Risk of epilepsy in opposite-sex and same-sex twins: a twin cohort study

Female preponderance in genetic generalized epilepsies

INTRODUCTION

Epilepsy is more prevalent in men but Genetic Generalized Epilepsies (GGE) seem to be more common in women. A predominant maternal inheritance has been previously described in GGE. Our objective was to determine sex and inheritance patterns in a GGE population compared to mesial temporal lobe epilepsy with hippocampal sclerosis (MTLEHS).

METHODS

We performed a prospective observational study including adult GGE and MTLEHS patients followed up at a tertiary epilepsy center from January 2016 to December 2019. Patients' familial history was obtained by a detailed questionnaire. Clinical and demographic data was retrieved from clinical notes.

RESULTS

A cohort of 641 patients, 403 with GGE and 238 with MTLEHS, was analyzed. GGE was more common in women than MTLEHS (58.8% vs 44.5%, OR=1.63, p = 0.004). Compared to MTLEHS patients, more GGE patients had familial history of epilepsy (45.4% vs 25.2%; p<0.001). The GGE group had a higher percentage of female relatives with epilepsy (55% vs 37%; p = 0.006). The prevalence of maternal inheritance was not different between GGE and MTLEHS groups (62.9% vs 57.7%; p = 0.596). Photosensitivity was more common in females than in males (44.7% vs 34.3%, p = 0.036).

CONCLUSION

There is a female preponderance in GGE when compared to MTLEHS, as both GGE patients and their affected relatives are more frequently women. The prevalence of maternal inheritance was not higher in GGE than in MTLEHS.

The effects of sex on prevalence and mechanisms underlying neurodevelopmental disorders

Neurodevelopmental disorders occur more frequently in boys than in girls and often differ in presentation between the sexes. The sex differences in prevalence and presentation of autism spectrum disorder, intellectual disability, communication disorders, specific learning disabilities, attention deficit/hyperactivity disorder, Tourette's syndrome, and epilepsy are discussed, as well as sex differences in the patterns of comorbidities between these disorders. Prominent theories have been proposed to explain sex biases. These include genetic factors, sex hormones, sociological factors, cognitive differences between the sexes, and environmental insult. Despite the large body of research reviewed in this chapter, many aspects of sex-related effects in neurodevelopmental disorders remain poorly understood.

Opposite-sex and same-sex twin studies of physiological, cognitive and behavioral traits

A scientific interest in opposite-sex (OS) twins comes from animal studies showing hormone transfer between fetuses in utero. A parallel effect in humans may occur, especially for OS females who may be exposed to androgens, in particular testosterone, from the male co-twin. Conversely, OS males may be exposed to lower levels of prenatal testosterone than do same-sex (SS) males. In this special issue, we reviewed published studies investigating potential differences between OS and SS twins in physiological, cognitive and behavioral traits focusing on the Twin Testosterone Transfer (TTT) hypothesis. Sixty articles fulfilled the eligibility criteria including 23 studies published since the review by Tapp et al. (2011). In general, studies of cognition are conflicting, but it is the phenotype for which most support for the TTT hypothesis is found. Less consistent evidence has been found regarding physiological and behavioral traits. We hope that this special issue will stimulate a discussion about how an investigation of the TTT hypothesis should continue in future research.