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Neurology supplements are not peer-reviewed. Information contained in Neurology supplements represent the opinions of the authors and are not endorsed by nor do they reflect the views of the American Academy of Neurology, Editor-in-Chief, or Associate Editors of Neurology.

Reproductive health effects and teratogenicity of antiepileptic drugs

From the Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.

Address correspondence and reprint requests to Dr. Peter W. Kaplan, Chairman, Department of Neurology, Johns Hopkins Bayview Medical Center, B. Bldg., 1 North, Rm. 125, 4940 Eastern Avenue, Baltimore, MD 21224; e-mail: pkaplan{at}jhmi.edu

Women with epilepsy are less likely to bear children than women in the general population, and although this reduced fertility can be attributed in part to effects of the disease itself, the effects of antiepileptic drugs (AEDs), including changes in reproductive endocrine function, are also a factor. Conversely, some AEDs interact with oral contraceptives and can increase the risk for contraceptive failure and unplanned pregnancy. Women with epilepsy also have elevated rates of congenital anomalies and major malformations in their offspring, for which exposure of the developing fetus to AEDs taken by the mother appears to be responsible. In utero exposure to some AEDs may also be associated with increased risk for impaired cognitive function in the growing child. Clearly, possible long-term effects on reproductive health and pregnancy outcomes require careful attention when AED therapy is being considered for a patient with childbearing potential. Moreover, because AEDs are increasingly being used in therapy for other conditions such as migraine, bipolar disorder, and pain, it is not only the treatment of women with epilepsy that will be affected by these concerns.

Publication of this supplement was supported by an unrestricted educational grant from GlaxoSmithKline.

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