A successful partnership. Making progress in understanding the genetics of the epilepsies requires a successful partnership involving many players. Researchers, clinicians, patients, and families must work together in order to advance scientific goals. Since the first genetic etiology was discovered in a large family with Autosomal Dominant Nocturnal Frontal Lobe Epilepsy nearly 20 years ago, we have made many strides scientifically, in terms of technologies, our clinical classifications, and our knowledge of genetics. Our views on how we approach research from an ethical perspective is also continuing to evolve. Genetic research hinges on the participation of patients and families, and returning results to participants is increasingly viewed as imperative. A recent paper has used the Epilepsy Phenome/Genome Project (EPGP) and Epi4K studies as a case example of the challenges and opportunities regarding returning genetic results to research participants. Continue reading
Category Archives: Bioethics
A genetic counselor’s wish list for epilepsy genetics in 2015
Mt. Rainier. After our recent posts about the 2014 AES in Seattle, we received an email from Beth in Boston, highlighting some of the issues that genetic counselor face in epilepsy genetics when dealing with next gen sequencing data. Beth drew up a wish list for 2015 and asked us for comments. Here is a brief discussion between Beth and me on how high throughput epilepsy genetics sometimes comes to grinding halt in clinical practice. Continue reading
The five critical components of a clinical exome team
Fall break. Before our blog will go on a two week hiatus, I wanted to share some ideas with you on the team it takes to get a clinical exome analyzed – my impression is that you need at least different five people to translate genomics into patient care. Continue reading
Publications and thoughts of the week – SUMO, SENP2, and data return from exome studies
This week. Because I was traveling this week, I didn’t manage to put a blog post together for you. However, I wanted to catch up with recent publications in the field. Also, I wanted to point out a recent trend in the field – emerging interest and concern about data return from next-generation sequencing studies. However, let’s start with this week’s publications. Continue reading
Three things you didn’t know about epilepsy and genes
Fall colors. Just a brief summary of how this post originated. Eckernförde is a small city north of Kiel and the weekly Sunday destination of my daughter and me because of the wave pool. This past Sunday, daylight saving and the fact that she didn’t like her dinner had confused the little girl, and we had been awake since 4AM. As a consequence, she fell asleep on the way, and I kept driving to let her sleep. We made it as far as Haddeby, and I used this time to mentally put a post together that I had been planning for some time. These are the three things that are often misunderstood with regards to epilepsy and genes. Continue reading
Relationship quality equals bandwidth – a love letter to my wife
Transatlanticism. This is the 165th post on this blog. My wife Katie read every single one of them, correcting my Denglish phrases, adding Oxford commas, and giving me valuable feedback from her unique perspective as a certified genetic counselor with a research background in epilepsy genetics. Today is Katie’s birthday, and I would like to dedicate this post to her by saying thank you and I love you. Katie and I met at the Epilepsy Research Centre in Melbourne, Australia. In 2007, while driving around Lake Alexandrina in South Australia on a road trip, we listened to Transatlanticism by Death Cab for Cutie. This song became emblematic of our relationship for the years to come while we maintained a long-distance relationship between the US (Katie’s Masters in genetic counseling) and Germany (my residency in Kiel). In 2009, after two years of living on different continents, we were finally reunited. If you were to ask me about the main lesson I took away from this time apart, I would sum this up in a single sentence: “Relationship quality equals bandwidth”. This post is a reflection on why quality matters in the communication between geographically separated individuals. It won’t be a purely romantic post. That’s not my style, and that’s ok with Katie – she has corrected this post, as well. Continue reading
Identifying core phenotypes – epilepsy, ID and recurrent microdeletions
Triad. There are three microdeletions in particular that increase the risk for the Idiopathic/Genetic Generalized Epilepsies (IGE/GGE). This triad includes microdeletions at 15q13.3, 16p13.11 and 15q11.2, which are hotspot deletions arising from the particular architecture of the human genome. While the association of these microdeletions with epilepsy and other neurodevelopmental disorders including autism, intellectual disability and schizophrenia is well established, the core phenotype of these variants remains elusive, including the question whether such a core phenotype actually exists. In a recent paper in Neurology, Mullen and collaborators zoom in on a possible core phenotype of these microdeletions. The authors investigate a phenotype in which these microdeletions are particularly enriched: generalized epilepsy with intellectual disability. Continue reading
Are there incidental findings in exomes that require immediate action?
Guidelines. High throughput sequencing generates an unprecedented amount of genetic data. Most exomes are generated in a specific context, i.e. the genetic data is screened for variations in specific candidate genes or screened for de novo mutations. However, these approaches only use a small fraction of the genetic data generated per individual. High-throughput sequencing may also reveal clues towards possibly relevant diseases, and there is an ongoing debate if and how incidental findings should be returned to individuals undergoing high-throughput sequencing. Now, a recent paper in the American Journal of Human Genetics uses a very stringent clinical approach to assess the frequency of medically actionable findings in exome data. The results are not what you would think, and there is an urgent need to fix the existing databases. Continue reading
Three things the beach taught me about science
Endless summer. I am quoting from a representative email that I received this summer from a fellow scientist in the EuroEPINOMICS consortium: “XYZ will reply to you once he is back from his holiday – IF he comes back”. A metereological anomaly had given us one of the longest and most intense summers that I can remember. No rain for roughly four weeks, a new temperature record and a heat that was so intense that the tarmac on the highways started to melt. Accordingly, the motivation in EuroEPINOMICS land to leave the beach behind and return to the office was at an all time low. We spent our summer holiday in Marielyst, Denmark and I just wanted to share some thoughts on how the world of science looks when you’re at the beach. Yes, this post is not too serious. Continue reading
Genes, patents and the Myriad story
When genes meet the law. Last week, the Supreme Court of the United States of America (SCOTUS) ruled that genes are not patentable, a decision that will be known as the “Myriad Decision”, named after Myriad Genetics, a commercial laboratory that is the single provider for BRCA1/2 testing in breast cancer and ovarian cancer in the United States. For more than a decade, Myriad has had virtually exclusive rights to the genetic analysis of both genes, given a large number of patents surrounding BRCA1/2 analysis. Continue reading
