Age at first seizure within the first 6 months of life predicted progression to Dravet syndrome in SCN1A mutation carriers with 83.3% sensitivity and 76.6% specificity.
Observational (n=200)
What clinical and genetic factors predict progression to Dravet syndrome in infants with SCN1A mutations?
In infants with SCN1A mutations, age at seizure onset (specifically within the first 6 months) is a stronger predictor of progression to Dravet syndrome than mutation type.
OBJECTIVE: mutations. METHODS: Combining sex, age/fever at first seizure, family history of epilepsy, EEG, and mutation type, we analyzed the accuracy of significant associations in predicting Dravet syndrome vs milder outcomes in 182 mutation carriers ascertained after seizure onset. To assess the diagnostic accuracy of all parameters, we calculated sensitivity, specificity, receiver operating characteristic (ROC) curves, diagnostic odds ratios, and positive and negative predictive values and the accuracy of combined information. We also included in the study demographic and mutational data of the healthy relatives of mutation carrier patients. RESULTS: Ninety-seven individuals (48.5%) had Dravet syndrome, 49 (23.8%) had generalized/genetic epilepsy with febrile seizures plus, 30 (14.8%) had febrile seizures, 6 (3.5%) had focal epilepsy, and 18 (8.9%) were healthy relatives. The association study indicated that age at first seizure and frameshift mutations were associated with Dravet syndrome. The risk of Dravet syndrome was 85% in the 0- to 6-month group, 51% in the 6- to 12-month range, and 0% after the 12th month. ROC analysis identified onset within the sixth month as the diagnostic cutoff for progression to Dravet syndrome (sensitivity = 83.3%, specificity = 76.6%). CONCLUSIONS: mutations, age at seizure onset appears to predict outcome better than mutation type. Because outcome is not predetermined by genetic factors only, early recognition and treatment that mitigates prolonged/repeated seizures in the first year of life might also limit the progression to epileptic encephalopathy.
Cetica et al. (Thu,) conducted a observational in SCN1A mutations (n=200). Clinical and genetic factors (age at first seizure, mutation type) was evaluated on Progression to Dravet syndrome. Age at first seizure within the first 6 months of life predicted progression to Dravet syndrome in SCN1A mutation carriers with 83.3% sensitivity and 76.6% specificity.