Abstracts

The treatment of female epilepsy patients during gestation presents a considerable clinical dilemma. On the one hand, it is necessary to keep the patient free of seizures and, at the same time, try to maintain the patient on monotherapy with the lowest possible dose, because of the effects medication may have on progeny. The use of classic antiepileptic drugs (AEDs; eg, sodium valproate) during gestation is associated with a wide range of disorders in the growth and development of the child. Although there is relatively limited data on the effects of the newer AEDs (eg, lamotrigine, carbamazepine) on offspring, there are no evidence of similar developmental disturbances. Among these drugs, lamotrigine is the medication with which the most wide-ranging experience is available, and so far no greater incidence of congenital anomalies has been observed in comparison with the general population. The goal of our study has been to monitor children newly born to epileptic mothers receiving monotherapy with lamotrigine (LTG) during gestation. Sixty-two children newly born to mothers diagnosed as having secondarily widespread partial complex epilepsy were studied. This patient population received monotherapy with lamotrigine. The family and personal history of the parents were assessed together with the obstetric data on the pregnancy and delivery. Findings on the examination of each newborn child with regard to psychomotor development at the moment of birth and after 1, 3, and 6 months, and 1 year after birth also were evaluated. Among the patients examined in this study, no congenital malformation was evident. Seven patients presented seizures during gestation (2 in the first trimester, 1 in the second trimester, and 4 in the third trimester), without detectable impact on the fetus. It was not necessary to effect any adjustment in the habitual dosage of medication in the remainder of the subjects. No complications in relation to epilepsy arose during delivery or puerperium. The mean APGAR score was 8 at 1 minute and 9 at 5 minutes after birth. Weight, size, and cranial perimeter in all assessments were between the 50th and 75th percentiles. The psychomotor development of the children was appropriate throughout the study according to the Denver test. None of the newborn children suffered from seizures. All of them received artificial lactation. Anthropometric growth and psychomotor development of children born to epileptic mothers under treatment with lamotrigine monotherapy during gestation are similar to those of the general population. These data indicate that the new AEDs present a considerable therapeutic advantage not only in the handling of epilepsy in different clinical situations, but also with the good results observed in the use of lamotrigine with female epileptic patients of child-bearing age.