Is epilepsy inherited?

Epilepsy is a chronic neurological disease that causes attacks of varying intensity in patients. With epilepsy, cognitive, sensory, and autonomic functions are impaired. The question of whether epilepsy is a hereditary disease is relevant for couples planning a pregnancy, as well as for people who have been diagnosed with this disease.

When making a diagnosis, neurologists at the Yusupov Hospital analyze the patient’s pedigree and identify the presence of epilepsy in his relatives. Cooperation between the Yusupov Hospital and large research institutes makes it possible to conduct genetic research and identify the nature of inheritance of the disease.

Types of inheritance of epilepsy

The development of epilepsy can occur due to various reasons. Clients often come to the neurology clinic of the Yusupov Hospital with the question of whether epilepsy is inherited. Every person wants to have healthy children, so this issue is relevant both for epileptics and for people who do not suffer from this disease.

Depending on the causes of development, the following types of epilepsy are distinguished:

• symptomatic, or acquired form, is associated with diseases of the cardiovascular, nervous systems, and various injuries;
• bdiopathic, or genuine, has a primary origin, which is caused by genetic disorders. In this case, epilepsy is inherited;
• The riptogenic form is characterized by unknown causes.

Genuine epilepsy can be transmitted as a dominant or recessive trait. An example of inheritance by a dominant trait is Rolandic epilepsy. Transmission of the disease in this case occurs through one sex and a direct line through one generation. So, if epilepsy is inherited from a father, then his child will be healthy, but his grandson will have this disease.

When inheriting a recessive trait, for example, juvenile myoclonic epilepsy, it is necessary that each parent is a carrier of this disease. In this case, epilepsy may not manifest itself in parents.

It is important for a neurologist to determine whether epilepsy is inherited, since the treatment tactics for epilepsy depend on its form. The epilepsy treatment program is drawn up by specialists at the Yusupov Hospital, taking into account the results of examinations and data collected by a neurologist.

Development of pathology

Epilepsy is a disease that affects the brain. For various reasons, a malfunction occurs in the electrical activity of its cells, neurons begin to behave inappropriately, and as a result, a pathological electrical discharge occurs in certain areas of the brain, leading to seizures. The disease is considered quite common: 20 affected per 1000 people.

From medical statistics it is known that every one of 50 children out of 1000 had an epileptic attack against a background of very high body temperature.

If future parents are interested in whether epilepsy is inherited or not, it is better for them to visit a geneticist. He will conduct a conversation and prescribe an examination that will help you more likely to name the correct answer, and most likely it will be positive.

It is important to understand that it is not the disease itself that is genetically transmitted, but the pathological structure of the neurons of the brain, which leads to seizures.

Diagnosis of hereditary epilepsy

A neurologist at the Yusupov Hospital will be able to answer the patient’s question about whether epilepsy in this case is a hereditary disease only after a thorough examination. For diagnostic purposes, the patient is prescribed MRI and EEG. The absence of functional lesions of brain structures may indicate genetic factors in the development of epilepsy.

Genetic testing can determine whether epilepsy is inherited from the father or mother. The main indications for this procedure are:

• burdened heredity;
• suspicion of monogenic epilepsy;
• combination of epilepsy with mental disorders, congenital defects and other pathologies;
• exclusion from several types of genetic epilepsies.

The Neurology Clinic of the Yusupov Hospital is equipped with high-precision European equipment, which reduces the processing time of results and increases their reliability. An important advantage of examination at the Yusupov Hospital is the absence of queues and visits to specialists at a time convenient for the patient.

Is it possible to reduce the risk of inheriting epilepsy?

A geneticist can make a prognosis regarding a child’s predisposition to epilepsy after conducting a series of appropriate tests. The likelihood of the disease depends on the gender of the parent with the diagnosed pathology:

• how often can epilepsy be inherited from the father? The risk of developing a disease in a child is from 1% to 4%

• how often can epilepsy be inherited from the mother? If the mother has pathology, the child becomes ill in 2.5%-9% of cases.

It is impossible to prevent the transfer of the gene, but the disease may not manifest itself. It is within the power of parents to eliminate as much as possible the provoking factors that can cause epilepsy. The child should be protected from falls, injuries, serious infectious diseases, and stress.

It is important to pay attention to characteristic symptoms and consult a doctor immediately. Timely adequate treatment will help delay the progression of epilepsy and reduce the severity of the clinical picture.

Treatment of hereditary epilepsy at the Yusupov Hospital

Modern experts have discovered that epilepsy is inherited in certain cases. When patients come to the Yusupov Hospital with complaints of epileptic attacks, neurologists determine what factors determine the development of the disease. This information is necessary not only for making a diagnosis, but also for choosing adequate treatment tactics.

The methods currently used in medicine to treat epilepsy achieve remission in more than 70% of cases. Drug therapy for epilepsy is leading, but it is successfully combined in the neurology clinic with other methods.

The technologies used at the Yusupov Hospital make it possible to determine whether epilepsy is transmitted in a particular case, and what is the mechanism of its manifestation. At the Neurology Clinic, real medicine is successfully combined with high-quality patient care. To receive specialist advice and quality treatment for epileptic seizures, make an appointment by calling the Yusupov Hospital.

Epilepsy in pregnant women

Previously, doctors did not allow women with epilepsy to give birth to children, but now medicine has gained new knowledge and this issue is resolved by a neurologist, based on the type of pathology. Women with diagnosed epilepsy should report their condition to their gynecologist. When planning a pregnancy, a period of remission is selected and a thorough examination is carried out. In some cases, the doctor may advise against conceiving. This may be associated with severe damage to the body.

When pregnancy occurs, the patient is prescribed drugs for epilepsy with a less pronounced effect on the body of the unborn child. At the same time, vitamins and medications are prescribed to increase the chances of having a healthy baby.

During pregnancy, a woman should avoid stress, illness, and any factors that can provoke an attack of epilepsy and worsen the condition.

Clinical picture

The course of hereditary epilepsy is no different from the course of acquired pathology. It is characterized by:

• fainting;
• convulsions;
• foaming at the mouth during an attack;
• short-term loss of consciousness.

In some cases, a patient who has already had a series of attacks can anticipate the onset of a new one several days in advance. This happens:

• disturbance of night sleep;
• headache and excessive irritability appear;
• decreased appetite;
• the appearance of a stereotypical aura and other symptoms by which the patient understands the approach of the inevitable.

After the appearance of the aura (lasting several seconds), loss of consciousness is possible with the patient falling to the floor, which is very often accompanied by a scream. Breathing movements slow down, the veins in the neck swell. The facial coverings turn pale, the jaws clench tightly. Tonic convulsions appear, and this state continues for approximately 20 seconds. The duration of this phase is about three minutes.

For Rolandic epilepsy, the characteristic time of occurrence is mainly at night (80% - the first half of the night, 20% - while awake). The convulsive state is more short-term in nature.

The first appearance of attacks for the myoclonic form is typical at the age of 10-19 years. Mental disorders act as precursors. Seizures are observed either daily, or at intervals of several months, or even less frequently.

The correct diagnosis is established by a qualified specialist. Only about 8% of sick people have a history of this pathology in their relatives.

What should parents do?

The transmission of the disease by inheritance largely depends on the type of epilepsy in the mother or father. The symptomatic disease is not inherited, since this information is not contained in the genes. You should consult a geneticist about the risks of idiopathic transmission.

It often happens that healthy parents give birth to a child with epilepsy. In this case, the gene was passed on from generation to generation, and the disease appeared only in the newborn. If a child is diagnosed with this disease, it is necessary to undergo a comprehensive examination. Modern treatment methods will significantly delay the progression of the pathology and reduce its symptoms.

No one is immune from the sudden development of a symptomatic form of the disease, including newborns. With timely elimination of the provoking factor, such pathology can be cured forever. Timely diagnosis and therapy will help avoid the development of convulsive conditions in a child.

How to prevent inheritance of allergies?

Modern medicine does not consider allergies to be a genetic disease, but does not rule out inheriting a predisposition to it from close relatives. Therefore, before planning a pregnancy, both future parents must strictly follow medical recommendations to prevent the development of allergies in the child.

The pattern of inheritance of predisposition to allergies in a family, according to modern research, is as follows:

Despite the hereditary factor in the transmission of predisposition to allergic reactions, you can try to reduce its occurrence to a minimum. To do this, you need to follow the following recommendations:

It is important to approach pregnancy planning with all responsibility. Both future parents must give up bad habits at least 3 months before the expected conception. If both parents or one of them are employed in hazardous work, it is recommended to change jobs in favor of more favorable working conditions

And this must be done no later than 6 months before conception. If the environmental conditions of the area where the future parents live leave much to be desired, for example: the house is located near a highway or the family lives in a metropolis, everything must be done to minimize this unsafe influence. It is advisable to travel to forested areas more often, spend vacations outside the city, etc.

Use household chemicals as little as possible, it is important to avoid passive smoking, and also limit the use of cosmetics and perfumes to reasonable limits. Do not carry out any repair work in the living space during conception, pregnancy and during the first year of the child’s life. Follow the principles of a hypoallergenic diet. The expectant mother should not overuse potential food allergens

It is important to remove citruses, chocolate, strawberries, etc. from a pregnant woman’s diet.

The most important thing is not to be afraid of the problem

It is important to focus all your efforts on maintaining the immune system in a normal state so that a recurrence of the disease does not occur during pregnancy. You should also protect yourself from the negative impact of the environment and give up bad habits

Under these conditions, the possibility that the transmission of a genetic predisposition to allergic diseases to the child will be minimized

You should also protect yourself from the negative impact of the environment and give up bad habits. Under these conditions, the possibility that the transmission of a genetic predisposition to allergic diseases to the child will be minimized.

Types of pathology

“Epileptic” is a disorder in the functioning of the nervous system, which results in increased nervous excitability of certain areas of the brain. This leads to sudden seizures.

There are several forms of the disease:

• idiopathic;
• symptomatic;
• cryptogenic form.

Idiopathic epilepsy is a genetically determined disease, the causes of which are still unclear. This form of pathology can be transmitted from parents. However, a transmitted hereditary gene does not mean the development of the disease; children can only be its carriers.

The symptomatic type of pathology is an acquired form of the disease. It can develop under the influence of certain factors - head injuries, brain tumors, cysts or aneurysms. This form is not “remembered” by genes, therefore healthy children are born to parents with a symptomatic form of the pathology. However, no healthy person is immune from this type of disease, since the disorder can develop due to a traumatic brain injury.

Nothing is still known about the cryptogenic form of the disease, and no one can definitely say whether it is inherited. There is an opinion that the cryptogenic form of epilepsy is caused by a gene mutation, but whether this gene is inherited is not clear.

The likelihood of inheritance and characteristics of epilepsy in children from parents with epilepsy

D.V. MOROZOV

Kazan State Medical Academy, 420012, Kazan, st. Mushtari, 11

Morozov Dmitry Valerievich - assistant at the Department of Child Neurology, tel., e-mail: [email protected]

100 children born to parents with epilepsy were examined. All children underwent a continued video-electroencephalographic study including a sleep episode and a detailed neurological examination; if necessary, magnetic resonance imaging of the brain was performed. During the examination, the form of epilepsy was verified in all children in accordance with the criteria of the International League Against Epilepsy. The authors describe the likelihood of inheritance of epilepsy, its forms, features of electroencephalographic changes and changes in neurological status in this group of children. As a result of the study, data were obtained on a high percentage of inheritance of epilepsy, frequent changes in the neurological status of children, especially those whose mothers had epilepsy. In children of mothers with epilepsy, the disease debuts at an earlier age. In addition, in children with an early onset, the frequency of attacks is significantly higher than in children with the onset of the disease after three years. Children with onset of the disease before the age of three are much less likely to experience remission. In the subgroup of children with neurological impairment, seizures began at an earlier age.

Key words : epilepsy, parents with epilepsy, electroencephalogram, neurological status.

DV MOROZOV

Kazan State Medical Academy, 11 Mushtari St., Kazan, Russian Federation, 420012

Probability of inheritance and features of epilepsy in children born to epileptic parents

Morozov DV - Assistant of the Department of Neurology and Neurosurgery, tel. (843) 2734909, e-mail: [email protected]

The article contains information on a group of 100 children born to epileptic parents. All children went through video-EEG evaluation with a sleep episode and thorough, neurological examination; MRI evaluation of the brain was conducted if necessary. During examination the epilepsy form was verified in all children in accordance with the criteria of the International League Against Epilepsy. The author describes the probability of epilepsy inheritance, its forms, features of electroencephalographic changes and changes in neurological status in the examined group of children. As a result of the carried out research, a high percentage of inheritance was found, as well as frequent changes in neurological status of children, especially those whose mothers suffered from epilepsy. In children born to epileptic mothers the earlier onset of epilepsy was noted. Moreover, in children with the early onset of the disease the frequency of attacks was much higher than in children with the disease onset after the age of three. In children with epilepsy onset before three years the probability of remission was significantly lower. In the children who had neurological status disorders the onset of epilepsy was noted in earlier age.

Key words: epilepsy, parents with epilepsy, EEG, neurological status.

Epilepsy is one of the most common chronic diseases affecting the brain. The social significance of the disease increases significantly due to the fact that it affects young people. In a third of patients, despite the emergence of new antiepileptic drugs (AEDs), seizures cannot be controlled [1]. Patients of reproductive age are 25-40% of patients with epilepsy [2]. Despite significant social stigmatization of patients with epilepsy, an increasing number of patients of both sexes are getting married. According to Russian authors, 1 pregnancy out of 200 is from a woman with epilepsy [3]. It is a well-known fact that pregnancy and childbirth in this category of women are more difficult. A number of articles note a significant decrease in fetal weight at birth, a decrease in head volume, and a reduced Apgar score [4, 5].

A large number of works are devoted to the health of the offspring of parents with epilepsy. In these articles, great importance is given to the effect of drugs on the intelligence and morphological characteristics of the child (stigmas of dysembryogenesis and developmental anomalies); most publications reflect exclusively the teratogenic effects of antiepileptic drugs on the fetus. Unfortunately, in the world and domestic literature there is practically no information about the health of children born to fathers with epilepsy. Despite the recognition of the fact that pregnancy and childbirth are more severe in women with epilepsy, there is no detailed analysis in the literature of the neurological status of children born to this category of women. According to many authors, the likelihood of inheriting idiopathic forms of epilepsy exceeds that from parents with symptomatic forms [6-8]. However, scientists agree that individuals with symptomatic forms of epilepsy undoubtedly have a certain genetic predisposition to the generation of seizures, which is realized in the form of a higher risk of developing epilepsy in their offspring (2%) relative to population data [9]. It is a known fact that epilepsy is more often inherited from mothers with epilepsy than from sick fathers [10].

The article presents the results of assessing the nature of epilepsy identified in children from parents with epilepsy, and studies the features of electroencephalographic changes and the neurological status of this group of children.

Materials and methods

A survey of 100 children born to parents with epilepsy was conducted: 53 children were born to mothers with epilepsy and 47 children were descendants of sick fathers. The group of children from mothers with epilepsy consisted of 26 (49%) boys and 27 (51%) girls. Among the children from fathers with epilepsy, there were 27 (57.4%) boys and 20 (42.6%) girls. The diagnosis of epilepsy was established on the basis of the definition proposed by the World Anti-Epileptic League in 1989: epilepsy is a chronic disease characterized by repeated unprovoked attacks of disturbances in motor, sensory, autonomic, mental or mental functions resulting from excessive neural discharges in the gray matter of the cerebral cortex. When making a diagnosis, the electro-clinical-anatomical criterion was observed.

The examination of children began with detailed collection of information about the details and evolution of epilepsy in the child’s parent, which made it possible, in combination with instrumental research data, to verify the form of epilepsy. In the process of collecting information, data on the age of onset of the disease was analyzed, which was one of the necessary criteria for the form of epilepsy. Information about the type of seizures the child’s parent had was mandatory, which also made it possible to clarify the form of epilepsy. Young children, especially the first year of life, were examined repeatedly to assess the dynamics of their neurological status. This was due to a more distinct evolution of neurological symptoms in this age group: the state of cranial innervation, sensitivity, motor function, the study of tendon reflexes, features of muscle tone, the presence of coordination disorders, hyperkinesis, the degree of maturity of higher cortical functions and the correspondence of their development to the age of the child, indicators of the state of the autonomic nervous system. All children from parents with epilepsy underwent video-EEG monitoring including a sleep episode. Depending on the clinical situation, the duration of the study ranged from 2 to 9 hours. If necessary, children underwent CT and MRI of the brain.

results

13 (13%) children with epilepsy were identified (Table 1). The number of sick children from fathers with epilepsy was 8 (17%). In the group of children from women with epilepsy, 5 (9.43%) sick children were identified.

Idiopathic generalized epilepsy was observed in 1 child from the group of children from mothers with epilepsy and 2 children from the group from sick fathers with epilepsy. Idiopathic focal epilepsy was observed in 1 child from the group of children from fathers with epilepsy. Symptomatic focal epilepsy was detected in 1 child from the group of sick mothers and 1 child from the group of sick fathers. Cryptogenic focal epilepsy was observed in 2 children from mothers with epilepsy and in 4 children from fathers with epilepsy. The cryptogenic generalized form was identified in 1 child from the group from mothers with epilepsy. In total, 4 girls and 9 boys had epilepsy.

Table 1.

Forms of epilepsy in children born to parents with epilepsy

In 4 children (Table 2) with epilepsy, simple partial seizures were observed. Complex partial seizures were recorded in 7 children. Seizures with secondary generalization were identified in 3 children. Primary generalized seizures occurred in 4 children. No unclassifiable seizures or cases of status epilepticus were found in the presented sample of children. This was probably due to the timely administration of adequate antiepileptic therapy.

Table 2.

Types of seizures in children born to patients with epilepsy

A group of children with epilepsy was analyzed to determine the age of onset of the first clinical manifestations. In the group of children from women with epilepsy, the average age of onset of epilepsy was 2.43 years. In the group of children from fathers with epilepsy, the average age of onset of the disease was 6.16 years. In the study cohort of patients, there were 6 children with the onset of epileptic seizures before the age of three years and 7 children whose seizures began after three years. In the group of children over three years old, 1 child had frequent attacks, 3 children had attacks of average frequency, 3 in this age group were in remission. There were no attacks with a frequency of once a year or less in the study group of children.

According to the frequency of attacks, children with epilepsy were divided into 4 groups: patients with frequent attacks (once a week or more), patients with moderate attacks (less than once a week, more than once a year), patients with rare attacks (once a year or less), patients are in remission (no attacks during the previous year). Frequent attacks were observed in 3 children under the age of three, attacks of moderate frequency were noted in 2 children from this age group, 1 child under the age of three was in remission.

Analysis of the bioelectrical activity of the brain of children with epilepsy showed the following results: epileptiform activity was detected in 6 children, signs of a violation of bioelectrical activity of an organic nature in the form of regional slowing were found in 2 children, a normal electroencephalogram was recorded in 1 child, a combination of epileptiform activity and slowing of bioelectrical activity was detected in 4 children.

In a group of 4 children with idiopathic forms of epilepsy (focal and generalized), a slowdown in bioelectrical activity, which is an indicator of organic brain damage, was not found in any case. Changes in the electroencephalogram in children with idiopathic forms of epilepsy consisted of the presence of epileptiform activity. Of the 2 children with symptomatic epilepsy, in both cases there was a combination of epileptiform activity and a slowdown in bioelectrical activity of a regional nature. Among 7 children with cryptogenic forms of epilepsy (focal and generalized), a slowdown in the recording structure occurred in 4 cases.

Among children with epilepsy, neurological symptoms of varying severity were found in 9 children. In the group of sick mothers, changes in neurological status occurred in 5 children. In the group of children from sick fathers, changes in neurological status were found in 4 patients.

During the examination of a group of children with epilepsy, the following neurological symptoms were identified: coordination disorders - in 2 children, pyramidal insufficiency - in 3, tetraparesis - in 2 children, double athetosis - in 1 child, anisoreflexia - in 1 child, diffuse muscular hypotonia - in 3 children, dysfunction of the pelvic organs - in 1 child, mental retardation - in 2 children, strabismus - in 2 children.

In the group of children with the onset of the disease before the age of three years, changes in the neurological status were detected in 5 people; in the group of older patients, neurological symptoms were found in 4 children.

Discussion

The study revealed a high percentage of children with epilepsy, exceeding population figures by 4-5 times, judging by the data of many authors on the frequency of epilepsy in the pediatric population, up to 1-3%. Despite the fact that the literature describes a high probability of inheritance of idiopathic forms of epilepsy, a similar pattern was not obtained in our sample. When assessing the age of onset of the disease among children of the two compared groups, an earlier development of epilepsy was noted in children from mothers, which is likely due to the unfavorable course of pregnancy and childbirth and the more frequent occurrence of organic changes in the central nervous system in this group. A large number of children with epilepsy exhibit neurological symptoms, and children of mothers with epilepsy suffer much more often. These changes can most likely be associated with the severe course of the perinatal period in this category of women (more frequent increase in uterine tone, bleeding, tears as a result of falls and tonic contractions during generalized convulsive attacks). Often, in children with intrauterine hypoxia, the periventricular zones, which are especially sensitive to hypoxia, suffer, which leads to the development of periventricular leukomalacia and subsequent pyramidal symptoms.

An analysis of the characteristics of epileptiform activity in a group of parents with epilepsy led to the conclusion that among children with cryptogenic and focal epilepsies, the phenomenon of a slowdown in background activity is often observed, which is an indirect sign of damage to the brain structure. At the same time, among idiopathic forms of epilepsy, which are associated with disturbances in the electrolyte balance in the cell, a slowdown in bioelectrical activity was not noted in any case. The higher frequency of neurological symptoms in children with the onset of epilepsy before the age of three years turned out to be logical. Perhaps this fact can be explained by the fact that gross organic changes in the brain soon lead to the development of an epileptogenic focus in the cortex.

The conducted study of the offspring of parents with epilepsy dictates the need for especially close attention to this category of children - regular and timely neurophysiological research for an adequate diagnosis of epilepsy and verification of its form. Unfortunately, due to the insufficient quality of neuroimaging equipment and the qualifications of specialists, a large percentage of children receive a diagnosis of cryptogenic epilepsy due to the lack of detection of the etiological factor. The least favorable factor for the development of epilepsy is the presence of neurological symptoms. Children with neurological symptoms born from parents with epilepsy need to undergo a more detailed study of the bioelectrical activity of the brain to identify subclinical epileptiform activity, which may be a precursor to epileptic seizures and a factor that impairs the patient’s cognitive status.

LITERATURE

1. Wolfgang Losher. Mechanisms of drug resistance // Epileptic disord. - 2005. - Vol. 7 (Suppl. 1). — P. 3-9.

2. Prusakov V.F. Clinical and epidemiological characteristics of childhood epilepsy in Kazan // Kazan Medical Journal. - 2006. - T. 87, No. 2. - P. 111-114.

3. Karlov V.A. Epilepsy in women // Journal of neurology and psychiatry. - 2006. - No. 1. - P. 41-46.

4. Astedt B. Antenatal drugs affecting the status of the fetus and the newborn // SeminThrombHemost. - 1995. - Vol. 21. - P. 364-370.

5. Hiilesma VK Pregnancy and birth in women with epilepsy // Neurology. - 1992. - Vol. 42 (Suppl. 5). — P. 8-11.

6. Choi H., Winawer M., Kalachikov S. et al. Classification of partial seizure symptoms in genetic studies of the epilepsies // Neurology. — 2006. — Vol. 66. - P. 1648-1653.

7. Hesdorffer DC, Logroscino G, Benn EK et al. Estimating risk for developing epilepsy: A population-based study in Rochester, Minnesota // Neurology. — 2011. — Vol. 76. - P. 23-27.

8. Helbig KL, Bernhardt BA, Conway LJ et al. Genetic risk perception and reproductive decision making among people with epilepsy // Epilepsia. — 2010. — Vol. 51. - P. 1874-1877.

9. Berkovic SF, Howell RA, Hay DA et al. Epilepsies in twins: genetics of the major epilepsy syndromes //Ann Neurol. - 1998. - Vol. 43. - P. 435-45.

10. Annegers J., Hauser WA, Anderson BE Risk of seizures among relatives of patients with epilepsy: families in a defined population. In: Anderson VE, Penry JK, eds. Genetic basis of the epilepsies. — New York: Raven Press; 1982. - R. 151-9.

REFERENCES

1. Wolfgang Losher. Mechanisms of drug resistance. Epileptic disord., 2005, vol. 7 (suppl. 1). pp. 3-9.

2. Prusakov VF Clinical and epidemiological characteristics of childhood epilepsy in Kazan. Kazanskiy meditsinskiy zhurnal, 2006, vol. 87, no. 2, pp. 111-114 (in Russ.).

3. Karlov VA Women's epilepsy. Zhurnal nevrologii i psikhiatrii, 2006, no.1, pp. 41-46 (in Russ.).

4. Astedt B. Antenatal drugs affecting the status of the fetus and the newborn. SeminThrombHemost, 1995, vol. 21, pp. 364-370.

5. Hiilesma VK Pregnancy and birth in women with epilepsy. Neurology, 1992, vol. 42 (suppl. 5), pp. 8-11.

6. Choi H., Winawer M., Kalachikov S. et al. Classification of partial seizure symptoms in genetic studies of the epilepsies. Neurology, 2006, vol. 66, pp. 1648-1653.

7. Hesdorffer DC, Logroscino G, Benn EK et al. Estimating risk for developing epilepsy: A population-based study in Rochester, Minnesota. Neurology, 2011, vol. 76, pp. 23-27.

8. Helbig KL, Bernhardt BA, Conway LJ et al. Genetic risk perception and reproductive decision making among people with epilepsy. Epilepsia, 2010, vol. 51, pp. 1874-1877.

9. Berkovic SF, Howell RA, Hay DA et al. Epilepsies in twins: genetics of the major epilepsy syndromes. Ann Neurol., 1998, vol. 43, pp. 435-45.

10. Annegers J., Hauser WA, Anderson BE Risk of seizures among relatives of patients with epilepsy: families in a defined population. Genetic basis of the epilepsies. New York: Raven Press; 1982. pp. 151-9.