mention major malformations with PRM and PB and one cardiac abnormality with PHT96 Clefts were also described with ESM therapy,106 which was often given as an add-on AED. Animal studies emphasize the prenatal toxic effects of the drug.134 New AEDs The teratogenic
effects of new AEDs are difficult, to assess. In almost all instances the data do not allow unequivocal conclusions. Inhibitors,research,lifescience,medical Animal studies that are usually performed using extensive dosages and that indicated teratogenic effects from LEV, TPM, OXC, and VGB but not from FBM, GPB, LTG and TGB100 do not necessarily help to estimate the normal risk in humans. The only new AED that has been extensively studied in humans is LTG. According to the Lamotriginc Pregnancy Registry, the malformation rate was 2.9% and was therefore comparable to the spontaneous rate in the healthy population.82 Major malformations with LTG monotherapy were not described in the ongoing EURAP registries of Australia or Germany.96,132 The UK Pregnancy Registry reported a possible dose-dependency
with a rate of malformations with LTG dosages above 200 mg Inhibitors,research,lifescience,medical that, were approximately in the range of 600 to 1000 mg VPA.103 This was not confirmed by the reanalysis of the data of the Lamotrigine Pregnancy Registry.135 Finally, Inhibitors,research,lifescience,medical orofacial clefts were reported in a few cases,83 but were not identified as a convincing drug-specific event in the ongoing registries.81,82,96,103,132 Thus, the teratogenic risk of monotherapies with LTG appears to be Inhibitors,research,lifescience,medical see more moderate. More reliable data on other new AEDs are urgently needed. Folic acid prophylaxis Several studies have shown that, folic acid or combinations of vitamins including folic acid were useful to reduce the risk of neural tube defects in pregnancies of women with a genetically elevated risk of having a Inhibitors,research,lifescience,medical child with a neural tube defect, and in women
during their first pregnancy,136,137,138 so that folic acid prophylaxis is generally recommended if pregnancies are planned. It is tempting to speculate that women with epilepsy who have an elevated risk of malformations with AED intake might benefit even more from folic acid prophylaxis. However, this hypothesis, though convincing, has not yet been proven by confirmatory studies.118 In two patients on VPA, folic acid did not prevent neural tube defects.138 Table II. Recommendations during pregnancy.24 AED, antiepileptic drug; VPA, valproic acid; Adenosine LTG, lamotrigine; OXC, oxcarbazepine Recommendations usually suggest high dosages such as 5 mg per day to overcome the theoretical drawback of enzyme-inducing AEDs.24,49,100 A summary of the recommended strategics to reduce the teratogenic risk in women with epilepsy is shown in Table II. Impact of AEDs on further development Data on the impact, of AEDs on the further development. of children of women with epilepsy are controversial,100 if variables such as APGAR score, the risk of mental retardation, behavioral disorders, and the development of verbal skills arc considered.
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