title: COL4A1 mutations should not be a contraindication for epilepsy surgery.
abstract: OBJECTIVE
  We describe the first case in the literature of complication-free epilepsy surgery in a paediatric patient with collagen type IV alpha 1 (COL4A1) mutation.
  
  
  METHODS
  This is a case report.
  
  
  RESULTS
  COL4A1 mutations disrupt the integrity of vascular basement membranes, so predisposing to a broad spectrum of disorders including periventricular leucomalacia, haemorrhagic stroke, aneurysm formation, epilepsy and developmental delay. Intracranial haemorrhage is reported and may be recurrent or associated with trauma and anticoagulant therapy. Children have an increased risk of stroke with general anaesthesia. A 6-year-old girl, COL4A1 mutation positive, had drug-resistant epilepsy, cerebral palsy and developmental delay. Following presurgical evaluation, she was a candidate for corpus callosotomy. Previous general anaesthesia had been uncomplicated. Preoperative full blood count and coagulation studies were normal. Perioperatively, normotension was maintained, and anticoagulation was avoided. A complete corpus callosotomy was performed with no intracranial haemorrhage or other perioperative complications.
  
  
  CONCLUSIONS
  Although there is an increased risk of intracranial haemorrhages in COL4A1 patients, this is not clearly quantifiable. There are minimal data in the literature on the subject. COL4A1 mutations should not be a contraindication for presurgical evaluation. Each patient should be individually evaluated and assessed, risks and benefits were carefully weighed, and informed decisions were reached after thorough discussions with patients and families.
authors.affiliation: Paediatric Neurology Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK, apostolos.papandreou@gosh.nhs.uk.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Papandreou
authors.forename: Martin M
authors.initials: MM
authors.lastname: Tisdall
authors.forename: W K
authors.initials: WK
authors.lastname: Chong
authors.forename: J Helen
authors.initials: JH
authors.lastname: Cross
authors.forename: William F
authors.initials: WF
authors.lastname: Harkness
authors.forename: Sophia M
authors.initials: SM
authors.lastname: Varadkar
mesh_terms: D001921:Brain / Q000473:pathology; D002648:Child; D024141:Collagen Type IV / Q000235:genetics*; D004827:Epilepsy / Q000235:genetics* / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009154:Mutation / Q000235:genetics*
chemical_list: C547475:COL4A1 protein, human; D024141:Collagen Type IV