Homozygous SCN1B variants causing early infantile epileptic encephalopathy 52 affect voltage-gated sodium channel function

We identified nine patients from four unrelated families harboring three biallelic variants in SCN1B (NM_001037.5: c.136C>T; p.[Arg46Cys], c.178C>T; p.[Arg60Cys], and c.472G>A; p.[Val158Met]). All subjects presented with early infantile epileptic encephalopathy 52 (EIEE52), a rare, severe developmental and epileptic encephalopathy featuring infantile onset refractory seizures followed by developmental stagnation or regression. Because SCN1B influences neuronal excitability through modulation of voltage-gated sodium (NaV) channel function, we examined the effects of human SCN1BR46C (β1R46C), SCN1BR60C (β1R60C), and SCN1BV158M (β1V158M) on the three predominant brain NaV channel subtypes NaV1.1 (SCN1A), NaV1.2 (SCN2A), and NaV1.6 (SCN8A). We observed a shift toward more depolarizing potentials of conductance–voltage relationships (NaV1.2/β1R46C, NaV1.2/β1R60C, NaV1.6/β1R46C, NaV1.6/β1R60C, and NaV1.6/β1V158M) and channel availability (NaV1.1/β1R46C, NaV1.1/β1V158M, NaV1.2/β1R46C, NaV1.2/β1R60C, and NaV1.6/β1V158M), and detected a slower recovery from fast inactivation for NaV1.1/β1V158M. Combined with modeling data indicating perturbation-induced structural changes in β1, these results suggest that the SCN1B variants reported here can disrupt normal NaV channel function in the brain, which may contribute to EIEE52.