The teratogenic potential of anti-epileptic drugs and the implications for clinical practice

The first part of the dissertation reviews the existing evidence regarding epilepsy and the management ofwomen with epilepsy. The heterogenous nature of epilepsy, the classification of seizures and epilepsies, the nature, role and the strategies employed in choosing anti-epileptic medications are reviewed. The relationship between anti-epileptic medication and the management ofepilepsy in female patients and the nature ofthe complex decision making mechanism involved in the selection of the correct antiepileptic drug therapy are discussed. The dissertation then describes the rationale, methodology and, results ofa national, prospective epilepsy and pregnancy register to examine the teratogenic potential ofantiepileptic medication. The results from this register are presented in an assessment ofthe teratogenic potential of the individual anti-epileptic drugs with reference to this at risk population. Where sufficient numbers are available, comparisons are made between drug groups and with pre-existing data. With many ofthe newer drugs, where to date insufficient numbers ofpatients to draw fmn conclusions may be reached, individual teratogenic risks are presented and compared to any pre-existing data. The role offolic acid in the prevention ofmajor congenital malformation is examined. The final section of the dissertation addresses the implications for clinical practice through the mechanism of pre-conceptual counselling. Given an increased awareness of the teratogenic potential ofindividual anti-epileptic drugs, the major clinical implication would be a practical application of this knowledge, principally through the imparting of information to those at risk through pre-conceptual counselling.