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BACKGROUND In pregnant women with epilepsy the use of antiepileptic drugs may increase the risk of harming the foetus. For the treating neurologist it may be challenging to find a balance between optimal seizure control and the lowest possible drug dosage. The aim of this study was to assess the prevalence and type of congenital malformations in children exposed to antiepileptic drugs during pregnancy. MATERIAL AND METHOD In Norway we have prospectively followed 813 pregnancies in women with epilepsy as part of an international cohort study. The women had three check-ups during the pregnancy, and the children were followed up twice during their first year of life. RESULTS We found a total of 34 congenital malformations in the children, of which 12 were heart defects, yielding a malformation rate of 4.5%. Six of the malformations (18%) were detected prenatally, 20 (59%) were reported immediately after birth, and eight (24%) were discovered during the child's first year of life. INTERPRETATION Our study shows that 95.5%.of the women included who used antiepileptic drugs during pregnancy gave birth to a healthy child. This Norwegian cohort is too small to evaluate the teratogenic risk associated with the individual drugs.

Background Dravet syndrome is a severe, genetic epileptic encephalopathy with seizures starting during the first year of life. We present a review of the genetic and clinical picture along with treatment aspects. Material and methods This review is based on a non-systematic literature search in PubMed until April 2011 and the personal experiences of the authors. Results Dravet syndrome should be suspected in children with febrile hemiconvulsions or tonic-clonic seizures in the first year of life. Non-febrile seizures also occur, and other seizure types gradually appear, e.g. myoclonic jerks, atypical absences or focal seizures. In adulthood the clinical picture is less characteristic. The clinical diagnosis is supported by genetic testing; 70-80% of the patients have mutations in the sodium channel subunit gene SCN1A. Seizure control is difficult to achieve, but valproate, benzodiazepines and stiripentol may cause improvement, whereas sodium channel blockers, such as lamotrigine and carbamazepine may aggravate the tendency towards seizures. Interpretation Dravet syndrome appears to be an under-recognised condition among both children and adults with severe epilepsy and learning disability. Clinical information from the first years of life is essential in making the diagnosis. A correct diagnosis at an early age is essential for appropriate treatment and genetic counselling.

BACKGROUND: Throughout mankind's history, epilepsy has been perceived as a mysterious and supernatural disorder. People with epileptic seizures were seen either as demonic or holy. Here we present a survey of our current knowledge on the association between epilepsy and religion from a medical viewpoint. MATERIAL AND METHOD: The article is based on a non-systematic search of the database PubMed, biographies of Wise-Knut, and the authors' own experiences. RESULTS: A number of people with epilepsy, particularly those with temporal lobe epilepsy, have reported experiencing religious feelings during their seizures. Some experience a feeling of perfect harmony, the presence of God or a state of ecstasy. Insula is probably of importance for the seizure semiology. Postictally, some may develop religious delusions that can last for several days. A subgroup have an interictal personality characterized by a preoccupation with philosophical or religious questions, as well as hypergraphia. Wise-Knut, who lived in the 1800 s, is a well known example of this in Norway. There is now some evidence that a number of religious people, including prophets, saints, and cult founders, may have had temporal lobe seizures. INTERPRETATION: Using epilepsy as a model to explain spiritual experiences is controversial. However, temporal lobe epilepsy has probably influenced our religious and literary history more than has been previously acknowledged.

Background Lennox-Gastaut syndrome (LGS) is a severe epileptic encephalopathy, which starts in childhood with various seizure types. The children develop cognitive impairment and a typical EEG pattern. The aim of this article is to describe the clinical presentation of LGS, with particular emphasis on the course in adulthood. Material and methods The article is based on literature (up to November 2009) identified through a non-systematic search in PubMed and our own clinical experience. Results There are cases with unknown etiology and symptomatic cases with a wide spectrum of etiologies. While children with LGS have a high frequency of generalized seizures, seizure activity tends to decrease somewhat in adulthood and the seizures may become more focal. The prognosis is usually poor. The adult patient with LGS is clearly affected by global encephalopathy and is typically characterized by bluntness, apathy, progressive cognitive failure and motoric deficits. Valproate has been the first-line treatment for many years, but newer antiepileptic drugs; such as lamotrigine, topiramate and rufinamide, have shown efficacy as add-on therapy. Overtreatment with antiepileptic drugs is common. Interpretation For optimal treatment, a specialist should follow LGS patients at all ages. New treatment options with milder side effects may improve the quality of life for these patients.