35Mutations in KCNQ2, which encodes a pore-forming K + channel subunit responsible for 36 neuronal M-current, cause neonatal epileptic encephalopathy, a complex disorder presenting 37 with severe early-onset seizures and impaired neurodevelopment. The condition is exceptionally 38 difficult to treat, partially because the effects of KCNQ2 mutations on the development and 39 function of human neurons are unknown. Here, we used induced pluripotent stem cells and gene 40 editing to establish a disease model, and measured the functional properties of patient-derived 41 neurons using electrophysiological and optical approaches. We find that while patient-derived 42 excitatory neurons exhibit reduced M-current early, they develop intrinsic and network 43 hyperexcitability progressively. This hyperexcitability is associated with faster action potential 44 repolarization, larger afterhyperpolarization, and a functional enhancement of large conductance 45 Ca 2+ -activated K + (BK) channels. These properties facilitate a burst-suppression firing pattern 46 that is reminiscent of the interictal electroencephalography pattern in patients. Importantly, we 47 were able to phenocopy these excitability features in control neurons only by chronic but not 48 acute pharmacological inhibition of M-current. Our findings suggest that dyshomeostatic 49 mechanisms compound KCNQ2 loss-of-function and lead to alterations in the 50 neurodevelopmental trajectory of patient-derived neurons. Our work has therapeutic implications 51 in explaining why KCNQ2 agonists are not beneficial unless started at an early disease stage. 52 53 KEYWORDS 54 KCNQ2, Kv7.2, epileptic encephalopathy, human induced pluripotent stem cells, excitatory 55 neurons, M-current, epilepsy, dyshomeostatic and homeostatic plasticity, burst firing, disease 56 modeling 57 58 59 60 61 62 63 64 65 66 92However, some variants associated with severe clinical phenotypes produce gain-of-function 93 effects (23,24). Enhanced K + conductance, specifically in the AIS, could hyperpolarize the AIS 94 membrane, decreasing steady state inactivation for sodium channels. This would increase the 95 rate of action potential activation and action potential repolarization (25). 96 The mechanisms by which developmental expression of KCNQ2 channels impact 97 neuronal excitability are not clear. What remains elusive is how the defects in M-current affect 98 the electrophysiological properties of human neurons leading to impaired neurodevelopment. 99 The use of patient-specific induced pluripotent stem cell (iPSC) technology has enabled a new 100 4 approach for elucidating pathogenic mechanisms of genetic disorders such as the epileptic 101 channelopathies as it allows for the generation of otherwise inaccessible human neurons (26-102 28). Here, we use KCNQ2-NEE patient-specific and isogenic control iPSC-derived excitatory 103 neurons to elucidate the dynamic functional effects of a prototypical KCNQ2 mutation during 104 differentiation and maturation in culture.