Increased HCN1 activity in human excitatory neurons drives excessive network bursting in Dravet syndrome

Dravet syndrome (DS) is a severe childhood epilepsy caused by mutations of the sodium channel NaV1.1. These mutations are thought to compromise the ability of inhibitory interneurons to regulate network activity, leading to seizure events. However, standard treatments to restore inhibition have limited efficacy, suggesting the existence of additional pathological mechanisms. Here, we use hiPSC-derived neuronal networks containing both excitatory and inhibitory neurons to show that excessive bursting activity in DS cultures is driven by excitatory neurons. This rise in bursting frequency is caused by the increased expression of HCN1 “pacemaker” channels in excitatory neurons, and bursting activity can be normalised using a channel blocker. With this work, we propose a new pathophysiological mechanism in DS and identify HCN1 as a novel therapeutic target.