institute of Neuroscience and Neurotechnology, BRAINN, at UNICAMP, Campinas, SP, Brazil.
| | - Íscia Lopes-Cendes
- Department of Translational Medicine, UNICAMP, Campinas - SP, Brazil; Brazilian Institute of Neuroscience and Neurotechnology, BRAINN, at UNICAMP, Campinas, SP, Brazil.
| | - Ana Carolina Coan
- Child Neurology Service, Department of Neurology, University of Campinas (UNICAMP), Campinas - São Paulo (SP), Brazil; Brazilian Institute of Neuroscience and Neurotechnology, BRAINN, at UNICAMP, Campinas, SP, Brazil; Neuroimaging Laboratory, UNICAMP, Campinas, SP, Brazil.
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