The general organization and structure of the nerve ring, the main mass of central nervous system neuropil, in the small soil nematode Caenorhabditis elegans is described. The nerve ring receives sensory input from the anterior tip of the animal by means of six nerve bundles, all nerve fibers of which have centrally located cell bodies. The anterior sensory structures are classically divided into two types, papillary and amphidial, and are assumed responsible for mechano-and chemoreception, respectively. Papillary fibers enter directly into the nerve ring, whereas amphidial fibers enter the ventral ganglion, a posterior extension of the nerve ring, in a circuitous manner which is not discussed in detail. Of those papillary fibers which project into the nerve ring neuropil, 22 end in easily characterized sensory structures whereas 14 terminate distally near sensory organs but have no function which can be deduced on the basis of comparative morphology. After entering the ring the fibers maintain their identity and do not anastamose with one another. Cell bodies of each papillary sensory neuron have been mapped around the nerve ring. The cephalic musculature is shown to consist of 32 muscle cells which form four longitudinal submedial groups of eight muscles each. Innervation of this musculature occurs wholly within the CNS by means of processes of the muscle cells which are sent centrally. The anterior 16 cephalic muscle cells are innervated by the ring only, in well delimited regions termed muscle plates. The posterior 16 are dually innervated by means of processes sent both to the nerve ring plates and to their nearest medial longtitudinal nerve cord. The nerve ring neuropil is characterized as having fibers containing one of four morphologically distinct vesicle types. Gap junction contacts are observed within the main neuropil involving one of these fiber types and within the muscle plate regions among muscle processes, which do not contain vesicles. An evolutionarily primitive sensory-motor synapse within the nerve ring is described from an identified sensory neuron onto an identified cephalic muscle cell process. Comparisons are made with the nervous system of Ascaris lumbricoides, the only other nematode to be extensively studied, to illustrate the conservativeness of the nemic nervous system.

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We examined the phenotypic variation and clinical genetics in nine families with generalized epilepsy with febrile seizures plus (GEFS+). This genetic epilepsy syndrome with heterogeneous phenotypes was hitherto described in only one family. We obtained genealogical information on 799 individuals and conducted detailed evaluation of 272 individuals. Ninety‐one individuals had a history of seizures and 63 had epilepsy consistent with the GEFS+ syndrome. Epilepsy phenotypes were febrile seizures (FS) in 31, febrile seizures plus (FS+) in 15, FS+ with other seizure types (atonic, myoclonic, absence, or complex partial) in 8, and myoclonic–astatic epilepsy in 9 individuals. Inheritance was autosomal dominant with approximately 60% penetrance. This study confirms and expands the spectrum of GEFS+ and provides new insights into the phenotypic relationships and genetics of FS and the generalized epilepsies of childhood. Moreover, the ability to identify large families with this newly recognized common, childhood‐onset, generalized genetic epilepsy syndrome suggests that it should be a prime target for attempts to identify genes relevant to FS and generalized epilepsy. Ann Neurol 1999;45:75–81

Summary:Purpose: Severe myoclonic epilepsy of infancy (SMEI) is an intractable epilepsy of early childhood of unknown etiology. It is often associated with a family history of seizure disorders, but epilepsy phenotypes have not been well described. We sought to characterize the seizure phenotypes of relatives to better understand to the genetic basis of SMEI.Methods: Probands with SMEI were identified, and systematic family studies were performed. Epilepsy syndromes were characterized in affected family members.Results: Twelve probands with SMEI were identified. Eleven of the 12 probands with SMEI had a family history of seizures, and the twelfth was the result of a consanguineous marriage. We found that 16.7% of full siblings and 8.3% of parents had definite seizures. A total of 39 affected family members was identified. The most common phenotype was febrile seizures in 14, febrile seizures plus in seven, partial epilepsy in two, and there were single individuals with SMEI, myoclonic-astatic epilepsy, Lennox-Gastaut syndrome, and 13 cases with unclassified or unconfirmed seizures.Conclusions: The family history of seizures in SMEI is in keeping with the spectrum of seizure phenotypes seen in generalized epilepsy with febrile seizures plus (GEFS + ). Our findings suggest that SMEI is the most severe phenotype in the GEFS + spectrum.

Summary:Purpose: In families with idiopathic generalized epilepsy (IGE), multiple IGE subsyndromes may occur. We performed a genetic study of IGE families to clarify the genetic relation of the IGE subsyndromes and to improve understanding of the mode(s) of inheritance.Methods: Clinical and genealogic data were obtained on probands with IGE and family members with a history of seizures. Families were grouped according to the probands' IGE subsyndrome: childhood absence epilepsy (CAE), juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME), and IGE with tonic-clonic seizures only (IGE-TCS). The subsyndromes in the relatives were analyzed. Mutations in genes encoding α1 and γ 2 γ -aminobutyric acid (GABA)-receptor subunits, α1 and β1 sodium channel subunits, and the chloride channel CLC-2 were sought.Results: Fifty-five families were studied. 122 (13%) of 937 first-and second-degree relatives had seizures. Phenotypic concordance within families of CAE and JME probands was 28 and 27%, respectively. JAE and IGE-TCS families had a much lower concordance (10 and 13%), and in the JAE group, 31% of relatives had CAE. JME was rare among affected relatives of CAE and JAE probands and vice versa. Mothers were more frequently affected than fathers. No GABA-receptor or sodium or chloride channel gene mutations were identified. Conclusions:The clinical genetic analysis of this set of families suggests that CAE and JAE share a close genetic relation, whereas JME is a more distinct entity. Febrile seizures and epilepsy with unclassified tonic-clonic seizures were frequent in affected relatives of all IGE individuals, perhaps representing a nonspecific susceptibility to seizures. A maternal effect also was seen. Our findings are consistent with an oligogenic model of inheritance. Key Words: Genetics-Idiopathic generalized epilepsy-Family studies.Idiopathic generalized epilepsies (IGEs) are the most common types of epilepsy in childhood and adolescence. Based on the main seizure type and age at onset, four classic subsyndromes exist: childhood absence epilepsy (CAE), juvenile absence epilepsy (JAE), juvenile myoclonic epilepsy (JME), and IGE with tonic-clonic seizures ( Although in rare families, autosomal dominant inheritance occurs (6), clinical genetic data indicate that in the majority of families, a single-gene mode of inheritance is implausible, and complex inheritance involving two or more genes is likely (3)(4)(5)7,8).Studies of families with IGEs show that 5 to 10% of first-degree relatives have seizures but with phenotypic heterogeneity (7,9-11). Two centers have analyzed the IGE subsyndromic patterns in large numbers of families. An Italian study of the families of 46 probands with IGE, excluding JAE, showed that 24% relatives of CAE probands and 44% relatives of JME probands were 467

Summary:Purpose: We analyzed databases on chromosomal anomalies and epilepsy to identify chromosomal regions where abnormalities are associated with clinically recognizable epilepsy syndromes. The expectation was that these regions could then be offered as targets in the search for epilepsy genes.Methods: The cytogenetic program of the Oxford Medical Database, and the PubMed database were used to identify chromosomal aberrations associated with seizures and/or EEG abnormalities. The literature on selected small anomalies thus identified was reviewed from a clinical and electroencephalographic viewpoint, to classify the seizures and syndromes according to the current International League Against Epilepsy (ILAE) classification.Results: There were 400 different chromosomal imbalances described with seizures or EEG abnormalities. Eight chromosomal disorders had a high association with epilepsy. These comprised: the Wolf-Hirschhorn (4p-) syndrome, MillerDieker syndrome (del 17p13.3), Angelman syndrome (del 15q11-q13), the inversion duplication 15 syndrome, terminal deletions of chromosome 1q and 1p, and ring chromosomes 14 and 20. Many other segments had a weaker association with seizures. The poor quality of description of the epileptology in many reports thwarted an attempt to make precise karyotypephenotype correlations.Conclusions: We identified certain chromosomal regions where aberrations had an evident association with seizures, and these regions may be useful targets for gene hunters. New correlations with specific epilepsy syndromes were not revealed. Clinicians should continue to search for small chromosomal abnormalities associated with specific epilepsy syndromes that could provide important clues for finding epilepsy genes, and the epileptology should be rigorously characterized.

Autosomal dominant nocturnal frontal-lobe epilepsy (ADNFLE) is a recently identified partial epilepsy in which two different mutations have been described in the alpha4 subunit of the neuronal nicotinic acetylcholine receptor (CHRNA4). An additional seven families are presented in which ADNFLE is unlinked to the CHRNA4 region on chromosome 20q13.2. Seven additional sporadic cases showed no evidence of defective CHRNA4. One of the families showed evidence of linkage to 15q24, close to the CHRNA3/CHRNA5/CHRNB4 cluster (maximum LOD score of 3.01 with D15S152). Recombination between ADNFLE and CHRNA4, linkage to 15q24 in one family, and exclusion from 15q24 and 20q13.2 in others demonstrate genetic heterogeneity with at least three different genes for ADNFLE. The CHRNA4 gene and the two known CHRNA4 mutations are responsible for only a minority of ADNFLE. Although the ADNFLE phenotype is clinically homogeneous, there appear to be a variety of molecular defects responsible for this disorder, which will provide a challenge to the understanding of the basic mechanism of epileptogenesis.