Autosomal dominant sleep-related hypermotor epilepsy caused by a previously unreported CHRNA4 variant

Eur J Med Genet. 2022 Mar;65(3):104444. doi: 10.1016/j.ejmg.2022.104444. Epub 2022 Jan 29.

Abstract

Autosomal dominant sleep-related hypermotor epilepsy (ADSHE) is a rare heritable form of epilepsy. It is characterized by hypermotor seizures occurring mainly during sleep. Seizures are typically abrupt in onset and offset and tend to increase in complexity and duration during the night. ADSHE is inherited in an autosomal dominant manner, and penetrance is estimated to be 70%. We describe two brothers with ADSHE with a previously unreported variant in CHRNA4, and the effect of medical treatment with carbamazepine. We highlight the relevance of genetic testing in patients with atypical and clustering episodes of nightmares, night terrors, or panic attacks, as these patients could be misdiagnosed, and instead be suffering from ADSHE, a potentially treatable condition.

Keywords: ADNFLE; ADSHE; CHRNA4; Nocturnal epilepsy; Sleep-related hypermotor epilepsy.

MeSH terms

  • Arthrogryposis*
  • Epilepsy* / drug therapy
  • Epilepsy* / genetics
  • Humans
  • Male
  • Receptors, Nicotinic* / genetics
  • Seizures
  • Sleep

Substances

  • Receptors, Nicotinic
  • nicotinic acetylcholine receptor alpha4 subunit