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From the Danish National Patient Register since 1977, we identified epilepsy diagnoses in all study participants and their family members. Cox regression models were used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CI), adjusted for relevant confounders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 1,754,742 individuals contributing &gt;\u00a030 million person\u2010years of follow\u2010up. The incidence rate of epilepsy in offspring of unaffected parents was 78.8 (95% CI: 77.8\u201379.8) per 100,000 person\u2010years, while the corresponding rate in offspring with an affected father was 172 per 100,000 person\u2010years (95% CI: 156\u2013187) and in offspring with an affected mother was 260 per 100,000 person\u2010years (95% CI: 243\u2013277). Having an affected mother was associated with a 1.45\u2010fold (95% CI: 1.30\u20131.63) higher risk of epilepsy in the offspring, compared to having an affected father. This maternal effect was found both in male (HR\u00a0=\u00a01.39, 95% CI: 1.19\u20131.62) and female offspring (HR\u00a0=\u00a01.53, 95% CI: 1.30\u20131.80), and across various ages at onset in the offspring. The maternal effect was also found in familial epilepsies (i.e. where the affected parent had an affected sibling; HR\u00a0=\u00a01.50, 95% CI: 1.04\u22122.16).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>We found a clear maternal effect on offspring risk of epilepsy in this nationwide cohort study.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.51258","type":"journal-article","created":{"date-parts":[[2020,11,29]],"date-time":"2020-11-29T18:54:17Z","timestamp":1606676057000},"page":"153-162","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Epilepsy risk in offspring of affected parents; a cohort study of the \u201cmaternal effect\u201d in epilepsy"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9339-4170","authenticated-orcid":false,"given":"Julie W.","family":"Dreier","sequence":"first","affiliation":[{"name":"National Centre for Register\u2010Based Research Department of Economics and Business Economics Aarhus BSS Aarhus University Aarhus Denmark"},{"name":"Centre for Integrated Register\u2010based Research CIRRAU Aarhus University Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin A.","family":"Ellis","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pennsylvania Perelman School of Medicine Philadelphia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4580-841X","authenticated-orcid":false,"given":"Samuel F.","family":"Berkovic","sequence":"additional","affiliation":[{"name":"Epilepsy Research Centre Department of Medicine University of Melbourne (Austin Health) Heidelberg Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Cotsapas","sequence":"additional","affiliation":[{"name":"Departments of Neurology and Genetics Yale School of Medicine New Haven USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Ottman","sequence":"additional","affiliation":[{"name":"Departments of Epidemiology and Neurology, and the G. 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Sergievsky Center Columbia University New York New York USA"},{"name":"Division of Translational Epidemiology New York State Psychiatric Institute New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob","family":"Christensen","sequence":"additional","affiliation":[{"name":"National Centre for Register\u2010Based Research Department of Economics and Business Economics Aarhus BSS Aarhus University Aarhus Denmark"},{"name":"Department of Neurology Aarhus University Hospital Aarhus Denmark"},{"name":"Department of Clinical Medicine Aarhus University Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,11,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2005.00354.x"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(08)70039-5"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awt368"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1976.tb03375.x"},{"key":"e_1_2_9_6_1","first-page":"257","article-title":"Higher risk of seizures in offspring of mothers than of fathers with epilepsy","volume":"43","author":"Ottman R","year":"1988","journal-title":"Am J Hum Genet"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.37.2.177"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.78.4.613"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a114197"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25625"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002404"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/1403494810387965"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/1403494811401482"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2007.05.009"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/1403494811405098"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1403494810394715"},{"key":"e_1_2_9_17_1","first-page":"320","article-title":"The Danish medical birth registry","volume":"45","author":"Knudsen LB","year":"1998","journal-title":"Dan Med Bull"},{"key":"e_1_2_9_18_1","volume-title":"Analysing Survival Data from Clinical Trials and Observational Studies","author":"Marubini E","year":"1995"},{"key":"e_1_2_9_19_1","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1542\/peds.66.6.1009a","article-title":"Febrile seizures: long\u2010term management of children with fever\u2010associated seizures","volume":"66","author":"Consensus statement","year":"1980","journal-title":"Pediatrics"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/1403494810395825"},{"key":"e_1_2_9_21_1","unstructured":"StataCorp.Stata Statistical Software: Release 14 In. ed. 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