Somatic variants in focal cortical malformations

Cortical malformations are a frequent cause of infantile drug-resistant epilepsy. Somatic variants in only a fraction of brain cells are now an established cause of cortical malformations found in epilepsy surgical resections. Recent major technological and conceptual advances have improved our understanding of such mosaic neurodevelopmental disorders. Here, we review the genetics and neuropathology of focal cortical malformations caused by somatic mosaicism, focusing on the mechanistic target of rapamycin (mTOR) pathway-related focal cortical dysplasia type II and the glycosylation-defective mild malformation of cortical development with oligodendroglial hyperplasia in epilepsy (MOGHE). We discuss technical implementations and remaining challenges in the detection of low-level somatic variants and highlight how single-cell approaches have provided new insights into the disease mechanisms. Further, we cover the recent in vivo efforts to better characterize MOGHE, a newly defined cortical malformation.