[Teratogenic effects of epilepsy and anti epileptic drugs].

OBJECTIVE

In this paper we review the main studies on teratogenicity related to epilepsy and especially use of anti epileptic drugs (AED), with special emphasis on recently acquired knowledge regarding the new AED.

DEVELOPMENT

When considering the teratogenic effects of epilepsy and the anti epileptic drugs it should be remembered that there are a series of premises and considerations which undoubtedly play an important part in causing possible damage to the foetus. These factors include changes caused during pregnancy, the passage of drugs across the placenta barrier , malformations occurring in the children and relations of women with epilepsy and finally the effect of seizures on the foetus. We then review the mechanisms of the teratogenicity of the classical AED and the new AED. Little is known about the adverse effects of the new AED, and many are used together as polytherapy. Multicenter studies involving large numbers of participants are therefore necessary to obtain results which can be extrapolated to the whole population. Unfortunately, at present, this is not yet so and there are no clear recommendations for their use during pregnancy. The EURAP was designed for this reason. It is one of the multicenter studies being carried out in Europe at present with many Spanish specialists participating.

CONCLUSIONS

Multicenter studies with many participants are necessary to obtain reliable data on the teratogenicity of the various AED, used as monotherapy and bitherapy, particularly regarding the new AED. We conclude by considering measures to try to reduce, as far as possible, the teratogenic effects in pregnant women.