Genetic Epilepsy
Gene: RYR3 Amber List (moderate evidence)Comment on mode of inheritance: Limited by clingen for AD epilepsy, not considered for AR by ClinGen.
All of the recessive DEE patients are from the 2 Chinese papers PMID 39840699, PMID: 29667327. Amber for AR DEECreated: 24 Apr 2026, 1:37 p.m. | Last Modified: 24 Apr 2026, 1:37 p.m.
Panel Version: 1.410
I don't know
Dominant DEE:
4 dominant DEE reports, 3 of which are present in gnomad, so most of the dominant reports are not compelling.
PMID: 39220738 2024 - 1x de novo het T3648M. tis variant has 12 hets in gnomad v4
PMID 39840699 2025 - the 1 de novo patient had p.Glu4316Gly which has 3 hets in gnomad v4
PMID: 25262651 2014 - Ile3202del is absent from gnomad, Asp4702Asn has 10 hets in gnomad
Recessive DEE
7 recessive DEE cases all with chet missense PMID 39840699, PMID: 29667327. No functional or segregation evidence, the missense are spread throughout the gene. Some of the missense have homs in gnomad: p.Lys916Thr 2 homs, p.Asp4155Asn 1 hom, p.Glu4455Lys 1 hom.
PMID: 31230720 1 patient compound het for Asp667Gly and c.11164+1G>A with arthrogryposis, dev delay, ID, some seizure like episode over 4 months that disappeared without treatment. So different to the phenotype reported in the other papers
DECIPHER also has a possibly recessive DEE case but both missense have many homs in gnomad p.Asn2604Lys, p.Pro3085Arg.
Note Clingens DEE limited review is for AD only, they have not looked at the recessive DEE. Recessive myopathy is reviewed as disputed by clingen.
RED for dominant DEE, amber/green for recessive DEECreated: 24 Apr 2026, 12:24 p.m. | Last Modified: 24 Apr 2026, 12:24 p.m.
Panel Version: 1.409
Mode of inheritance
BIALLELIC, autosomal or pseudoautosomal
Phenotypes
Developmental and epileptic encephalopathy MONDO:0100620, RYR3-related
Publications
Green List (high evidence)
PMID 39840699 2025 - 7x unrelated indiv with partial seizures or secondary generalised tonic-clonic seizures - 1 de novo het, 6 chet
PMID: 39220738 2024 - 1x de novo het T3648M. 10m infantile spasm syndrome and DEE
PMID: 25262651 2014 - 2x de novo; G14104A (infantile spasms at 6m), c.9603_9605del (multiple seizures per day 8.5m)
PMID: 29667327 2018 - 1x chet with West syndrome (classic form early infantile encephalopathy) - ClinGen did not weight this paper for review
2 internal VCGS siblings with DEE have also been observed with the same compound heterozygous variants. Carrier parents not affected.Created: 15 Apr 2026, 4:28 p.m. | Last Modified: 15 Apr 2026, 4:28 p.m.
Panel Version: 1.408
Mode of inheritance
BOTH monoallelic and biallelic, autosomal or pseudoautosomal
Phenotypes
undetermined early-onset epileptic encephalopathy (MONDO:0018614)
Publications
I don't know
Epilepsy - mild to severe phenotypes reported with both de novo heterozygous (3) and biallelic (7). However, no supporting functional evidence for a gene-disease association
PMID: 39840699
Families: 7 families (7 unrelated)
Patients: 7 patients
Phenotype: partial seizures, febrile seizures, normal brain MRI
Mode of inheritance: Monoallelic and biallelic (1 de novo heterozygous; 6 compound heterozygous inherited from asymptomatic parents)
Variants: c.12947A>G (missense); c.2747A>C (missense); c.12514G>A (missense); c.3697G>A (missense); c.9994A>G (missense); c.4936G>A (missense); c.10859G>T (missense); c.9917A>G (missense); c.12463G>A (missense); c.11386G>C (missense); c.13690G>C (missense); c.11798C>G (missense); c.13363G>A (missense)
Population Frequency: gnomAD: 0–0.00022 (overall); up to 0.0031 in East Asian controls
Functional: protein modeling (I‑TASSER, PyMOL) and stability predictions (I‑Mutant)
PMID: 39220738, 25262651, 29667327
Families: 4 families (4 unrelated)
Patients: 4 patients
Phenotype: infantile spasm syndrome, developmental regression, multifocal EEG discharges, intractable seizures
Mode of inheritance: Monoallelic (de novo heterozygous; also 1 AR compound heterozygote reported)Created: 13 Oct 2025, 8:29 a.m. | Last Modified: 13 Oct 2025, 8:29 a.m.
Panel Version: 1.242
2 probands with different de novo missense variants in a single publication. Classified as Limited by ClinGen Epilepsy GCEP - Classification - 06/19/2018.
Sources: ClinGenCreated: 11 Nov 2021, 6:48 p.m.
Mode of inheritance
BOTH monoallelic and biallelic, autosomal or pseudoautosomal
Phenotypes
undetermined early-onset epileptic encephalopathy (MONDO:0018614)
Publications
Red List (low evidence)
LIMITED by ClinGEN for epilepsy.Created: 27 Feb 2025, 4:14 p.m. | Last Modified: 27 Feb 2025, 4:14 p.m.
Panel Version: 1.109
One family reported with nemaline myopathy and other cases reported as part of large fetal akinesia/arthrogryposis discovery cohorts reporting multiple novel gene candidates.
Sources: Expert listCreated: 15 Jun 2020, 10:29 a.m.
Mode of inheritance
BIALLELIC, autosomal or pseudoautosomal
Phenotypes
Developmental and epileptic encephalopathy MONDO:0100062, RYR3-related
Publications
Mode of inheritance for gene: RYR3 was changed from MONOALLELIC, autosomal or pseudoautosomal, NOT imprinted to BOTH monoallelic and biallelic, autosomal or pseudoautosomal
Publications for gene: RYR3 were set to 25262651
Gene: ryr3 has been classified as Amber List (Moderate Evidence).
Phenotypes for gene: RYR3 were changed from undetermined early-onset epileptic encephalopathy (MONDO:0018614) to Developmental and epileptic encephalopathy MONDO:0100062, RYR3-related
Gene: ryr3 has been classified as Red List (Low Evidence).
Gene: ryr3 has been classified as Amber List (Moderate Evidence).
Gene: ryr3 has been classified as Amber List (Moderate Evidence).
gene: RYR3 was added gene: RYR3 was added to Genetic Epilepsy. Sources: ClinGen Mode of inheritance for gene: RYR3 was set to MONOALLELIC, autosomal or pseudoautosomal, NOT imprinted Publications for gene: RYR3 were set to 25262651 Phenotypes for gene: RYR3 were set to undetermined early-onset epileptic encephalopathy (MONDO:0018614) Review for gene: RYR3 was set to AMBER
If promoting or demoting a gene, please provide comments to justify a decision to move it.
Genes included in a Genomics England gene panel for a rare disease category (green list) should fit the criteria A-E outlined below.
These guidelines were developed as a combination of the ClinGen DEFINITIVE evidence for a causal role of the gene in the disease(a), and the Developmental Disorder Genotype-Phenotype (DDG2P) CONFIRMED DD Gene evidence level(b) (please see the original references provided below for full details). These help provide a guideline for expert reviewers when assessing whether a gene should be on the green or the red list of a panel.
A. There are plausible disease-causing mutations(i) within, affecting or encompassing an interpretable functional region(ii) of this gene identified in multiple (>3) unrelated cases/families with the phenotype(iii).
OR
B. There are plausible disease-causing mutations(i) within, affecting or encompassing cis-regulatory elements convincingly affecting the expression of a single gene identified in multiple (>3) unrelated cases/families with the phenotype(iii).
OR
C. As definitions A or B but in 2 or 3 unrelated cases/families with the phenotype, with the addition of convincing bioinformatic or functional evidence of causation e.g. known inborn error of metabolism with mutation in orthologous gene which is known to have the relevant deficient enzymatic activity in other species; existence of an animal model which recapitulates the human phenotype.
AND
D. Evidence indicates that disease-causing mutations follow a Mendelian pattern of causation appropriate for reporting in a diagnostic setting(iv).
AND
E. No convincing evidence exists or has emerged that contradicts the role of the gene in the specified phenotype.
(i)Plausible disease-causing mutations: Recurrent de novo mutations convincingly affecting gene function. Rare, fully-penetrant mutations - relevant genotype never, or very rarely, seen in controls. (ii) Interpretable functional region: ORF in protein coding genes miRNA stem or loop. (iii) Phenotype: the rare disease category, as described in the eligibility statement. (iv) Intermediate penetrance genes should not be included.
It’s assumed that loss-of-function variants in this gene can cause the disease/phenotype unless an exception to this rule is known. We would like to collect information regarding exceptions. An example exception is the PCSK9 gene, where loss-of-function variants are not relevant for a hypercholesterolemia phenotype as they are associated with increased LDL-cholesterol uptake via LDLR (PMID: 25911073).
If a curated set of known-pathogenic variants is available for this gene-phenotype, please contact us at panelapp@genomicsengland.co.uk
We classify loss-of-function variants as those with the following Sequence Ontology (SO) terms:
Term descriptions can be found on the PanelApp homepage and Ensembl.
If you are submitting this evaluation on behalf of a clinical laboratory please indicate whether you report variants in this gene as part of your current diagnostic practice by checking the box
Standardised terms were used to represent the gene-disease mode of inheritance, and were mapped to commonly used terms from the different sources. Below each of the terms is described, along with the equivalent commonly-used terms.
A variant on one allele of this gene can cause the disease, and imprinting has not been implicated.
A variant on the paternally-inherited allele of this gene can cause the disease, if the alternate allele is imprinted (function muted).
A variant on the maternally-inherited allele of this gene can cause the disease, if the alternate allele is imprinted (function muted).
A variant on one allele of this gene can cause the disease. This is the default used for autosomal dominant mode of inheritance where no knowledge of the imprinting status of the gene required to cause the disease is known. Mapped to the following commonly used terms from different sources: autosomal dominant, dominant, AD, DOMINANT.
A variant on both alleles of this gene is required to cause the disease. Mapped to the following commonly used terms from different sources: autosomal recessive, recessive, AR, RECESSIVE.
The disease can be caused by a variant on one or both alleles of this gene. Mapped to the following commonly used terms from different sources: autosomal recessive or autosomal dominant, recessive or dominant, AR/AD, AD/AR, DOMINANT/RECESSIVE, RECESSIVE/DOMINANT.
A variant on one allele of this gene can cause the disease, however a variant on both alleles of this gene can result in a more severe form of the disease/phenotype.
A variant in this gene can cause the disease in males as they have one X-chromosome allele, whereas a variant on both X-chromosome alleles is required to cause the disease in females. Mapped to the following commonly used term from different sources: X-linked recessive.
A variant in this gene can cause the disease in males as they have one X-chromosome allele. A variant on one allele of this gene may also cause the disease in females, though the disease/phenotype may be less severe and may have a later-onset than is seen in males. X-linked inactivation and mosaicism in different tissues complicate whether a female presents with the disease, and can change over their lifetime. This term is the default setting used for X-linked genes, where it is not known definitately whether females require a variant on each allele of this gene in order to be affected. Mapped to the following commonly used terms from different sources: X-linked dominant, x-linked, X-LINKED, X-linked.
The gene is in the mitochondrial genome and variants within this can cause this disease, maternally inherited. Mapped to the following commonly used term from different sources: Mitochondrial.
Mapped to the following commonly used terms from different sources: Unknown, NA, information not provided.
For example, if the mode of inheritance is digenic, please indicate this in the comments and which other gene is involved.