Cited by 53Epilepsy research and treatmentGenetics and Neurodevelopmental DisordersPharmacological Effects and Toxicity Studies

Natural History Studies and Clinical Trial Readiness for Genetic Developmental and Epileptic Encephalopathies

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Palmer, Elizabeth E., Howell, Katherine, Scheffer, Ingrid E.·2021·Neurotherapeutics

Abstract

The developmental and epileptic encephalopathies (DEEs) are the most severe group of epilepsies. They usually begin in infancy or childhood with drug-resistant seizures, epileptiform EEG patterns, developmental slowing or regression, and cognitive impairment. DEEs have a high mortality and profound morbidity; comorbidities are common including autism spectrum disorders. With advances in genetic sequencing, over 400 genes have been implicated in DEEs, with a genetic cause now identified in over 50% patients. Each genetic DEE typically has a broad genotypic-phenotypic spectrum, based on the underlying pathophysiology. There is a pressing need to improve health outcomes by developing novel targeted therapies for specific genetic DEE phenotypes that not only improve seizure control, but also developmental outcomes and comorbidities. Clinical trial readiness relies firstly on a deep understanding of phenotype-genotype correlation and evolution of a condition over time, in order to select appropriate patients for clinical trials. Understanding the natural history of the disorder informs assessment of treatment efficacy in terms of both clinical outcome and biomarker utility. Natural history studies (NHS) provide a high quality, integrated, comprehensive approach to understanding a complex disease and underpin clinical trial design for novel therapies. NHS are pre-planned observational studies designed to track the course of a disease and identify demographic, genetic, environmental, and other variables, including biomarkers, that correlate with the disease's evolution and outcomes. Due to the rarity of individual genetic DEEs, appropriately funded high-quality DEE NHS will be required, with sustainable frameworks and equitable access to affected individuals globally.

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  • The disease-modifying potential of new treatments, especially precision and gene therapies, can only be determined if natural history profiles of each genetic DEE are well described.

    “The disease-modifying potential of new treatments, especially precision and gene therapies, can only be determined if natural history profiles of each genetic DEE are well described 243 .”

    From Developmental and epileptic encephalopathies (2024) · cites this paper as [243]

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  1. [22]22. Moller RS, Hammer TB, Rubboli G, Lemke JR, Johannesen KM. From next-generation sequencing to targeted treatment of non- acquired epilepsies. Expert Rev Mol Diagn. 2019;19(3):217-28.
  2. [26]26. Steriade C, French J, Devinsky O. Epilepsy: key experimental therapeutics in early clinical development. Expert Opin Investig Drugs. 2020 Apr;29(4):373-83.
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Authors
Palmer, E. E., Howell, K., & Scheffer, I. E.
Affiliations
  • UNSW Sydney (AU)
  • Royal Children's Hospital (AU)
Corresponding author
Scheffer, Ingrid E.
Venue
Neurotherapeutics
Publisher
Elsevier BV
Published
2021-07
Volume
18
Issue
3
Pages
1432-1444
ISSN
1878-7479 (ISSN-L)
OpenAlex
W3208946353
Cited by
53
References
82
Citations by year
2026: 10 · 2025: 13 · 2024: 11 · 2023: 12 · 2022: 5 · 2021: 2
FWCI
1.34
Type
journal article
Language
en
Open access
Locations
  • Neurotherapeutics (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion)
Funders
  • Medical Research Council
  • National Health and Medical Research Council
  • Medical Research Future Fund
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetics and Neurodevelopmental Disorders
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmacological Effects and Toxicity Studies
Keywords
developmental and epileptic encephalopathy, natural history research, clinical trial readiness, genotype-phenotype correlation, drug-resistant epilepsy, biomarkers, targeted therapy, autism spectrum disorder comorbidity, disease progression
MeSH terms
Brain Diseases, Clinical Trials as Topic, Epilepsy, Humans, Medical History Taking, Biomarkers, Neurodevelopmental Disorders

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