错义突变
Dravet综合征
癫痫
表型
遗传学
基因型
外显子组测序
医学
生物信息学
队列
外显子
生物
内科学
基因
神经科学
作者
D S Gallagher,Eduardo Pérez‐Palma,Tobias Bruenger,Ismael Ghanty,Eva H. Brilstra,Berten Ceulemans,Nicole Chémaly,Iris Lange,Christel Depienne,Renzo Guerrini,Davide Mei,Ulrich Stephani,Rima Nabbout,Brigid M. Regan,Amy Schneider,Ingrid E. Scheffer,An‐Sofie Schoonjans,Joseph D. Symonds,Sarah Weckhuysen,Sameer M. Zuberi,Dennis Lal,Andreas Brunklaus
摘要
Abstract Objective SCN1A variants are associated with epilepsy syndromes ranging from mild genetic epilepsy with febrile seizures plus (GEFS+) to severe Dravet syndrome (DS). Many variants are de novo, making early phenotype prediction difficult, and genotype–phenotype associations remain poorly understood. Methods We assessed data from a retrospective cohort of 1018 individuals with SCN1A‐ related epilepsies. We explored relationships between variant characteristics (position, in silico prediction scores: Combined Annotation Dependent Depletion (CADD), Rare Exome Variant Ensemble Learner (REVEL), SCN1A genetic score), seizure characteristics, and epilepsy phenotype. Results DS had earlier seizure onset than other GEFS+ phenotypes (5.3 vs. 12.0 months, p < .001). In silico variant scores were higher in DS versus GEFS+ ( p < .001). Patients with missense variants in functionally important regions (conserved N‐terminus, S4–S6) exhibited earlier seizure onset (6.0 vs. 7.0 months, p = .003) and were more likely to have DS (280/340); those with missense variants in nonconserved regions had later onset (10.0 vs. 7.0 months, p = .036) and were more likely to have GEFS+ (15/29, χ 2 = 19.16, p < .001). A minority of protein‐truncating variants were associated with GEFS+ (10/393) and more likely to be located in the proximal first and last exon coding regions than elsewhere in the gene (9.7% vs. 1.0%, p < .001). Carriers of the same missense variant exhibited less variability in age at seizure onset compared with carriers of different missense variants for both DS (1.9 vs. 2.9 months, p = .001) and GEFS+ (8.0 vs. 11.0 months, p = .043). Status epilepticus as presenting seizure type is a highly specific (95.2%) but nonsensitive (32.7%) feature of DS. Significance Understanding genotype–phenotype associations in SCN1A ‐related epilepsies is critical for early diagnosis and management. We demonstrate an earlier disease onset in patients with missense variants in important functional regions, the occurrence of GEFS+ truncating variants, and the value of in silico prediction scores. Status epilepticus as initial seizure type is a highly specific, but not sensitive, early feature of DS.
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