Detection of brain somatic mutations in focal cortical dysplasia during epilepsy presurgical workup

Checri et al. report the detection of somatic mutations at low allele frequency from brain-derived trace-tissue DNA recovered from stereo-EEG electrodes used in the presurgical evaluation of patients with epileptogenic focal cortical dysplasia. This proof-of-concept study illustrates a minimally invasive approach for detecting mosaic variants in refractory epilepsies. Brain-restricted somatic variants in genes of the mechanistic target of rapamycin signalling pathway cause focal epilepsies associated with focal cortical dysplasia type II. We hypothesized that somatic variants could be identified from trace tissue adherent to explanted stereoelectroencephalography electrodes used in the presurgical epilepsy workup to localize the epileptogenic zone. We investigated three paediatric patients with drug-resistant focal epilepsy subjected to neurosurgery. In the resected brain tissue, we identified low-level mosaic somatic mutations in AKT3 and DEPDC5 genes. We collected stereoelectroencephalography depth electrodes in the context of a second presurgical evaluation and identified 4/33 mutation-positive electrodes that were either located in the epileptogenic zone or at the border of the dysplasia. We provide the proof-of-concept that somatic mutations with low levels of mosaicism can be detected from individual stereoelectroencephalography electrodes and support a link between the mutation load and the epileptic activity. Our findings emphasize future opportunities for integrating genetic testing from stereoelectroencephalography electrodes into the presurgical evaluation of refractory epilepsy patients with focal cortical dysplasia type II to improve the patients' diagnostic journey and guide towards precision medicine.

Automated summary

Checri et al. detect somatic mutations at low allele frequency from brain-derived trace-tissue DNA recovered from stereo-EEG electrodes, demonstrating a minimally invasive approach for detecting mosaic variants in refractory epilepsies. The detected somatic mutations in genes of the mechanistic target of rapamycin signalling pathway emphasize the potential of integrating genetic testing into the presurgical evaluation of focal cortical dysplasia type II patients.