The expanding field of genetic developmental and epileptic encephalopathies: current understanding and future perspectives.

Recent advances in genetic testing technologies have revolutionised the identification of genetic abnormalities in early onset developmental and epileptic encephalopathies (DEEs). In this Review, we provide an update on the expanding landscape of genetic factors contributing to DEEs, encompassing over 800 reported genes. We focus on the cellular and molecular mechanisms driving epileptogenesis, with an emphasis on emerging therapeutic strategies and effective treatment options. We explore noteworthy, novel genes linked to DEE phenotypes, such as gBRAT-1 and GNAO1, and gene families such as GRIN and HCN. Understanding the network-level effects of gene variants will pave the way for potential gene therapy applications. Given the diverse comorbidities associated with DEEs, a multidisciplinary team approach is essential. Despite ongoing efforts and improved genetic testing, DEEs lack a cure, and treatment complexities persist. This Review underscores the necessity for larger international prospective studies focusing on both seizure outcomes and developmental trajectories.

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Declaration of interests NS has served on scientific advisory boards for GW Pharma, BioMarin, Arvelle, Marinus, and Takeda; has received speaker honoraria from Eisai, BioMarin, Livanova, Sanofi; and has served as an investigator for Zogenix, Marinus, BioMarin, Union Chimique Belge (UCB), and Roche. MT has served on advisory boards for BioMarin and Biocodex; has received speaker honoraria from BioMarin, Biocodex, and Orion; and has served as an investigator for Zogenix, Marinus, BioMarin, UCB, and Roche. SB has served on advisory boards for Biocodex and has received speaker and consultant honoraria from Angelini, Biocodex, and Jazz Pharmaceutics. AA has received speaker and consultant honoraria from Biocodex, EISAI, Jazz Pharmaceutics, Sanofi, and UCB and is co-director of the European Consortium for Epilepsy Trials. JHC has received grants from Stoke Therapeutics, Ultragenyx, UCB, the National Institute for Health and Care Research, Great Ormond Street Hospital Children's Charity, LifeARC, the Waterloo Foundation, and Action Medical Research. JHC has also received honoraria payments from Biocodex, Nutricia, Jazz Pharmaceuticals, Nutricia, Takeda, and UCB, all of which have been paid to University College London. JMW is associate editor of Epilepsia and chief editor of the Paediatric Neurology subsection of Frontiers in Neurology and has served on advisory boards for Sanofi and Novartis. FV has received speaker fees from Zogenix, Neuraxpharm, Angelini, and Eisai and has served on advisory boards for Zogenix, Neuraxpharm, Angelini, and Eisai. SA has received honoraria for lectures from Biocodex, BioMarin, Eisai, Jazz Pharmaceuticals, Neuraxpharm, Nutricia, Stoke, UCB, and Zogenix; has been paid as a consultant for lectures by Biocodex, Encoded, Grintherapeutics, Jazz Pharmaceuticals, Neuraxpharm, Nutricia, Orion, Proveca, Supernus, Stoke, Takeda, UCB, and Xenon; and has been an investigator for clinical trials for Eisai, Proveca, Takeda, and UCB. RN has served as principal investigator in clinical trials for Novartis, Nutricia, Eisai, UCB, GW Pharma, and Livanova; has received consulting and lecturer honoraria from BioGene, BioMarin, Praxis, GW Pharma, Zogenix, Novartis, Nutricia, Stoke, Ionis, Targeon, Neuraxpharma, Takeda, Nutricia, Biocodex, Advicennes, and Eisai; and has received unrestricted research grants from Eisai, UCB, Livanova, and GW Pharma and academic research grants from the European Joint Programme on Rare Diseases (Horizons 2020). PC has served on a scientific advisory board for Novartis, has received speaker honoraria from Jazz Pharmaceuticals and ItalFarmaco, and has served as investigator for clinical trials for Novartis. All other authors declare no competing interests.