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CACNA1A-associated epilepsy: Electroclinical findings and treatment response on seizures in 18 patients

Marie Le Roux 1 Magalie Barth 1 Sophie Gueden 1 Patrick Desbordes de Cepoy 1 Alec Aeby 2 Catheline Vilain 3 Edouard Hirsch 4 Anne de Saint Martin 4 Vincent Des Portes 5 Gaëtan Lesca 5 Audrey Riquet 6 Laurence Chaton 6 Nathalie Villeneuve 7 Laurent Villard 8, 9 Claude Cances 10 Luc Valton 10 Florence Renaldo 11 Anne-Isabelle Vermersch 11 Cecilia Altuzarra 12 Marie-Ange Nguyen-Morel 13 Julien van Gils 14 Chloé Angelini 14 Arnaud Biraben 15 Lionel Arnaud 16 Florence Riant 17 Patrick van Bogaert 1, 18 
Abstract : CACNA1A pathogenic mutations are involved in various neurological phenotypes including episodic ataxia (EA2), spinocerebellar ataxia (SCA6), and familial hemiplegic migraine (FHM1). Epilepsy is poorly documented. We studied 18 patients (10 males) carrying de novo or inherited CACNA1A mutations, with median age of 2,5 years at epilepsy onset. Eight mutations were novel. Two variants known leading to gain of function (GOF) were found in 5 patients. Five other patients had non-sense variants leading to loss of function (LOF). Seizures were most often revealed by either status epilepticus (SE) (n = 8), eventually triggered by fever (n = 5), or absences/behavioural arrests (n = 7). Non-epileptic paroxysmal events were frequent and consisted in recurrent hemiplegic accesses (n = 9), jitteriness in the neonatal period (n = 6), and ocular paroxysmal events (n = 9). Most of the patients had early permanent cerebellar dysfunction (n = 16) and early moderate to severe global developmental delay (GDD)/intellectual deficiency (ID) (n = 17). MRI was often abnormal, with cerebellar (n = 8) and/or cerebral (n = 6) atrophy. Stroke-like occurred in 2 cases. Some antiepileptic drugs including topiramate, levetiracetam, lamotrigine and valproate were effective on seizures. Acetazolamide and calcium channel blockers were often effective when used. More than half of the patients had refractory epilepsy. CACNA1A mutation should be evoked in front of 2 main electro-clinical phenotypes that are associated with permanent cerebellar dysfunction and moderate to severe GDD/ID. The first one, found in all 5 patients with GOF variants, is characterized by intractable seizures, early and recurrent SE and hemiplegic accesses. The second, less severe, found in 5 patients with LOF variants, is characterized by refractory early onset absence seizures.
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Submitted on : Monday, May 9, 2022 - 3:00:29 PM
Last modification on : Monday, November 14, 2022 - 2:46:05 AM

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Marie Le Roux, Magalie Barth, Sophie Gueden, Patrick Desbordes de Cepoy, Alec Aeby, et al.. CACNA1A-associated epilepsy: Electroclinical findings and treatment response on seizures in 18 patients. European Journal of Paediatric Neurology, 2021, 33, pp.75-85. ⟨10.1016/j.ejpn.2021.05.010⟩. ⟨hal-03662709⟩



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