Mutations in GRIN2A cause idiopathic focal epilepsy with rolandic spikes.

Idiopathic focal epilepsy (IFE) with rolandic spikes is the most common childhood epilepsy, comprising a phenotypic spectrum from rolandic epilepsy (also benign epilepsy with centrotemporal spikes, BECTS) to atypical benign partial epilepsy (ABPE), Landau-Kleffner syndrome (LKS) and epileptic encephalopathy with continuous spike and waves during slow-wave sleep (CSWS). The genetic basis is largely unknown. We detected new heterozygous mutations in GRIN2A in 27 of 359 affected individuals from 2 independent cohorts with IFE (7.5%; P = 4.83 × 10(-18), Fisher's exact test). Mutations occurred significantly more frequently in the more severe phenotypes, with mutation detection rates ranging from 12/245 (4.9%) in individuals with BECTS to 9/51 (17.6%) in individuals with CSWS (P = 0.009, Cochran-Armitage test for trend). In addition, exon-disrupting microdeletions were found in 3 of 286 individuals (1.0%; P = 0.004, Fisher's exact test). These results establish alterations of the gene encoding the NMDA receptor NR2A subunit as a major genetic risk factor for IFE.

Comprehensive analysis of candidate genes for photosensitivity using a complementary bioinformatic and experimental approach.

Photoparoxysmal response (PPR) is a highly heritable electroencephalographic trait characterized by an increased sensitivity to photic stimulation. It may serve as an endophenotype for idiopathic generalized epilepsy. Family linkage studies identified susceptibility loci for PPR on chromosomes 5q35.3, 8q21.13, and 16p13.3. This study aimed to identify key candidate genes within these loci. We used bioinformatics tools for gene prioritization integrating information on biologic function, sequence data, gene expression, and others. The prime candidate gene from this analysis was sequenced in 48 photopositive probands. Presumed functional implications of identified polymorphisms were investigated using bioinformatics methods. The glutamate receptor subunit gene GRIN2A was identified as a prime candidate gene. Sequence analysis revealed various new polymorphisms. None of the identified variants was predicted to be functionally relevant. We objectified the selection of candidate genes for PPR without an a priori hypothesis. Particularly among the various ion channel genes in the linkage regions, GRIN2A was identified as the prime candidate gene. GRIN2A mutations have recently been identified in various epilepsies. Even though our mutation analysis failed to demonstrate direct involvement of GRIN2A in photosensitivity, in silico gene prioritization may provide a useful tool for the identification of candidate genes within large genomic regions.

Deletions in 16p13 including GRIN2A in patients with intellectual disability, various dysmorphic features, and seizure disorders of the rolandic region.

Seizure disorders of the rolandic region comprise a spectrum of different epilepsy syndromes ranging from benign rolandic epilepsy to more severe seizure disorders including atypical benign partial epilepsy/pseudo-Lennox syndrome,electrical status epilepticus during sleep, and Landau-Kleffner syndrome. Centrotemporal spikes are the unifying electroencephalographic hallmark of these benign focal epilepsies, indicating a pathophysiologic relationship between the various epilepsies arising from the rolandic region. The etiology of these epilepsies is elusive, but a genetic component is assumed given the heritability of the characteristic electrographic trait. Herein we report on three patients with intellectual disability, various dysmorphic features, and epilepsies involving the rolandic region, carrying previously undescribed deletions in 16p13. The only gene located in the critical region shared by all three patients is GRIN2A coding for the alpha-2 subunit of the neuronal N-methyl-D-aspartate(NMDA) receptor.