# Neurologist’s Black Swan: Molecular Basis of Prenatal Seizures

## TL;DR

This paper reviews the molecular basis of seizures that occur before birth, highlighting the need for more research on this under-studied form of epilepsy.

## Contribution

The paper provides a comprehensive review of the known molecular foundations of prenatal-onset epilepsy and emphasizes the importance of timely diagnosis.

## Key findings

- Only two genes, SCN2A and SCN8A, have been reliably linked to fetal epilepsy.
- Prenatal seizures are likely more common than currently recognized.
- Timely diagnosis is crucial for improving patient outcomes in prenatal-onset epilepsy.

## Abstract

One of the least studied but clinically severe forms of epilepsy is seizures with prenatal manifestations. Our understanding of epilepsy disorders has advanced substantially; numerous disease-associated genes have been identified, classifications have been refined, and underlying mechanisms and diagnostic approaches have been elucidated. However, one group of patients—those with seizures before the birth—has remained largely overlooked by researchers, despite numerous similar clinical cases reported over the past two decades. To date, only two genes, SCN2A and SCN8A, have been shown to have pathogenic variants that are reliably related to fetal epilepsy. Yet, how many genes are truly involved? This review will examine the known molecular foundations of epilepsy with prenatal onset. The prevalence of fetal seizures in patients with epilepsy is likely underestimated, although timely diagnosis of the disease is crucial for patient outcomes.