Troxidone (trimethadione) embryopathy: case report with reveiw of the literature.

It has long been known or suspected that phenytoin and probably phenobarbitone prescribed in pregnancy may lead to fetal malformations. The use of troxidone for epileptic women during pregnancy was reported in 1970 to lead to malformations. Over 50 instances of pregnancy in women taking troxidone have since been reported. In 8 of these the drug was used alone. 13 pregnancies resulted in abortion and 33 of the 40 survivors had a minor congenital anomaly, leading to death in 14. Complex congenital heart lesions with patent ductus, septal defects and aortic hypoplasia were apparent in half the survivors. Malformed or low-set ears were seen in nearly half the cases, palatal deformities were less common and evidence intrauterine growth retardation was frequently present. A 29-year-old mother taking troxidon and carbamazepine, and with a history of hypertension and proteinuria dating back to adolescence, delivered her first child prematurely. The child was small, showed deformed ears, displayed feeding problems and was found to be in cardiac failure with a systolic murmur and absent femoral pulses. Postnatal growth was retarded and after further cyanotic attacks a cardiac catheter study was performed. This showed a hypoplastic aortic arch with an anomolous origin of the left subclavian artery and patent ductus arteriosus, findings similar to those previously reported in neonates following maternal use of troxidone.