Wave. Earlier today, I was invited to speak at the Kids First Spring Public Webinar, part of the Gabriella Miller Kids First Pediatric Research Program. The theme was “Ride the Wave of Discovery,” fitting for a program built around shared pediatric data and collaboration. In my talk, I focused on epilepsy genetics and on a question that now sits in front of pediatric genomics: what can we learn when many children already have genomes? My answer was that we need to move from genomes to phenomes to time.
Tag Archives: SCN1A
The Hidden Genome of Treatment: Lessons for Epilepsy Pharmacogenomics from GLP-1 Agonists
Signal. I admit that the title of this blog post is somewhat misleading, but please bear with me. Yes, GLP-1 receptor agonists have very little to do with epilepsy, but there is a larger story behind this. In a recent study, nearly 28,000 people taking GLP-1 receptor agonists answered a seemingly simple question: how much weight did you lose, and how bad were the side effects? This simple survey, coupled with genetic data, produced one of the cleanest pharmacogenomic signals seen in recent years. But it also emphasized that the genetics of treatment are often not the genetics of disease, and that matters far beyond obesity and weight loss. Here is why this should make us rethink pharmacogenomics in epilepsy.
STRIPE – When RNA Speaks Louder Than DNA
RNA. More than a decade ago, I remember reading an article arguing that we actually live in an RNA world. At the time, this felt a bit academic and not really relevant. Genetics was about sequencing and interpreting DNA. However, over the last few years, our ability to think in terms of RNA transcripts rather than DNA sequence has become increasingly relevant. When I teach trainees, I sometimes tell them: we do not care about genes. And then I pause, usually long enough to make people uncomfortable. Then I correct myself: we care about transcripts. In a recent publication, we assessed how a novel targeted long-read RNA sequencing approach can help with rare disease diagnosis. Here is what we found.
Familial Epilepsy Is Not as Simple as We Think
Families. We tend to think that we understand familial epilepsy. The mental image is almost fixed: large pedigrees, clean inheritance, recognizable syndromes, and genes that segregate exactly as expected. But in a recent study from our epilepsy genetics program, we looked at something different. Not discovery cohorts and carefully selected multiplex families, but real-world genetic testing in 484 consecutive families. All families were evaluated in routine clinical care through ENGIN, our Epilepsy Neurogenetics Initiative, which has now evaluated more than 7,000 individuals with epilepsy and related disorders. The result was a picture of familial epilepsy that is both reassuring and unexpectedly complicated. Here is what we found. Continue reading
Ten Years of Accumulation: Snow-Day Thoughts Between Jonas and Fern
Decade. Over the past week, winter storm Fern has blanketed large parts of the United States with several feet of snow, leading to a virtual standstill in many regions. When I looked back, I realized that the last major snowstorm that paralyzed public life was a decade ago, a storm called Jonas. Snowed in exactly ten years ago, I reflected on the state of epilepsy genetics. Let’s see what has changed in the field since Jonas in 2016.
Signals in the noise – qEEG patterns in genetic epilepsies
qEEG. The electroencephalogram is one of the oldest tools in neurology. We use it every day to diagnose and monitor brain function, yet, even in the era of genomic medicine, most of our EEG interpretation still relies on visual inspection, a human reading of squiggled traces. In a recent publication in Neurology, we asked whether the information embedded in these signals could be measured more objectively in children with STXBP1, SCN1A, and SYNGAP1-related disorders. Here is the story on how we identified hidden signals in the EEG tracings of individuals with genetic epilepsies.
RBFOX3 and the hunt for epilepsy genes in 100,000 genomes
Large scale. Novel epilepsy genes are typically discovered through collaborative studies that combine information across various centers and research groups. However, there are also large-scale sequencing initiatives on a national level that include individuals with epilepsy. In a recent study published in Nature, a wide range of clinical phenotypes were assessed in an initial cohort of 34,000 individuals in the UK 100,000 Genomes Project. Let me dive into the associations related to epilepsy in this publication.
Predicting genetic epilepsies through EMR fingerprints
EMR. Clinical data on rare disease is not necessarily rare; it is our ability to unlock already existing data that is rare. Over the last decade, we have tried to understand the fingerprints that rare genetic epilepsies leave in the electronic medical record (EMR). In our flagship publication last year, we tried to push the boundary. Is EMR data, with all its strength and weaknesses, able to predict genetic diagnosis? Here is our journey through the hidden signals in large EMR datasets.
Takeaways from the 2024 Dravet Syndrome Foundation Biennial Family and Professional Conference
DSF. This June, our team attended the Biennial Family and Professional Conference held by the Dravet Syndrome Foundation (DSF). Over three days in Minneapolis, research findings and therapeutic advances were discussed, and families shared their stories. As a first-time attendee, it was a humbling experience to be invited into this tight-knit, motivated, and inspiring community. Here, I would like to share some of the lessons I learned while in attendance.
SCN1A in FinnGen – epilepsy, dementia, and type 2 diabetes
Isolates. Last week, the FinnGen biobank went live, and Nature dedicated an entire issue to the launch of this initiative. In brief, FinnGen is a large Finnish research project providing genomic and clinical data from a Finnish biobank with the aim to provide new insights into human disease. Finland is an isolated population, which offers unique insights into the role of rare variants in disease. When I checked the FinnGen database for association with SCN1A, I was surprised that three missense variants have been associated with various diseases. Here is what a founder population can tell us about the various roles of SCN1A in human disease. Continue reading