Natural History Studies and Clinical Trial Readiness for Genetic Developmental and Epileptic Encephalopathies
Open accessAbstract
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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- 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)
- PMC
- PMC8608984
- 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
- bronze
- doi.org
- Licence
- 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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