Voltage-gated sodium channels initiate the rapid upstroke of action potentials in many excitable tissues. Mutations within intracellular C-terminal sequences of specific channels underlie a diverse set of channelopathies, including cardiac arrhythmias and epilepsy syndromes. The three-dimensional structure of the C-terminal residues 1777-1882 of the human Na V 1.2 voltagegated sodium channel has been determined in solution by NMR spectroscopy at pH 7.4 and 290.5 K. The ordered structure extends from residues Leu-1790 to Glu-1868 and is composed of four ␣-helices separated by two short anti-parallel -strands; a less well defined helical region extends from residue Ser-1869 to Arg-1882, and a disordered N-terminal region encompasses residues 1777-1789. Although the structure has the overall architecture of a paired EF-hand domain, the Na V 1. 2؉ titration also were performed for the Na V 1.5 (1773-1878) isoform, demonstrating similar secondary structure architecture and the absence of Ca 2؉ binding by the EFhand loops. Clinically significant mutations identified in the C-terminal region of Na V 1 sodium channels cluster in the helix I-IV interface and the helix II-III interhelical segment or in helices III and IV of the Na V 1.2 (1777-1882) structure.Voltage-gated sodium channels (VGSCs) 5 are molecular assemblies that span the plasma membrane of excitable cells and conduct sodium current selectively in response to depolarizing stimuli. Mutations in VGSCs underlie a variety of diseases, including the cardiac arrhythmogenic Long-QT3 and Brugada syndromes (1, 2) and neurological syndromes, such as epilepsy (3, 4).Known components of VGSCs include a pore-forming ␣ subunit, auxiliary  subunits, and associated modulating proteins, such as calmodulin (5, 6). The ␣ subunit is composed of four homologous six-transmembrane helical domains connected by inter-domain linkers and N-terminal and C-terminal cytoplasmic regions. Specific ␣ subunit isoforms are expressed differentially in skeletal muscle (Na V 1.4), cardiac muscle (Na V 1.5) and the nervous system (Na V 1.1, Na V 1.2, Na V 1.3, splice variants of Na V 1.5, and Na V 1.6-Na V 1.9) and control the rapid upstroke of action potentials (7). VGSC activity is characterized by two open states and several inactivated states (8). Kinetics of channel inactivation occur on timescales ranging from milliseconds to seconds and determine multiple aspects of action potentials (9, 10). The molecular mechanisms of VGSC inactivation are complex and involve the ␣ subunit, the  subunits, and calmodulin (11-13). Specific contributions to ␣ subunit inactivation have been localized to interhelical intra-domain regions (14 -16), the linker region between domains III-IV, which forms the pore occluding inactivation gate (17,18), and the C-terminal cytoplasmic domain (CTD) (19 -21).Specific disease-causing mutations within the CTD affect channel function by altering kinetics of channel inactivation (22). The CTD is predicted by sequence analysis (23, 24) and homology modeling (25-27) to c...