Anticonvulsants in Pregnancy
10 Epilepsy C LINICAL N EUROLOGY N EWS • August 2006 G UEST E DITORIAL Anticonvulsants in Pregnancy lthough it has been known for years facial abnormalities. Other defects, such In contrast, first-generation AEDs that for the other second-generation agents: that some first-generation as those involving the heart and growth, do not appear to be associated with a sig- felbamate (Felbatol), gabapentin (Neu- Aantiepileptic drugs (AEDs) cause are commonly observed. A syndrome nificant risk of birth defects include the rontin), pregabalin (Lyrica), levetiracetam birth defects, intrauterine growth retar- with carbamazepine consisting of minor benzodiazepines (clonazepam [Klonopin], (Keppra), tiagabine (Gabitril), and topira- dation (IUGR), and, possibly, develop- craniofacial defects, fingernail hypoplasia, clorazepate [Tranxene], diazepam [Vali- mate (Topamax). mental delay, these toxicities were not and developmental delay has been ob- um], and lorazepam [Ativan]) and succin- Although the data also are limited for thought to apply to the second-generation served; this drug may also cause neural- imides (ethosuximide [Zarontin] and zonisamide (Zonegran), the drug is ter- AEDs. New information has challenged tube defects (NTDs). methsuximide [Celontin]). However, some atogenic in three animal species and em- that belief. The defects observed with primidone of these drugs have very little human bryo lethal in a fourth and therefore is best The first-generation AEDs known to are similar to those in FHS. Phenobarbi- data, and the benzodiazepines are known avoided in the first trimester. Oxcar- cause birth defects and oth- tal has been associated with to cause toxicity in the newborn, most no- bazepine (Trileptal), a drug closely related er developmental toxicities an increase in congenital de- tably, floppy infant syndrome and with- to carbamazepine, has been associated include the hydantoins fects when used for epilepsy, drawal syndrome.
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