Mitochondrial epilepsy: a cross-sectional nationwide Italian survey

Chiara Ticci, Federico Sicca, Anna Ardissone, Enrico Bertini, Valerio Carelli, Daria Diodato, Lidia Di Vito, Massimiliano Filosto, Chiara La Morgia, Costanza Lamperti, Diego Martinelli, Isabella Moroni, Olimpia Musumeci, Daniele Orsucci, Elia Pancheri, Lorenzo Peverelli, Guido Primiano, Anna Rubegni, Serenella Servidei, Gabriele SicilianoCostanza Simoncini, Paola Tonin, Antonio Toscano, Michelangelo Mancuso, Filippo M Santorelli

Research output: Contribution to journalArticlepeer-review


Many aspects of epilepsy in mitochondrial disorders (MDs) need to be further clarified. To this aim, we explored retrospectively a cohort of individuals with MDs querying the "Nationwide Italian Collaborative Network of Mitochondrial Diseases" (NICNMD) database (1467 patients included since 2010 to December 2016). We collected information on age at epilepsy onset, seizure type and frequency, genetic findings, and antiepileptic drugs (AEDs). At the time of our survey, 147/1467 (10%) patients in the NICNMD database had epilepsy. Complete information was available only for 98 patients, 52 males and 46 females, aged 5-92 years (mean age 40.4 ± 18.4; 14/98 children/teenagers and 84 adults). Epilepsy was the presenting feature of MD in 46/98 (47%) individuals, with onset at a median age of 19 years (range, 0.2-68; < 3 years in 14/97 (14%), 3-19 years in 36/97 (37%), > 19 years in 47/97 (49%)). Moreover, 91/98 patients (93%) displayed multiple seizures, with daily or weekly frequency in 25/91 (28%). Interictal EEG was abnormal in 70/78 (90%) patients, displaying abnormal background (47/70; 67%) and/or interictal paroxysms (53/70; 76%). Eighty of 90 patients (89%) displayed a 50-100% reduction of seizures on AEDs; levetiracetam was the most commonly used. Forty-one patients (42%) carried the m.3243A>G mutation, 16 (16%) the m.8344A>G, and 9 (9%) nuclear DNA (nDNA) mutations. Individuals with early-onset seizures mainly carried nDNA mutations and had a more severe epilepsy phenotype, higher seizure frequency, and disorganized background EEG activity. A better definition of epilepsy in MDs may foster the diagnostic workup, management, and treatment of affected patients, and allow more homogeneous patient stratification.

Original languageEnglish
Pages (from-to)87-96
Number of pages10
Issue number2
Publication statusPublished - Apr 2020


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