Specific cognitive abilities and motor function were investigated at 5½ years in 104 children of epileptic mothers and in 105 control children with normal intelligence at the Child Neurology Department, Children’s Castle Hospital, Lastenlinnantie, Helsinki, Finland. The children of the epileptic mothers had been exposed to antiepileptic drugs during pregnancy, most commonly phenytoin (69%), and maternal seizures had occurred during pregnancy in 52%. The WPPSI and ITPA test results showed that the children of epileptic mothers had impaired visuospatial and auditory phonemic skills whereas motor development was normal. Increased risk was associated with maternal partial seizures, with seizures occurring during pregnancy, and with low paternal education, but not with exposure to antiepileptic drugs. The mechanisms suggested include subtle brain damage secondary to fetal asphyxia during the mother’s convulsions, genetically transmitted brain abnormalities, and psychosocial disadvantage. Most mothers in the study had relatively low anticonvulsant drug levels during pregnancy and polytherapy was extremely rare. 
COMMENT. The mechanisms by which maternal epilepsy might affect a child’s intellectual development may include a teratogenic effect of antiepileptic drugs, fetal brain damage or maldevelopment induced by maternal convulsions, or hereditary causes. In this study the prevalence of mental deficiency (1.4%) and borderline intelligence (1.7%) was not significantly higher than in the general population but specific cognitive dysfunctions were uncovered in children of epileptic mothers.