Benign familial neonatal seizures (BFNS) is a condition characterized by recurrent seizures in newborn babies. The seizures begin around day 3 of life and usually go away within 1 to 4 months. The seizures can involve only one side of the brain (focal seizures) or both sides (generalized seizures). This condition is often associated with generalized tonic-clonic seizures (also known as grand mal seizures). This type of seizure involves both sides of the brain and affects the entire body, causing a combination of seizure types: tonic seizures, which are characterized by uncontrolled muscle stiffness and rigidity, and clonic seizures, which are characterized by uncontrolled jerking of the muscles. Seizure episodes in infants with BFNS typically begin with tonic stiffness and pauses in breathing (apnea) followed by clonic jerking.

A test called an electroencephalogram (EEG) is used to measure the electrical activity of the brain. Abnormalities on an EEG test, measured during no seizure activity, can indicate a risk for seizures. However, infants with BFNS usually have normal EEG readings. In some affected individuals, the EEG shows a specific abnormality called the theta pointu alternant pattern. By age 2, most affected individuals who had EEG abnormalities have a normal EEG reading.

Typically, seizures are the only symptom of BFNS, and most people with this condition develop normally. However, some affected individuals develop intellectual disability that becomes noticeable in early childhood. A small percentage of people with BFNS also have a condition called myokymia, which is an involuntary rippling movement of the muscles. In addition, in about 15 percent of people with BFNS, recurrent seizures (epilepsy) will come back later in life after the seizures associated with BFNS have gone away. The age that epilepsy begins is variable.

Mutations in two genes, KCNQ2 and KCNQ3, have been found to cause BFNS. Mutations in the KCNQ2 gene are a much more common cause of the condition than mutations in the KCNQ3 gene.

The KCNQ2 and KCNQ3 genes provide instructions for making proteins that interact to form potassium channels. Potassium channels, which transport positively charged atoms (ions) of potassium into and out of cells, play a key role in a cell's ability to generate and transmit electrical signals.

Channels made with the KCNQ2 and KCNQ3 proteins are active in nerve cells (neurons) in the brain, where they transport potassium ions out of cells. These channels transmit a particular type of electrical signal called the M-current, which prevents the neuron from continuing to send signals to other neurons. The M-current ensures that the neuron is not constantly active, or excitable.

Mutations in the KCNQ2 or KCNQ3 gene result in a reduced or altered M-current, which leads to excessive excitability of neurons. Seizures develop when neurons in the brain are abnormally excited. It is unclear why the seizures stop around the age of 4 months. It has been suggested that potassium channels formed from the KCNQ2 and KCNQ3 proteins play a major role in preventing excessive excitability of neurons in newborns, but other mechanisms develop during infancy.

About 70 percent of people with BFNS have a mutation in either the KCNQ2 or the KCNQ3 gene. Researchers are working to identify other gene mutations involved in this condition.

Normal Function

The KCNQ2 gene belongs to a large family of genes that provide instructions for making potassium channels. These channels, which transport positively charged atoms (ions) of potassium into and out of cells, play a key role in a cell's ability to generate and transmit electrical signals.

The specific function of a potassium channel depends on its protein components and its location in the body. Channels made with the KCNQ2 protein are active in nerve cells (neurons) in the brain, where they transport potassium ions out of cells. These channels transmit a particular type of electrical signal called the M-current, which prevents the neuron from continuing to send signals to other neurons. The M-current ensures that the neuron is not constantly active, or excitable.

Potassium channels are made up of several protein components (subunits). Each channel contains four alpha subunits that form the hole (pore) through which potassium ions move. Four alpha subunits from the KCNQ2 gene can form a channel. However, the KCNQ2 alpha subunits can also interact with alpha subunits produced from the KCNQ3 gene to form a functional potassium channel, and these channels transmit a much stronger M-current.

Health Conditions Related to Genetic Changes

Benign familial neonatal seizures

A mutation in the KCNQ2 gene has been identified in most people with benign familial neonatal seizures (BFNS), a condition characterized by recurrent seizures (epilepsy) in newborn babies. The seizures begin around day 3 of life and usually go away within 1 to 4 months. More than 60 mutations in the KCNQ2 gene have been identified in families with this condition. Sometimes, the mutated protein never gets to the cell surface to form a channel, or the channel may be located in the wrong part of the neuron. Alternatively, the channel formed from the mutated protein may not function properly. As a result of these mutations, the M-current is reduced or altered, which leads to excessive excitability of neurons. Researchers believe that a reduction of the M-current by 25 percent is enough to cause BFNS. Seizures develop when neurons in the brain are abnormally excited. It is unclear why the seizures stop around the age of 4 months. It has been suggested that potassium channels formed from the KCNQ2 and KCNQ3 proteins play a major role in preventing excessive excitability of neurons in newborns, but other mechanisms that prevent constant neuron activity develop during infancy.

Other disorders

Mutations in the KCNQ2 gene are also involved in early-onset epileptic encephalopathy, a more severe condition than BFNS (described above) characterized by epilepsy and profound intellectual disability. The seizures begin in the first weeks of life and typically show little response to treatment. They usually go away in a few months to a few years but can return later in childhood. Most affected individuals are unable to talk, and they have low muscle tone (hypotonia) or very stiff muscles, causing difficulty with movement.

It has been suggested that KCNQ2 gene mutations that cause early-onset epileptic encephalopathy lead to production of an abnormal KCNQ2 protein that can still bind to normal subunits to form potassium channels. However, the presence of the abnormal KCNQ2 subunit keeps the channels from functioning, which likely leads to a severe reduction of the M-current. The resulting over-excitability of neurons can lead to seizures and brain dysfunction (encephalopathy).

Early-onset epileptic encephalopathy caused by KCNQ2 gene mutations resembles a condition called Ohtahara syndrome; however, seizures do not usually subside in people with Ohtahara syndrome. It is unclear whether the epileptic encephalopathy caused by KCNQ2 gene mutations is a form of Ohtahara syndrome or a separate disorder.

Other Names for This Gene

• BFNC
• BFNS1
• EBN
• EBN1
• EIEE7
• ENB1
• HNSPC
• KCNA11
• KCNQ2_HUMAN
• KQT-like 2
• KV7.2
• KVEBN1
• potassium channel, voltage gated KQT-like subfamily Q, member 2
• potassium voltage-gated channel subfamily KQT member 2
• potassium voltage-gated channel, KQT-like subfamily, member 2
• voltage-gated potassium channel subunit Kv7.2

Genomic Location

Normal Function

The KCNQ3 gene belongs to a large family of genes that provide instructions for making potassium channels. These channels, which transport positively charged atoms (ions) of potassium into and out of cells, play a key role in a cell's ability to generate and transmit electrical signals.

The specific function of a potassium channel depends on its protein components and its location in the body. Channels made with the KCNQ3 protein are active in nerve cells (neurons) in the brain, where they transport potassium ions out of cells. These channels transmit a particular type of electrical signal called the M-current, which prevents the neuron from continuing to send signals to other neurons. The M-current ensures that the neuron is not constantly active, or excitable.

Potassium channels are made up of several protein components (subunits). Each channel contains four alpha subunits that form the hole (pore) through which potassium ions move. Four alpha subunits from the KCNQ3 gene can form a channel. However, the KCNQ3 alpha subunits can also interact with alpha subunits from the KCNQ2 gene to form a functional potassium channel, and these channels transmit a much stronger M-current.

Health Conditions Related to Genetic Changes

Benign familial neonatal seizures

A mutation in the KCNQ3 gene has been identified in some people with benign familial neonatal seizures (BFNS), a condition characterized by recurrent seizures in newborn babies. The seizures begin around day 3 of life and usually go away within 1 to 4 months. At least three mutations have been identified in people with this condition, and these mutations change single protein building blocks (amino acids) in the KCNQ3 protein. As a result of these mutations, the M-current is reduced. Researchers believe that a reduction of the current by 25 percent is enough to cause BFNS. A reduced M-current leads to excessive excitability of neurons, which is known to cause seizures. It is unclear why the seizures stop around the age of 4 months. It has been suggested that potassium channels formed from the KCNQ2 and KCNQ3 proteins play a major role in preventing excessive excitability of neurons in newborns, but other mechanisms develop during infancy.

Other Names for This Gene

• BFNC2
• EBN2
• KCNQ3_HUMAN
• KV7.3
• potassium channel subunit alpha KvLQT3
• potassium channel, voltage gated KQT-like subfamily Q, member 3
• potassium channel, voltage-gated, subfamily Q, member 3
• potassium voltage-gated channel subfamily KQT member 3
• potassium voltage-gated channel, KQT-like subfamily, member 3
• voltage-gated potassium channel subunit Kv7.3

Genomic Location

Benign familial neonatal seizures occurs in approximately 1 in 100,000 newborns.

This condition is inherited in an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder. In most cases, an affected person inherits the mutation from one affected parent. A few cases result from new mutations in the KCNQ2 gene. These cases occur in people with no history of benign familial neonatal seizures in their family.