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CHD2 Variants Are a Risk Factor for Photosensitivity in Epilepsy

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CHD2 Variants Are a Risk Factor for Photosensitivity in Epilepsy Brain Advance Access published March 17, 2015 doi:10.1093/brain/awv052 BRAIN 2015: Page 1 of 10 | 1 CHD2 variants are a risk factor for photosensitivity in epilepsy Elizabeth C. Galizia,1,2,* Candace T. Myers,3,* Costin Leu,1,2,* Carolien G.F. de Kovel,4 Tatiana Afrikanova,5 Maria Lorena Cordero-Maldonado,5 Teresa G. Martins,5 Maxime Jacmin,5 Suzanne Drury,6 V. Krishna Chinthapalli,1,2 Hiltrud Muhle,7 Manuela Pendziwiat,7 Thomas Sander,8 Ann-Kathrin Ruppert,8 Rikke S. Møller,9,10 Holger Thiele,8 Roland Krause,5 Julian Schubert,11 Anna-Elina Lehesjoki,12,13 Peter Nu¨rnberg,8 Holger Lerche11 for the EuroEPINOMICS CoGIE Consortium,# Aarno Palotie,14,15,16 Antonietta Coppola,1,2,17 Salvatore Striano,17 Luigi Del Gaudio,17 Christopher Boustred,6 Amy L. Schneider,18 Nicholas Lench,6 Bosanka Jocic-Jakubi,19,20 Athanasios Covanis,21 Giuseppe Capovilla,22 Pierangelo Veggotti,23,24 Marta Piccioli,25 Pasquale Parisi,26 Laura Cantonetti,27 Lynette G. Sadleir,28 Saul A. Mullen,29 Samuel F Berkovic,18 Ulrich Stephani,7 Ingo Helbig,7 Alexander D. Crawford,5 Camila V Esguerra,5,30 Dorothee G. A. Kasteleijn-Nolst Trenite´,4 Bobby P. C. Koeleman,4,$ Heather C. Mefford,3,$ Ingrid E. Scheffer18,29,$ and Sanjay M. Sisodiya1,2,$ *,$These authors contributed equally to this work. #For details of the EuroEPINOMICS CoGIE Consortium see Supplementary material. Photosensitivity is a heritable abnormal cortical response to flickering light, manifesting as particular electroencephalographic changes, with or without seizures. Photosensitivity is prominent in a very rare epileptic encephalopathy due to de novo CHD2 mutations, but is also seen in epileptic encephalopathies due to other gene mutations. We determined whether CHD2 variation underlies photosensitivity in common epilepsies, specific photosensitive epilepsies and individuals with photosensitivity without seizures. We studied 580 individuals with epilepsy and either photosensitive seizures or abnormal photoparoxysmal response on electroencephalography, or both, and 55 individuals with photoparoxysmal response but no seizures. We compared CHD2 se- quence data to publicly available data from 34 427 individuals, not enriched for epilepsy. We investigated the role of unique variants seen only once in the entire data set. We sought CHD2 variants in 238 exomes from familial genetic generalized epilepsies, and in other public exome data sets. We identified 11 unique variants in the 580 individuals with photosensitive epilepsies and 128 unique variants in the 34 427 controls: unique CHD2 variation is over-represented in cases overall (P =2Á17 Â 10À5). Among epilepsy syndromes, there was over-representation of unique CHD2 variants (3/36 cases) in the archetypal photosensitive epilepsy syndrome, eyelid myoclonia with absences (P =3Á50 Â 10À4). CHD2 variation was not over-represented in photoparoxysmal response without seizures. Zebrafish larvae with chd2 knockdown were tested for photosensitivity. Chd2 knockdown markedly enhanced mild innate zebrafish larval photosensitivity. CHD2 mutation is the first identified cause of the archetypal generalized photosensitive epilepsy syndrome, eyelid myoclonia with absences. Unique CHD2 variants are also associated with photosensitivity in common epilepsies. CHD2 does not encode an ion channel, opening new avenues for research into human cortical excitability. Received November 17, 2014. Revised December 15, 2014. Accepted January 7, 2015. ß The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. 2 | BRAIN 2015: Page 2 of 10 E. C. Galizia et al. 1 NIHR Biomedical Research Centre Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK 2 Epilepsy Society, Bucks, UK 3 Department of Paediatrics, University of Washington, USA 4 Department of Medical Genetics Research, University Medical Centre Utrecht, The Netherlands 5 Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg 6 North East Thames Regional Genetics Laboratories, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK 7 Department of Neuropaediatrics, University Medical Centre Schleswig-Holstein and Christian-Albrechts-University of Kiel, Kiel, Germany 8 Cologne Centre for Genomics, University of Cologne, Cologne, Germany 9 Danish Epilepsy Centre, Dianalund, Denmark 10 Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark 11 Deptartment of Neurology and Epileptology, Hertie Institut for Clinical Brain Research, Tu¨ bingen, Germany 12 Folkha¨lsan Institute of Genetics and Neuroscience Centre, University of Helsinki Helsinki, Finland 13 Research Programs Unit, Molecular Neurology, University of Helsinki, Helsinki, Finland 14 Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, UK 15 Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland 16 Program in Medical and Population Genetics and Genetic Analysis Platform, The Broad Institute of MIT and Harvard, Cambridge, USA 17 Epilepsy Centre, Neurology Department, Federico II University of Naples, Naples Italy 18 Department of Medicine, University of Melbourne, Austin Health, Melbourne, Australia 19 Department of Child Neurology, Paediatric Clinic, Clinical Centre Nis, Serbia 20 Department of Paediatric Neurology, Paediatric Clinic, Al Sabah Hospital, Kuwait 21 Neurology Department, The Children’s Hospital Agia Sophia, Athens, Greece 22 Epilepsy Centre ‘C. Poma Hospital’, Mantova, Italy 23 Department of Child Neurology and Psychiatry C. Mondino National Neurological Institute, Via Mondino, 2, 27100, Pavia, Italy 24 Brain and Behaviour Department, University of Pavia, Pavia, Italy 25 Neurophysiopathology Unit, San Filippo Neri Hospital, Rome, Italy 26 Child Neurology, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy 27 Neurorehabilitation Unit, Department of Neuroscience and Neurorehabilitation, IRCCS, Bambino Gesu’ Children’s Hospital, Rome, Italy 28 Department of Paediatrics and Child Health, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand 29 Florey Institute of Neurosciences and Mental Health, and Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, Melbourne, Australia 30 Chemical Neuroscience Group, Biotechnology Centre of Oslo, University of Oslo, Norway Correspondence to: Sanjay M Sisodiya, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK E-mail: [email protected] Correspondence may also be addressed to: Ingrid E. Scheffer, Epilepsy Research Centre, Austin Health, 245 Burgundy St, Heidelberg, Victoria 3081, Australia E-mail: [email protected] Heather C. Mefford, Department of Pediatrics, Division of Genetic Medicine, 1959 NE Pacific St., Box 356320, Seattle, WA 98195, USA E-mail: [email protected] CHD2 in photosensitive epilepsy BRAIN 2015: Page 3 of 10 | 3 Bobby P. C. Koeleman, Medical Genetics, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, The Netherlands E-mail: [email protected] Keywords: photosensitive; seizure; eyelid myoclonia with absences Abbreviations: dpf = day post-fertilization; EMA = eyelid myoclonia with absences; ExAC = Exome Aggregation Consortium; GGE = genetic generalized epilepsy Photosensitivity occurs in some epileptic encephalopa- Introduction thies, such as Dravet syndrome due to mutation in Photosensitivity is a heritable abnormal cortical response SCN1A and encephalopathy associated with mutation in to flickering light, often manifesting as EEG changes called CHD2 (Carvill et al., 2013). Published data do not allow a photoparoxysmal response (Walter et al., 1946). determination of whether the photosensitivity in these con- Photoparoxysmal response may occur with seizures, and in ditions is due to the underlying gene mutation or to the normal subjects, or with neuropsychiatric disorders (So et al., epileptic encephalopathy per se. CHD2 encodes chromodo- 1993). The photoparoxysmal response is age-dependent: main helicase DNA-binding protein 2, involved in tran- prevalence in healthy children is between 1.4 and 8.3%, drop- scriptional regulation. Additional attention was drawn to CHD2 as a candidate photosensitive epilepsy gene as the ping to 51% in adults (Gregory et al.,1993; Quirk et al., only shared gene within several reported overlapping copy 1995; Kasteleijn-Nolst Trenite et al., 2003; Verrotti et al., number variants of the chromosome 15q26.1 region asso- 2012). Photosensitive epilepsy is a reflex epilepsy, with seiz- ciated with complex phenotypes including epilepsy with ures triggered by visual stimuli. A population-based study in photosensitivity. Eight patients with de novo deletions of Great Britain determined that the annual incidence of epilepsy 15q26 encompassing part or all of CHD2 have been re- with photoparoxysmal response was 1.1 per 100 000 in the ported (Veredice et al., 2009; Dhamija et al., 2011; Capelli overall population, and 5.7 per 100 000 between 7 and 19 et al., 2012; Lund et al., 2013; Mullen et al., 2013; Che´nier years of age (Quirk et al., 1995). About
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