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  1. Article ; Online: Clinically significant changes in genes and variants associated with epilepsy over time: implications for re-analysis.

    Robertson, Alan J / Tran, Khoa A / Bennett, Carmen / Sullivan, Clair / Stark, Zornitza / Vadlamudi, Lata / Waddell, Nicola

    Scientific reports

    2024  Volume 14, Issue 1, Page(s) 7717

    Abstract: Despite the significant advances in understanding the genetic architecture of epilepsy, many patients do not receive a molecular diagnosis after genomic testing. Re-analysing existing genomic data has emerged as a potent method to increase diagnostic ... ...

    Abstract Despite the significant advances in understanding the genetic architecture of epilepsy, many patients do not receive a molecular diagnosis after genomic testing. Re-analysing existing genomic data has emerged as a potent method to increase diagnostic yields-providing the benefits of genomic-enabled medicine to more individuals afflicted with a range of different conditions. The primary drivers for these new diagnoses are the discovery of novel gene-disease and variants-disease relationships; however, most decisions to trigger re-analysis are based on the passage of time rather than the accumulation of new knowledge. To explore how our understanding of a specific condition changes and how this impacts re-analysis of genomic data from epilepsy patients, we developed Vigelint. This approach combines the information from PanelApp and ClinVar to characterise how the clinically relevant genes and causative variants available to laboratories change over time, and this approach to five clinical-grade epilepsy panels. Applying the Vigelint pipeline to these panels revealed highly variable patterns in new, clinically relevant knowledge becoming publicly available. This variability indicates that a more dynamic approach to re-analysis may benefit the diagnosis and treatment of epilepsy patients. Moreover, this work suggests that Vigelint can provide empirical data to guide more nuanced, condition-specific approaches to re-analysis.
    MeSH term(s) Humans ; Epilepsy/diagnosis ; Epilepsy/genetics ; Genomics ; Genetic Testing
    Language English
    Publishing date 2024-04-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-024-57976-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Early cost-utility analysis of genetically guided therapy for patients with drug-resistant epilepsy.

    Gordon, Louisa G / Elliott, Thomas M / Bennett, Carmen / Hollway, Georgina / Waddell, Nicola / Vadlamudi, Lata

    Epilepsia

    2022  Volume 63, Issue 12, Page(s) 3111–3121

    Abstract: Objective: Existing gene panels were developed to understand the etiology of epilepsy, and further benefits will arise from an effective pharmacogenomics panel for personalizing therapy and achieving seizure control. Our study assessed the cost- ... ...

    Abstract Objective: Existing gene panels were developed to understand the etiology of epilepsy, and further benefits will arise from an effective pharmacogenomics panel for personalizing therapy and achieving seizure control. Our study assessed the cost-effectiveness of a pharmacogenomics panel for patients with drug-resistant epilepsy, compared with usual care.
    Methods: A cost-utility analysis was employed using a discrete event simulation model. The microsimulation model aggregated the costs and benefits of genetically guided treatment versus usual care for 5000 simulated patients. The 10-year model combined data from various sources including genomic databases on prevalence of variants, population-level pharmaceutical claims on antiseizure medications, published long-term therapy retention rates, patient-level cost data, and systematic reviews. Incremental cost per quality-adjusted life-year (QALY) gained was computed. Deterministic and probabilistic sensitivity analyses were undertaken to address uncertainty in model parameters.
    Results: The mean cost of the genetically guided treatment option was AU$98 199 compared with AU$95 386 for usual care. Corresponding mean QALYs were 4.67 compared with 4.28 for genetically guided and usual care strategies, respectively. The incremental cost per QALY gained was AU$7381. In probabilistic sensitivity analyses, the incremental cost per QALY gained was AU$6321 (95% uncertainty interval = AU$3604-AU$9621), with a 100% likelihood of being cost-effective in the Australian health care system. The most influential drivers of the findings were the monthly health care costs associated with reduced seizures, costs when seizures continued, and the quality-of-life estimates under genetically guided and usual care strategies.
    Significance: This early economic evaluation of a pharmacogenomics panel to guide treatment for drug-resistant epilepsy could potentially be cost-effective in the Australian health care system. Clinical trial evidence is necessary to confirm these findings.
    MeSH term(s) Humans ; Cost-Benefit Analysis ; Australia ; Quality of Life ; Seizures ; Epilepsy
    Language English
    Publishing date 2022-10-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 216382-2
    ISSN 1528-1167 ; 0013-9580
    ISSN (online) 1528-1167
    ISSN 0013-9580
    DOI 10.1111/epi.17408
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: A Multi-Disciplinary Team Approach to Genomic Testing for Drug-Resistant Epilepsy Patients-The GENIE Study.

    Vadlamudi, Lata / Bennett, Carmen Maree / Tom, Melanie / Abdulrasool, Ghusoon / Brion, Kristian / Lundie, Ben / Aung, Hnin / Lau, Chiyan / Rodgers, Jonathan / Riney, Kate / Gordon, Louisa

    Journal of clinical medicine

    2022  Volume 11, Issue 14

    Abstract: Background: The genomic era has led to enormous progress in clinical care and a multi-disciplinary team (MDT) approach is imperative for integration of genomics into epilepsy patient care.: Methods: The MDT approach involved patient selection, ... ...

    Abstract Background: The genomic era has led to enormous progress in clinical care and a multi-disciplinary team (MDT) approach is imperative for integration of genomics into epilepsy patient care.
    Methods: The MDT approach involved patient selection, genomic testing choice, variant discussions and return of results. Genomics analysis included cytogenomic testing and whole exome sequencing (WES). Neurologist surveys were undertaken at baseline and after genomic testing to determine if genomic diagnoses would alter their management, and if there was a change in confidence in genomic testing and neurologist perceptions of the MDT approach.
    Results: The total diagnostic yield from all genomic testing was 17% (11/66), with four diagnoses from cytogenomic analyses. All chromosomal microarray (CMA) diagnoses were in patients seen by adult neurologists. Diagnostic yield for WES was 11% (7/62). The most common gene with pathogenic variants was
    Conclusions: We demonstrated diagnostic yield from genomic testing, and the impact on management in a cohort with drug-resistant epilepsy. The MDT approach increased confidence in genomic testing and neurologists valued the input from this approach. The utility of CMA was demonstrated in epilepsy patients seen by adult neurologists as was the importance of considering mosaicism for previously undiagnosed patients.
    Language English
    Publishing date 2022-07-21
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm11144238
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Evidence for type-specific DNA methylation patterns in epilepsy: a discordant monozygotic twin approach.

    Mohandas, Namitha / Loke, Yuk Jing / Hopkins, Stephanie / Mackenzie, Lisa / Bennett, Carmen / Berkovic, Samuel F / Vadlamudi, Lata / Craig, Jeffrey M

    Epigenomics

    2019  Volume 11, Issue 8, Page(s) 951–968

    Abstract: Aim: ...

    Abstract Aim:
    MeSH term(s) Adult ; Aged ; Cohort Studies ; DNA Methylation ; Epigenesis, Genetic ; Epigenomics ; Epilepsy/genetics ; Female ; Genome, Human/genetics ; Humans ; Infant ; Male ; Middle Aged ; Twins, Monozygotic/genetics ; Young Adult
    Language English
    Publishing date 2019-06-05
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 1750-192X
    ISSN (online) 1750-192X
    DOI 10.2217/epi-2018-0136
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Deciphering the role of epigenetics in self-limited epilepsy with centrotemporal spikes.

    Mohandas, Namitha / Loke, Yuk Jing / Mackenzie, Lisa / Bennett, Carmen / Berkovic, Samuel F / Craig, Jeffrey M / Vadlamudi, Lata

    Epilepsy research

    2019  Volume 156, Page(s) 106163

    Abstract: Objective: The aetiology of self-limited epilepsy with centro-temporal spikes (SECTS) remains controversial and a strong genetic basis has long been presumed. The discordant monozygotic twin (MZ) model controls for shared genetic and environmental ... ...

    Abstract Objective: The aetiology of self-limited epilepsy with centro-temporal spikes (SECTS) remains controversial and a strong genetic basis has long been presumed. The discordant monozygotic twin (MZ) model controls for shared genetic and environmental factors, enabling focus on the potential role of the non-shared environment.
    Methods: DNA methylation data was acquired from DNA extracted from three discordant MZ twin pairs, from both new born blood spots before epilepsy onset, and blood samples taken after epilepsy onset. An epigenome-wide analysis was performed, using the Illumina Infinium EPIC array. Differentially methylated regions (DMR) were identified using the bumphunter package in R. Comparative analyses were undertaken at the two different time points as well as a combined analysis independent of time.
    Results: Many of the top DMR-associated genes have previously been described in neurodevelopmental disorders. The LYPD8 gene was associated with a top-ranked DMR both at birth and across the two time points.
    Conclusion: We have demonstrated the novel utility of the longitudinal, discordant MZ twin model, to facilitate a deeper appreciation of the complex neurobiology of SECTS. The genetic architecture of SECTS is complex and is likely to involve an interplay between genes and environment, in part mediated by epigenetics.
    MeSH term(s) Child ; DNA Methylation/genetics ; Environment ; Epigenesis, Genetic/genetics ; Epilepsy/genetics ; Female ; Genome-Wide Association Study ; Humans ; Male ; Twins, Monozygotic/genetics
    Language English
    Publishing date 2019-07-04
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 632939-1
    ISSN 1872-6844 ; 0920-1211
    ISSN (online) 1872-6844
    ISSN 0920-1211
    DOI 10.1016/j.eplepsyres.2019.106163
    Database MEDical Literature Analysis and Retrieval System OnLINE

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