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Epilepsia. 2018 Mar;59(3):679-689. doi: 10.1111/epi.14003. Epub 2018 Jan 28.

PCDH19-related epilepsy is associated with a broad neurodevelopmental spectrum.

Author information

Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA.
Neurogenetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA.
Department of Neurology, Division of Epilepsy, University of California, San Francisco, San Francisco, CA, USA.
Department of Neurology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.
F. M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA.

Erratum in



To characterize the features associated with PCDH19-related epilepsy, also known as "female-limited epilepsy."


We analyzed data from participants enrolled in the PCDH19 Registry, focusing on the seizure-related, developmental, neurobehavioral, and sleep-related features. We evaluated variants for pathogenicity based on previous reports, population databases, and in silico predictions, and included individuals with pathogenic or potentially pathogenic variants. We performed a retrospective analysis of medical records and administered a targeted questionnaire to characterize current or past features in probands and genotype-positive family members.


We included 38 individuals with pathogenic or potentially pathogenic variants in PCDH19: 21 de novo, 5 maternally inherited, 7 paternally inherited, and 5 unknown. All 38 had epilepsy; seizure burden varied, but typical features of clustering of seizures and association with fever were present. Thirty individuals had intellectual disability (ID), with a wide range of severity reported; notably, 8/38 (22%) had average intellect. Behavioral and sleep dysregulation were prominent, in 29/38 (76%) and 20/38 (53%), respectively. Autistic features were present in 22/38 (58%), of whom 12 had a formal diagnosis of autism spectrum disorder. We had additional data from 5 genotype-positive mothers, all with average intellect and 3 with epilepsy, and from 1 genotype-positive father.


Our series represents a robust cohort with carefully curated PCDH19 variants. We observed seizures as a core feature with a range of seizure types and severity. Whereas the majority of individuals had ID, we highlight the possibility of average intellect in the setting of PCDH19-related epilepsy. We also note the high prevalence and severity of neurobehavioral phenotypes associated with likely pathogenic variants in PCDH19. Sleep dysregulation was also a major area of concern. Our data emphasize the importance of appropriate referrals for formal neuropsychological evaluations as well as the need for formal prospective studies to characterize the PCDH19-related neurodevelopmental syndrome in children and their genotype-positive parents.


PCDH19 ; autism spectrum disorder; female-limited epilepsy; seizure; sleep disorder

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