Sex differences in human epilepsy

•The overall prevalence of epilepsy shows only a slight gender difference, which varies with the epilepsy syndrome.•Gender differences are, however, reported in seizure semiology and spreading pattern.•They seem to reflect inherent sex differences detected in functional and structural connections of certain brain networks.

In the majority of neuropsychiatric conditions, marked gender-based differences have been found in the epidemiology, clinical manifestations, and therapy of disease. Emerging data suggest that gender differences exist also in the epidemiology, and pathophysiology of epilepsy. The present review summarizes the current information regarding gender and epilepsy. These differences are regarded from the perspective of innate sex differences in cerebral morphology, structural and functional connections, and assuming that these differences may render men and women differently vulnerable to epileptogenicity.