0% of children of mothers on polytherapy

as opposed to a 3.7% incidence in patients on monotherapy (P=0.01) and 3.5% in women with epilepsy who were not taking AEDs.103 Others described a higher incidence in monotherapy as compared with children of healthy controls or children of mothers with epilepsy but without AFT) intake.108 Combinations with VPA carried a higher risk for VX-689 solubility dmso malformations than other combinations.103 The combination of VPA and LTG which is commonly used96 was associated with a higher risk of major congenital malformations than the monotherapy with VPA126 or any other combination with LTG.81 If the AED treatment. prior to pregnancy is changed from VPA to Inhibitors,research,lifescience,medical LTG for safety reasons, one should advise the patient about the dangers of falling pregnant while the combination is still taken. Classical AEDs The most, important, finding

concerning teratogenicity that helped to raise awareness in the epilepsy community was the description of neural tube defects under the influence of Inhibitors,research,lifescience,medical VPA.127 Neural tube defects develop between the 17th and the 30th day of a pregnancy.128 The risk of neural tube defects with VPA is reported to range between 1 % and 2%, with maximum figures of 5.4% during monotherapy.71,122,129 In the present, Inhibitors,research,lifescience,medical interim analysis of the German EURAP study, no neural tube defect with VPA monotherapy whas been observed.96 Major congenital malformations with VPA monotherapy occur in 6.2% to 11.1%.52,76,103,109,130 Beyond neural tube defects, skeletal abnormalities, cardiovascular, urogenital, and cerebral malformations have been typically reported.106 Dosages beyond 1000 mg per day appear to be associated Inhibitors,research,lifescience,medical with a markedly elevated risk of malformations83,109,131,132 and should therefore be avoided if at all possible. The rate of major congenital malformations with CBZ ranges Inhibitors,research,lifescience,medical from 2.2% and 5.7 %.76,103,109

Neural tube defects, cardiac malformations, hip dislocations, inguinal hernias, and hypospadia were reported as typical findings.106 Recent data103,115,116 indicate that the teratogenic potential of CBZ is probably not as high as was previously estimated.110 The UK pregnancy registry reports an incidence of 2.2% of major malformations and thus the lowest rate of all AEDs.103 Neural tube defects were reported in 0.5% to 1.0% in various series.71,122,133 The incidence before rates of congenital major malformations with PRM, PHT, and PB were 14.3%,’3.4% to 9.1% and 5.1% to 12%, respectively.109 Typical malformations under the influence of PHT are cardiac malformations, craniofacial clefts, and skeletal finger abnormalities.118 In addition one should be aware of the fetal hydantoin syndrome that comprises pre – and postnatal growth retardation, microcephalus, and developmental delay combined with the abovementioned malformations.106 Typical malformations with PB therapy are cardiac malformations and craniofacial clefts.