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Scientific article
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English

Natural History Study of STXBP1-Developmental and Epileptic Encephalopathy Into Adulthood

Published inNeurology, vol. 99, no. 3, p. e221-e233
Errata
  • Erratum in : Natural History Study of STXBP1-Developmental and Epileptic Encephalopathy Into Adulthood. Neurology. 2023 Jul 4;101(1):52. doi: 10.1212/WNL.0000000000201612.
  • DOI : 10.1212/wnl.0000000000201612
  • PMID : 36693729
Publication date2022-07-19
First online date2022-06-03
Abstract

Background and objectives: PathogenicSTXBP1variants cause a severe early-onset developmental and epileptic encephalopathy (STXBP1-DEE). We aimed to investigate the natural history of STXBP1-DEE in adults focusing on seizure evolution, the presence of movement disorders, and the level of functional (in)dependence.

Methods: In this observational study, patients with a minimum age of 18 years carrying a (likely) pathogenicSTXBP1variant were recruited through medical genetics departments and epilepsy centers. Treating clinicians completed clinical questionnaires and performed semistructured video examinations while performing tasks from the (modified) Unified Parkinson Disease Rating Scale when possible.

Results: Thirty adult patients were included for summary statistics, with video recordings available for 19 patients. The median age at last follow-up was 24 years (range 18-58 years). All patients had epilepsy, with a median onset age of 3.5 months. At last follow-up, 80% of adults had treatment-resistant seizures despite long periods of seizure freedom in 37%. Tonic-clonic, focal, and tonic seizures were most frequent in adults. Epileptic spasms, an unusual feature beyond infancy, were present in 3 adults. All individuals had developmental impairment. Periods of regression were present in 59% and did not always correlate with flare-ups in seizure activity. Eighty-seven percent had severe or profound intellectual disability, 42% had autistic features, and 65% had significant behavioral problems. Video examinations showed gait disorders in all 12 patients able to walk, including postural abnormalities with external rotation of the feet, broad-based gait, and asymmetric posture/dystonia. Tremor, present in 56%, was predominantly of the intention/action type. Stereotypies were seen in 63%. Functional outcome concerning mobility was variable ranging from independent walking (50%) to wheelchair dependence (39%). Seventy-one percent of adults were nonverbal, and all were dependent on caregivers for most activities of daily living.

Discussion: STXBP1-DEE warrants continuous monitoring for seizures in adult life. Periods of regression are more frequent than previously established and can occur into adulthood. Movement disorders are often present and involve multiple systems. Although functional mobility is variable in adulthood, STXBP1-DEE frequently leads to severe cognitive impairments and a high level of functional dependence. Understanding the natural history of STXBP1-DEE is important for prognostication and will inform future therapeutic trials.

eng
Keywords
  • Activities of Daily Living
  • Adolescent
  • Adult
  • Electroencephalography
  • Epilepsy
  • Humans
  • Infant
  • Middle Aged
  • Movement Disorders / genetics
  • Munc18 Proteins / genetics
  • Mutation
  • Seizures / genetics
  • Young Adult
Citation (ISO format)
STAMBERGER, Hannah et al. Natural History Study of STXBP1-Developmental and Epileptic Encephalopathy Into Adulthood. In: Neurology, 2022, vol. 99, n° 3, p. e221–e233. doi: 10.1212/WNL.0000000000200715
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ISSN of the journal0028-3878
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Technical informations

Creation10/04/2023 6:53:28 AM
First validation05/07/2024 3:06:00 PM
Update time05/07/2024 3:06:00 PM
Status update05/07/2024 3:06:00 PM
Last indexation05/07/2024 3:06:19 PM
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