Association of the APP rs463946 Polymorphism with Epilepsy Risk: A Case-Control Study from Georgia
DOI:
https://doi.org/10.66636/gmj.v1.i2.a110Keywords:
Epilepsy, Amyloid beta-Protein Precursor, Polymorphism, Single Nucleotide, Genetic Predisposition to Disease, Case-Control Studies, Georgia (Republic)Abstract
Background Epilepsy affects approximately 52 million people worldwide and genetic susceptibility plays an important role in epileptogenesis, yet evidence from Caucasus populations remains limited. The amyloid precursor protein (APP) gene is increasingly investigated for its role in neuronal excitability and neurodegeneration. This study evaluated the association between the APP rs463946 polymorphism and epilepsy risk in a Georgian cohort.
Methods In this hospital-based case-control study, 57 adult patients with epilepsy and 50 age- and sex-matched healthy controls were recruited between 1 February and 20 October 2025. Genotyping of rs463946 (C>G) was performed using a TaqMan allelic discrimination assay. Associations were evaluated using chi-square tests and multivariable logistic regression adjusted for age and sex; risk estimates are expressed as odds ratios (ORs) with 95% confidence intervals (CIs). A two-sided p-value < 0.05 defined statistical significance.
Results Genotype distribution differed significantly between patients and controls (χ² = 6.41; p = 0.041). The GG genotype was associated with increased odds of epilepsy compared with GC (OR 2.73; 95% CI 1.12–6.65; p = 0.027); the CC genotype showed a non-significant protective trend (OR 0.65; 95% CI 0.17–2.45; p = 0.53). At the allelic level, the C allele was associated with reduced odds of epilepsy (OR 0.54; 95% CI 0.31–0.94; p = 0.030). Multivariable logistic regression adjusted for age and sex yielded effect estimates consistent with the unadjusted analyses. Control genotypes showed modest deviation from Hardy-Weinberg equilibrium (p = 0.022).
Conclusions The APP rs463946 polymorphism may be associated with epilepsy susceptibility in this Georgian population, with the GG genotype conferring increased risk and the C allele conferring reduced risk. These findings should be interpreted cautiously as hypothesis-generating, pending replication in larger, multicentre studies with comprehensive genetic and phenotypic characterisation.
Keywords epilepsy; amyloid precursor protein; APP gene; rs463946; single nucleotide polymorphism; genetic predisposition; case-control study; Georgia; Caucasus genetics
References
1. World Health Organization. Epilepsy [Internet]. Geneva: WHO; 2024 [cited 2026 Apr 15]. Available from: https://www.who.int/news-room/fact-sheets/detail/epilepsy
2. Beghi E. The epidemiology of epilepsy. Neuroepidemiology. 2020;54(2):185–91. https://doi.org/10.1159/000503831
3. GBD 2021 Epilepsy Collaborators; Feigin VL, Vos T, Nair BS, Hay SI, et al. Global, regional, and national burden of epilepsy, 1990–2021. Lancet Public Health. 2025;10(3):e203–27. https://doi.org/10.1016/S2468-2667(24)00302-5
4. Pandolfo M. Genetics of epilepsy. Semin Neurol. 2011;31(5):506–18. https://doi.org/10.1055/s-0031-1299789
5. Ruggiero SM, Xian J, Helbig I. The current landscape of epilepsy genetics: where are we, and where are we going? Curr Opin Neurol. 2023;36(2):86–94. https://doi.org/10.1097/WCO.0000000000001141
6. Wang J, Lin ZJ, Liu L, Xu HQ, Shi YW, Yi YH, et al. Epilepsy-associated genes: an update. Seizure. 2023;111:225–38. https://doi.org/10.1016/j.seizure.2023.09.021
7. International League Against Epilepsy Consortium on Complex Epilepsies. GWAS meta-analysis of over 29,000 people with epilepsy identifies 26 risk loci and subtype-specific genetic architecture. Nat Genet. 2023;55(9):1471–82. https://doi.org/10.1038/s41588-023-01485-w
8. Zheng H, Koo EH. Biology and pathophysiology of the amyloid precursor protein. Mol Neurodegener. 2011;6:27. https://doi.org/10.1186/1750-1326-6-27
9. Müller UC, Deller T, Korte M. Not just amyloid: physiological functions of the amyloid precursor protein family. Nat Rev Neurosci. 2017;18(5):281–98. https://doi.org/10.1038/nrn.2017.29
10. Palop JJ, Mucke L. Epilepsy and cognitive impairments in Alzheimer disease. Arch Neurol. 2009;66(4):435–40. https://doi.org/10.1001/archneurol.2009.15
11. Vossel KA, Tartaglia MC, Nygaard HB, Zeman AZ, Miller BL. Epileptic activity in Alzheimer disease: causes and clinical relevance. Lancet Neurol. 2017;16(4):311–22. https://doi.org/10.1016/S1474-4422(17)30044-3
12. Lam AD, Sarkis RA, Pellerin KR, Jing J, Dworetzky BA, Hoch DB, et al. Association of epileptiform abnormalities and seizures in Alzheimer disease. Neurology. 2020;95(24):e3289–98. https://doi.org/10.1212/WNL.0000000000010612
13. International League Against Epilepsy Consortium on Complex Epilepsies. Genome-wide mega-analysis identifies 16 loci and highlights diverse biological mechanisms in the common epilepsies. Nat Commun. 2018;9(1):5269. https://doi.org/10.1038/s41467-018-07524-z
14. Lambert JC, Ibrahim-Verbaas CA, Harold D, Naj AC, Sims R, Bellenguez C, et al. Meta-analysis of 74,046 individuals identifies 11 new susceptibility loci for Alzheimer disease. Nat Genet. 2013;45(12):1452–8. https://doi.org/10.1038/ng.2802
15. Little J, Higgins JPT, Ioannidis JPA, Moher D, Gagnon F, von Elm E, et al. Strengthening the reporting of genetic association studies (STREGA): an extension of the STROBE statement. Ann Intern Med. 2009;150(3):206–15. https://doi.org/10.7326/0003-4819-150-3-200902030-00011
16. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4. https://doi.org/10.1001/jama.2013.281053
17. Scheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):512–21. https://doi.org/10.1111/epi.13709
18. Sanchez PE, Zhu L, Verret L, Vossel KA, Orr AG, Cirrito JR, et al. Levetiracetam suppresses neuronal network dysfunction and reverses synaptic and cognitive deficits in an Alzheimer disease model. Proc Natl Acad Sci U S A. 2012;109(42):E2895–903. https://doi.org/10.1073/pnas.1121081109
19. Palop JJ, Mucke L. Amyloid-β-induced neuronal dysfunction in Alzheimer disease: from synapses toward neural networks. Nat Neurosci. 2010;13(7):812–8. https://doi.org/10.1038/nn.2583
20. Dawson GR, Seabrook GR, Zheng H, Smith DW, Graham S, O’Dowd G, et al. Age-related cognitive deficits and synaptic changes in APP-deficient mice. Neuroscience. 1999;90(1):1–13. https://doi.org/10.1016/S0306-4522(98)00410-2
21. Lossin C, Rhodes TH, Desai RR, Vanoye CG, Wang D, Carniciu S, et al. Epilepsy-associated dysfunction in the voltage-gated sodium channel SCN1A. J Neurosci. 2003;23(36):11289–95. https://doi.org/10.1523/JNEUROSCI.23-36-11289.2003
22. Kananura C, Haug K, Sander T, Runge U, Gu W, Hallmann K, et al. A splice-site mutation in GABRG2 associated with childhood absence epilepsy. Arch Neurol. 2002;59(7):1137–41. https://doi.org/10.1001/archneur.59.7.1137
23. Wittke-Thompson JK, Pluzhnikov A, Cox NJ. Rational inferences about departures from Hardy–Weinberg equilibrium. Am J Hum Genet. 2005;76(6):967–86. https://doi.org/10.1086/430507
24. Institute for Health Metrics and Evaluation. GBD 2021 — Epilepsy Level 3 disease factsheet [Internet]. Seattle (WA): IHME, University of Washington; 2024 [cited 2026 Apr 15]. Available from: https://www.healthdata.org/research-analysis/diseases-injuries-risks/factsheets/2021-epilepsy-level-3-disease
25. Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon CS, Dykeman J, et al. Prevalence and incidence of epilepsy: a systematic review and meta-analysis. Neurology. 2017;88(3):296–303. https://doi.org/10.1212/WNL.0000000000003509
26. Thijs RD, Surges R, O’Brien TJ, Sander JW. Epilepsy in adults. Lancet. 2019;393(10172):689–701. https://doi.org/10.1016/S0140-6736(18)32596-0
27. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. A practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475–82. https://doi.org/10.1111/epi.12550
28. Myers CT, Mefford HC. Advancing epilepsy genetics in the genomic era. Genome Med. 2015;7:91. https://doi.org/10.1186/s13073-015-0214-7
29. Kwan P, Schachter SC, Brodie MJ. Drug-resistant epilepsy. N Engl J Med. 2011;365(10):919–26. https://doi.org/10.1056/NEJMra1004418
30. Moshé SL, Perucca E, Ryvlin P, Tomson T. Epilepsy: new advances. Lancet. 2015;385(9971):884–98. https://doi.org/10.1016/S0140-6736(14)60456-6
31. Perucca E, Perucca P, White HS, Wirrell EC. Drug resistance in epilepsy. Lancet Neurol. 2023;22(8):723–34. https://doi.org/10.1016/S1474-4422(23)00151-5
32. Klein P, Trinka E, Friedman D, Galanopoulou AS, Rho JM, Löscher W, et al. New epilepsy therapies in development. Nat Rev Drug Discov. 2024;23(9):682–708. https://doi.org/10.1038/s41573-024-00981-w
33. Beniczky S, Trinka E, Wirrell E, Abdulla F, Al Baradie R, Alonso Vanegas M, et al. Updated classification of epileptic seizures. Epilepsia. 2025;66(6):1804–23. https://doi.org/10.1111/epi.18338
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Shorena Vashadze, Maia Beridze, Nana Kvirkvelia, Keso Gorgiladze, Mariam Kekenadze

This work is licensed under a Creative Commons Attribution 4.0 International License.
This article is published open access under the Creative Commons Attribution 4.0 International (CC BY 4.0) licence.
You are free to: share and adapt the work for any purpose, even commercially.
Conditions: provide appropriate credit to the authors and the Georgian Medical Journal (GMJ), link to the licence, and indicate if changes were made. Do not apply legal terms or technological measures that legally restrict others from doing anything the licence permits.
Licence: creativecommons.org/licenses/by/4.0 · Legal code: creativecommons.org/licenses/by/4.0/legalcode
Third-party material. Images or other content credited to a third party are not covered by CC BY 4.0; permission must be obtained from the rights holder for reuse beyond statutory exceptions.
Authors' rights. Authors retain copyright. First publication rights are granted to GMJ.
Data and code. Where provided, datasets or code may carry their own licences; please follow the licence stated in the article or repository record.




















