Implications of genetic diagnostics in epilepsy surgery candidates: A single-center cohort study.

Autor: Sanders MWCB; Department of Child Neurology Brain Center Rudolf Magnus University Medical Center Utrecht The Netherlands., Lemmens CMC; Department of Child Neurology Brain Center Rudolf Magnus University Medical Center Utrecht The Netherlands., Jansen FE; Department of Child Neurology Brain Center Rudolf Magnus University Medical Center Utrecht The Netherlands., Brilstra EH; Department of Genetics Center for Molecular Medicine University Medical Center Utrecht The Netherlands., Koeleman BPC; Department of Genetics Center for Molecular Medicine University Medical Center Utrecht The Netherlands., Braun KPJ; Department of Child Neurology Brain Center Rudolf Magnus University Medical Center Utrecht The Netherlands.
Jazyk: angličtina
Zdroj: Epilepsia open [Epilepsia Open] 2019 Nov 15; Vol. 4 (4), pp. 609-617. Date of Electronic Publication: 2019 Nov 15 (Print Publication: 2019).
DOI: 10.1002/epi4.12366
Abstrakt: Objective: Genetic causes are increasingly identified in patients with focal epilepsy. These genetic causes may be related to the effectiveness of epilepsy surgery. We aimed to assess the use and yield of genetic testing in a large cohort of patients who were evaluated for epilepsy surgery.
Methods: We performed a retrospective single-center consecutive cohort study of patients who were evaluated for surgery between 1990 and 2016. Within this cohort, we assessed the use of genetic testing-either before or after presurgical decision-making. We evaluated genetic results as well as the outcome of presurgical decision-making and surgery, and compared these end points for different subgroups-especially MRI-positive vs MRI-negative patients. Patients with tuberous sclerosis (TSC) and KRIT1 mutations were excluded from analysis.
Results: Of the 2385 epilepsy patients who were evaluated for surgery, 1280 (54%) received surgical treatment in our center. Of the entire cohort, 325 (14%) underwent genetic testing, comprising 156 of 450 MRI-negative patients (35%) vs 169 of 1935 MRI-positive patients (9%). A genetic cause of epilepsy was found in 40 of the 325 patients (12%, 2% of the entire cohort), mainly consisting of mutations in ion channel function and synaptic transmission genes, and mTOR pathway gene mutations. Three of the seven patients with mTOR pathway gene mutations underwent surgery; two achieved complete seizure freedom. One of the 17 patients with germline mutations in ion channel function and synaptic transmission genes received resective surgery but was not rendered seizure-free; two other patients underwent invasive intracranial EEG-monitoring before being rejected.
Significance: This study shows that genetic testing is increasingly applied in focal epilepsy patients who are considered for epilepsy surgery. The diagnostic yield of genetic testing is highest in next generation sequencing techniques, and the outcome of genetic testing assists selecting eligible patients for invasive intracranial monitoring and resective surgery.
Competing Interests: Neither of the authors has any conflict of interest to disclose. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.
(© 2019 The Authors. Epilepsia Open published by Wiley Periodicals Inc. on behalf of International League Against Epilepsy.)
Databáze: MEDLINE
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