Exposure in the womb to antiseizure medications and their potential impact on the brain
of the developing child has long been researched. Despite this long period of interest, this review
highlights that above the well-known risks associated with valproate exposure, there are more data
required for conclusions regarding all other antiseizure medications. Limited experience with
phenytoin and phenobarbital in monotherapy makes clearly defining the risk to later child postnatal
functioning difficult, although the evidence of an impact is stronger for phenobarbital than for phenytoin.
The widely prescribed lamotrigine is limited in its investigation in comparison to unexposed
control children, and whilst it has been demonstrated to carry a lower risk than valproate for certain
outcomes, whether it is associated with a more moderate impact on wider aspects of neurodevelopmental
functioning is still to be understood. Data for levetiracetam, topiramate and oxcarbazepine
are too limited to confidently draw conclusions for most neurodevelopmental outcomes. This slow
accumulation of evidence impacts on the safest use of medications in pregnancy and makes counseling
women regarding the risks and benefits of specific antiseizure medications difficult. Improved
focus, funding, and research methodologies are urgently needed.
Keywords: Antiseizure medications, pregnancy, epilepsy, neurodevelopment, child development, antiepileptic drugs, teratology.
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