Stephanie Fehr1, Kingsley Wong1, Richard Chin1, Simon Williams1, Nick de Klerk1, David Forbes1, Rahul Krishnaraj1, John Christodoulou1, Jenny Downs1, Helen Leonard2. 1. From Telethon Kids Institute (S.F., K.W., N.d.K., J.D., H.L.) and the School of Paediatrics and Child Health (D.F.), The University of Western Australia, Perth; Muir Maxwell Epilepsy Centre (R.C.), Child Life and Health, The University of Edinburgh, UK; Department of Neurology and Rehabilitation (S.W.), Princess Margaret Hospital, Perth; Western Sydney Genetics Program (R.K.), The Children's Hospital at Westmead, Sydney; Department of Paediatrics (J.C.), University of Melbourne; Murdoch Childrens Research Institute (J.C.), The Royal Children's Hospital, Melbourne; and School of Physiotherapy and Exercise Science (J.D.), Curtin University, Perth, Australia. 2. From Telethon Kids Institute (S.F., K.W., N.d.K., J.D., H.L.) and the School of Paediatrics and Child Health (D.F.), The University of Western Australia, Perth; Muir Maxwell Epilepsy Centre (R.C.), Child Life and Health, The University of Edinburgh, UK; Department of Neurology and Rehabilitation (S.W.), Princess Margaret Hospital, Perth; Western Sydney Genetics Program (R.K.), The Children's Hospital at Westmead, Sydney; Department of Paediatrics (J.C.), University of Melbourne; Murdoch Childrens Research Institute (J.C.), The Royal Children's Hospital, Melbourne; and School of Physiotherapy and Exercise Science (J.D.), Curtin University, Perth, Australia. Helen.Leonard@telethonkids.org.au.
Abstract
OBJECTIVE: To investigate seizure outcomes and their relationships to genotype and functional abilities in individuals with the cyclin-dependent kinase-like-5 (CDKL5) disorder. METHODS: Using the International CDKL5 Disorder Database, we identified 172 cases with a pathogenic CDKL5 mutation. We categorized individual mutations into 4 groups based on predicted structural and functional consequences. Negative binomial regression was used to model the linear association between current seizure rate and mutation group, current level of assistance required to walk 10 steps, and the highest level of expressive communication used to convey refusal or request. RESULTS: All but 3 (169/172) patients had a history of epilepsy. The median age at seizure onset was 6 weeks (range 1 week-1.5 years) and the median seizure rate at ascertainment was 2 per day (range 0-20 per day). After adjusting for walking ability and confounders including use or otherwise of polytherapy, seizure rate was lower in those with truncating mutations between aa172 and aa781 compared to those with no functional protein (incidence rate ratio [IRR] 0.57; 95% confidence interval [CI] 0.35-0.93). Ability to walk and use of spoken language were associated with lower rates of current seizures when compared to those with the least ability after adjusting for genotype (walking: IRR 0.62; 95% CI 0.39-0.99, communication: IRR 0.48; 95% CI 0.23-1.02). At a median age at questionnaire completion of 5 years, those previously treated with corticosteroids had more frequent seizures than those who have never been treated, whether or not there was a history of infantile spasms. CONCLUSIONS: Epilepsy is pervasive but not mandatory for the CDKL5 disorder. Genotype and functional abilities were related to seizure frequency, which appears refractory to antiepileptic drugs.
OBJECTIVE: To investigate seizure outcomes and their relationships to genotype and functional abilities in individuals with the cyclin-dependent kinase-like-5 (CDKL5) disorder. METHODS: Using the International CDKL5 Disorder Database, we identified 172 cases with a pathogenic CDKL5 mutation. We categorized individual mutations into 4 groups based on predicted structural and functional consequences. Negative binomial regression was used to model the linear association between current seizure rate and mutation group, current level of assistance required to walk 10 steps, and the highest level of expressive communication used to convey refusal or request. RESULTS: All but 3 (169/172) patients had a history of epilepsy. The median age at seizure onset was 6 weeks (range 1 week-1.5 years) and the median seizure rate at ascertainment was 2 per day (range 0-20 per day). After adjusting for walking ability and confounders including use or otherwise of polytherapy, seizure rate was lower in those with truncating mutations between aa172 and aa781 compared to those with no functional protein (incidence rate ratio [IRR] 0.57; 95% confidence interval [CI] 0.35-0.93). Ability to walk and use of spoken language were associated with lower rates of current seizures when compared to those with the least ability after adjusting for genotype (walking: IRR 0.62; 95% CI 0.39-0.99, communication: IRR 0.48; 95% CI 0.23-1.02). At a median age at questionnaire completion of 5 years, those previously treated with corticosteroids had more frequent seizures than those who have never been treated, whether or not there was a history of infantile spasms. CONCLUSIONS:Epilepsy is pervasive but not mandatory for the CDKL5 disorder. Genotype and functional abilities were related to seizure frequency, which appears refractory to antiepileptic drugs.
Authors: Heather E Olson; Scott T Demarest; Elia M Pestana-Knight; Lindsay C Swanson; Sumaiya Iqbal; Dennis Lal; Helen Leonard; J Helen Cross; Orrin Devinsky; Tim A Benke Journal: Pediatr Neurol Date: 2019-02-23 Impact factor: 3.372
Authors: Scott Demarest; Elia M Pestana-Knight; Heather E Olson; Jenny Downs; Eric D Marsh; Walter E Kaufmann; Carol-Anne Partridge; Helen Leonard; Femida Gwadry-Sridhar; Katheryn Elibri Frame; J Helen Cross; Richard F M Chin; Sumit Parikh; Axel Panzer; Judith Weisenberg; Karen Utley; Amanda Jaksha; Sam Amin; Omar Khwaja; Orrin Devinsky; Jeffery L Neul; Alan K Percy; Tim A Benke Journal: Pediatr Neurol Date: 2019-03-27 Impact factor: 3.372
Authors: Scott T Demarest; Heather E Olson; Angela Moss; Elia Pestana-Knight; Xiaoming Zhang; Sumit Parikh; Lindsay C Swanson; Katherine D Riley; Grace A Bazin; Katie Angione; Lisa-Marie Niestroj; Dennis Lal; Elizabeth Juarez-Colunga; Tim A Benke Journal: Epilepsia Date: 2019-07-16 Impact factor: 5.864
Authors: Jacinta Saldaris; Judith Weisenberg; Elia Pestana-Knight; Eric D Marsh; Bernhard Suter; Rajsekar Rajaraman; Gena Heidary; Heather E Olson; Orrin Devinsky; Dana Price; Peter Jacoby; Helen Leonard; Tim A Benke; Scott Demarest; Jenny Downs Journal: J Child Neurol Date: 2021-08-11 Impact factor: 1.987
Authors: Regina J Faubel; Veronica S Santos Canellas; Jenna Gaesser; Nancy H Beluk; Tim N Feinstein; Yong Wang; Maya Yankova; Kalyani B Karunakaran; Stephen M King; Madhavi K Ganapathiraju; Cecilia W Lo Journal: Acta Neuropathol Date: 2022-08-18 Impact factor: 15.887
Authors: William Hong; Isabel Haviland; Elia Pestana-Knight; Judith L Weisenberg; Scott Demarest; Eric D Marsh; Heather E Olson Journal: CNS Drugs Date: 2022-05-28 Impact factor: 6.497