Side effects of antiepileptic drugs in children.

Side effects of antiepileptic drugs in children have to be considered at all stages of maturation: during pregnancy, at birth, during breast feeding and in older children treated for epilepsy. The offspring of drug treated epileptic mothers have a higher incidence of congenital malformations than do those of normal controls or of non treated epileptic mothers. According to recent prospective studies teratogenicity appears to be attributable to antiepileptic drugs rather than to epilepsy since more congenital anomalies have been found among infants of treated epileptic mothers than among untreated epileptic mothers. Monotherapy might be associated with a less pronounced risk for facial defects than is polytherapy. Some studies suggest that the actual drug used is significant for the teratogenic effect: a significant association was seen between maternal use of valproic acid and spina bifida; facial clefts were associated with both phenytoin and phenobarbitone use and also with polytherapy. These side effects do not however justify discouraging a woman on antiepileptic medications from having a child, nor do they perhaps justify changing a satisfactory drug regimen during pregnancy when the epilepsy is well controlled. The use of combinations of anticonvulsants should be avoided as well as anticonvulsants considered as not being safe (valproic acid, diones). However the danger of precipitating severe seizures or status epilepticus by overcautious treatment should be avoided because it poses a greater hazard to the fetus as compared to the low risk of teratogenicity due to anticonvulsants. Infants born to mothers taking either phenytoin or barbiturate derivatives or both may show clinical signs of bleeding and diminished level of coagulation factors, usually during the first 24 hours.(ABSTRACT TRUNCATED AT 250 WORDS)