Figure 1. Type and distribution within KCNQ2 protein of variants in self-limiting epilepsy vs epileptic encephalopathy Type and distribution within KCNQ2.

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Figure 1. Type and distribution within KCNQ2 protein of variants in self-limiting epilepsy vs epileptic encephalopathy Type and distribution within KCNQ2 protein of variants in self-limiting epilepsy vs epileptic encephalopathy Cartoon of KCNQ2 transmembrane topology, including intracellular amino (N) and carboxy (C) terminals, 6 transmembrane segments (S1–S6), and a pore loop between S5 and S6 which partly enters the membrane. The calmodulin-binding segments within the intracellular C-terminal domain are indicated. (A) Mutations found in BFNE/BFNIS/BFIS cases are distributed among all areas of the polypeptide sequence. Each symbol (n = 98) represents a de novo case or a pedigree, placed at the location within the channel polypeptide corresponding to the sequenced genetic variant. Orange symbols (n = 41) are missense variants. Yellow symbols are all other variant types (i.e., loss of start codon, insertions or deletions changing frame, and premature stop codon). Encircled regions, with the exception of the S4 helix, do not appear enriched in missense variants. (B) In patients with KCNQ2 encephalopathy, mutations are nearly always single nucleotide substitutions resulting in a single amino acid change. In one instance (cases 19 and 20 of this series, 2 identical twins), a single amino acid is deleted within an α-helix. Each red sphere represents an unrelated case. Encircled are the 4 hot spots for variants leading to epileptic encephalopathy: the S4 voltage-sensor, the pore, the proximal C-terminal domain that binds phosphatidylinositol 4,5-bisphosphate (PIP2) and calmodulin (CaM A), and the more distal domain which binds calmodulin (CaM B). Variant details for (A) are listed in table e-2; variant details for (B) are listed in table e-3. John J. Millichap et al. Neurol Genet 2016;2:e96 © 2016 American Academy of Neurology