David A Dyment1,2, Asuri N Prasad3, Kym M Boycott1,2, Grace U Ediae2, Taila Hartley2, Ayman Hassan4, Katherine E Muir5, Murray Potter6, Lysa Boisse Lomax7, Olga Jarinova1,2, Bekim Sadikovic8,9, Dimitri J Stavropoulos10, O Carter Snead11. 1. Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. 2. Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada. 3. Division of Pediatric Neurology, Department of Pediatrics, Children's Hospital, London Health Sciences Center & Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. 4. Thunder Bay Regional Health Science Centre, Thunder Bay, Ontario, Canada. 5. Division of Pediatric Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. 6. Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada. 7. Division of Neurology, Queens University, Kingston General Hospital, Kingston, Ontario, Canada. 8. Department of Pathology and Laboratory Medicine, Western University, London, Canada. 9. Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, Canada. 10. Genome Diagnostics, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada. 11. Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Epilepsy is a common neurological condition that shows a marked genetic predisposition. The advent of next-generation sequencing (NGS) has transformed clinical genetic testing by allowing the rapid screen for causative variants in multiple genes. There are currently no NGS-based multigene panel diagnostic tests available for epilepsy as a licensed clinical diagnostic test in Ontario, Canada. Eligible patient samples are sent out of country for testing by commercial laboratories, which incurs significant cost to the public healthcare system. OBJECTIVE: An expert Working Group of medical geneticists, pediatric neurologists/epileptologists, biochemical geneticists, and clinical molecular geneticists from Ontario was formed by the Laboratories and Genetics Branch of the Ontario Ministry of Health and Long-Term Care to develop a programmatic approach to implementing epilepsy panel testing as a provincial service. RESULTS: The Working Group made several recommendations for testing to support the clinical delivery of care in Ontario. First, an extension of community healthcare outcomes-based program should be incorporated to inform and educate ordering providers when requesting and interpreting a genetic panel test. Second, any gene panel testing must be "evidence-based" and takes into account varied clinical indications to reduce the chance of uncertain and secondary results. Finally, an ongoing evaluative process was recommended to ensure continued test improvement for the future. CONCLUSION: This epilepsy panel testing implementation plan will be a model for genetic care directed toward a specific set of conditions in the province and serve as a prototype for genetic testing for other genetically heterogeneous diseases.
BACKGROUND:Epilepsy is a common neurological condition that shows a marked genetic predisposition. The advent of next-generation sequencing (NGS) has transformed clinical genetic testing by allowing the rapid screen for causative variants in multiple genes. There are currently no NGS-based multigene panel diagnostic tests available for epilepsy as a licensed clinical diagnostic test in Ontario, Canada. Eligible patient samples are sent out of country for testing by commercial laboratories, which incurs significant cost to the public healthcare system. OBJECTIVE: An expert Working Group of medical geneticists, pediatric neurologists/epileptologists, biochemical geneticists, and clinical molecular geneticists from Ontario was formed by the Laboratories and Genetics Branch of the Ontario Ministry of Health and Long-Term Care to develop a programmatic approach to implementing epilepsy panel testing as a provincial service. RESULTS: The Working Group made several recommendations for testing to support the clinical delivery of care in Ontario. First, an extension of community healthcare outcomes-based program should be incorporated to inform and educate ordering providers when requesting and interpreting a genetic panel test. Second, any gene panel testing must be "evidence-based" and takes into account varied clinical indications to reduce the chance of uncertain and secondary results. Finally, an ongoing evaluative process was recommended to ensure continued test improvement for the future. CONCLUSION: This epilepsy panel testing implementation plan will be a model for genetic care directed toward a specific set of conditions in the province and serve as a prototype for genetic testing for other genetically heterogeneous diseases.