Abstract
Background and Objectives The genetic developmental and epileptic encephalopathies (DEEs) comprise a large group of severe epilepsy syndromes, with a wide phenotypic spectrum. Currently, the rates of convulsive status epilepticus (CSE), non-convulsive status epilepticus (NCSE) and sudden unexplained death in epilepsy (SUDEP) in these diseases are not well understood. We aimed to describe the proportions of patients with frequently observed genetic DEEs who developed CSE, NCSE, mortality and SUDEP. Understanding the risks of these serious presentations in each genetic DEE will enable earlier diagnosis and appropriate management.
Methods In this retrospective analysis of patients with a genetic DEE, we estimated the proportions with CSE, NCSE and SUDEP and the overall and SUDEP-specific mortality rates for each genetic diagnosis. We included patients with a pathogenic variant in the following genes: SCN1A, SCN2A, SCN8A, SYNGAP1, NEXMIF, CHD2, PCDH19, STXBP1, GRIN2A, KCNT1, KCNQ2 and Angelman syndrome (AS).
Results The cohort comprised 510 individuals with a genetic DEE; in whom we observed CSE in 47% and NCSE in 19%. The highest proportion of CSE occurred in patients with SCN1A-associated DEEs, including 181/203 (89%; 95%CI 84-93%) patients with Dravet syndrome and 8/15 (53%; 95%CI 27-79%) non-Dravet SCN1A-DEEs. CSE was also notable in patients with pathogenic variants in KCNT1 (6/10; 60%; 95%CI 26-88%) and SCN2A (8/15; 53%; 95%CI 27-79%). NCSE was common in patients with non-Dravet SCN1A-DEEs (8/15; 53%; 95%CI 27-79%) and was notable in patients with CHD2-DEEs(6/14; 43%; 95%CI 18-71%) and AS (6/19; 32%; 95%CI 13-57%). There were 42/510 (8%) deaths amongst the cohort, producing a mortality rate of 6.1 per 1000 person years (95% CI 4.4 – 8.3). SUDEP cases accounted for 20/42 (48%) deaths. Four genes were associated with SUDEP: SCN1A, SCN2A, SCN8A and STXBP1. The estimated SUDEP rate was 2.9 per 1000 person years (95% CI 1.7 – 4.5).
Discussion We showed that proportions of patients with CSE, NCSE and SUDEP differ for commonly encountered genetic DEEs. The estimates for each genetic DEE studied will inform early diagnosis and management of status epilepticus and SUDEP and inform disease-specific counselling for patients and families in this high-risk group of conditions.
- Received August 6, 2022.
- Accepted in final form January 5, 2023.
- © 2023 American Academy of Neurology
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