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September 09, 2014; 83 (11) Article

Genetic analysis of PHOX2B in sudden unexpected death in epilepsy cases

Richard D. Bagnall, Douglas E. Crompton, Carina Cutmore, Brigid M. Regan, Samuel F. Berkovic, Ingrid E. Scheffer, Christopher Semsarian
First published August 1, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000781
Richard D. Bagnall
From the Agnes Ginges Centre for Molecular Cardiology (R.D.B., C.C., C.S.), Centenary Institute, Sydney; Sydney Medical School (R.D.B., C.S.), University of Sydney; Neurology Department (D.E.C., B.M.R.), Northern Health, Melbourne; Epilepsy Research Centre (D.E.C., S.F.B., I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Melbourne; Florey Institute of Neurosciences and Mental Health (I.E.S.), Melbourne; Department of Paediatrics (I.E.S.), University of Melbourne, Royal Children's Hospital, Melbourne; and Department of Cardiology (C.S.), Royal Prince Alfred Hospital, Sydney, Australia.
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Douglas E. Crompton
From the Agnes Ginges Centre for Molecular Cardiology (R.D.B., C.C., C.S.), Centenary Institute, Sydney; Sydney Medical School (R.D.B., C.S.), University of Sydney; Neurology Department (D.E.C., B.M.R.), Northern Health, Melbourne; Epilepsy Research Centre (D.E.C., S.F.B., I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Melbourne; Florey Institute of Neurosciences and Mental Health (I.E.S.), Melbourne; Department of Paediatrics (I.E.S.), University of Melbourne, Royal Children's Hospital, Melbourne; and Department of Cardiology (C.S.), Royal Prince Alfred Hospital, Sydney, Australia.
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Carina Cutmore
From the Agnes Ginges Centre for Molecular Cardiology (R.D.B., C.C., C.S.), Centenary Institute, Sydney; Sydney Medical School (R.D.B., C.S.), University of Sydney; Neurology Department (D.E.C., B.M.R.), Northern Health, Melbourne; Epilepsy Research Centre (D.E.C., S.F.B., I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Melbourne; Florey Institute of Neurosciences and Mental Health (I.E.S.), Melbourne; Department of Paediatrics (I.E.S.), University of Melbourne, Royal Children's Hospital, Melbourne; and Department of Cardiology (C.S.), Royal Prince Alfred Hospital, Sydney, Australia.
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Brigid M. Regan
From the Agnes Ginges Centre for Molecular Cardiology (R.D.B., C.C., C.S.), Centenary Institute, Sydney; Sydney Medical School (R.D.B., C.S.), University of Sydney; Neurology Department (D.E.C., B.M.R.), Northern Health, Melbourne; Epilepsy Research Centre (D.E.C., S.F.B., I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Melbourne; Florey Institute of Neurosciences and Mental Health (I.E.S.), Melbourne; Department of Paediatrics (I.E.S.), University of Melbourne, Royal Children's Hospital, Melbourne; and Department of Cardiology (C.S.), Royal Prince Alfred Hospital, Sydney, Australia.
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Samuel F. Berkovic
From the Agnes Ginges Centre for Molecular Cardiology (R.D.B., C.C., C.S.), Centenary Institute, Sydney; Sydney Medical School (R.D.B., C.S.), University of Sydney; Neurology Department (D.E.C., B.M.R.), Northern Health, Melbourne; Epilepsy Research Centre (D.E.C., S.F.B., I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Melbourne; Florey Institute of Neurosciences and Mental Health (I.E.S.), Melbourne; Department of Paediatrics (I.E.S.), University of Melbourne, Royal Children's Hospital, Melbourne; and Department of Cardiology (C.S.), Royal Prince Alfred Hospital, Sydney, Australia.
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Ingrid E. Scheffer
From the Agnes Ginges Centre for Molecular Cardiology (R.D.B., C.C., C.S.), Centenary Institute, Sydney; Sydney Medical School (R.D.B., C.S.), University of Sydney; Neurology Department (D.E.C., B.M.R.), Northern Health, Melbourne; Epilepsy Research Centre (D.E.C., S.F.B., I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Melbourne; Florey Institute of Neurosciences and Mental Health (I.E.S.), Melbourne; Department of Paediatrics (I.E.S.), University of Melbourne, Royal Children's Hospital, Melbourne; and Department of Cardiology (C.S.), Royal Prince Alfred Hospital, Sydney, Australia.
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Christopher Semsarian
From the Agnes Ginges Centre for Molecular Cardiology (R.D.B., C.C., C.S.), Centenary Institute, Sydney; Sydney Medical School (R.D.B., C.S.), University of Sydney; Neurology Department (D.E.C., B.M.R.), Northern Health, Melbourne; Epilepsy Research Centre (D.E.C., S.F.B., I.E.S.), Department of Medicine, University of Melbourne, Austin Health, Melbourne; Florey Institute of Neurosciences and Mental Health (I.E.S.), Melbourne; Department of Paediatrics (I.E.S.), University of Melbourne, Royal Children's Hospital, Melbourne; and Department of Cardiology (C.S.), Royal Prince Alfred Hospital, Sydney, Australia.
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Citation
Genetic analysis of PHOX2B in sudden unexpected death in epilepsy cases
Richard D. Bagnall, Douglas E. Crompton, Carina Cutmore, Brigid M. Regan, Samuel F. Berkovic, Ingrid E. Scheffer, Christopher Semsarian
Neurology Sep 2014, 83 (11) 1018-1021; DOI: 10.1212/WNL.0000000000000781

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Abstract

Objective: To determine the contribution of sequence variations in PHOX2B to sudden unexpected death in epilepsy (SUDEP).

Methods: Patients who died of SUDEP were identified in 2 major Australian cohorts, the Epilepsy Genetics research program in Melbourne and postmortem cases at the Department of Forensic Medicine in Sydney. Coding exons of the PHOX2B gene were sequenced and a fluorescent sizing assay was used to measure the PHOX2B polyalanine repeat sequence.

Results: Sequencing of 68 cases of SUDEP identified a 15-nucleotide deletion in the PHOX2B polyalanine repeat region in one case, a 16-year-old adolescent with focal dyscognitive seizures from age 5 years. This deletion was verified using a fluorescent sizing assay. Two synonymous variants were identified in 4 cases, but no PHOX2B polyalanine repeat expansion alleles or point mutations were found.

Conclusions: The absence of PHOX2B polyalanine repeat expansion alleles or point mutations in 68 Australian cases of SUDEP, with one deletion of uncertain significance, shows that PHOX2B mutations are not a common risk factor for SUDEP.

GLOSSARY

CCHS=
congenital central hypoventilation syndrome;
SIDS=
sudden infant death syndrome;
SUDEP=
sudden unexpected death in epilepsy

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received April 16, 2014.
  • Accepted in final form June 18, 2014.
  • © 2014 American Academy of Neurology
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