User:Deborah Mann/sandbox

This article has been written with the support of the Organisation for Anti-Convulsant Syndromes

AED's or Anti-epileptic drugs/anticonvulsant medication is not only used for epilepsy, but also to treat pain, migraine and mental health conditions. It is not known why, but in some mothers taking this medication, the fetus is effected by the anticonvulsant medication. It is suspected that the mother is probably genetically inclined to transfer the effects of this medication, via the placenta to the unborn child, due to how these drugs are metabolised by the mother taking them. Fetal anticonvulsant syndrome and mutation in the maternal MTHFR gene.Dean JC1, Moore SJ, Osborne A, Howe J, Turnpenny PD. At present there is no test for fetal anti-convulsant syndrome.

The nature of the disability is predetermined by the anti-epileptic medication taken, however there are often some similarities in the disabilities of this group of medicines. The damage to the fetus occurs during the first trimester. Paediatric and Perinatal Drug Therapy, 2006; 7 (3) Fetal valproate syndrome: a review - Usha Kini

Those foetuses born to mothers using polytherapy (using more than one drug) and those taking higher dosages of anti-convulsant medication are more likely to be susceptible to developing fetal anticonvulsant syndromes. There is sometimes a need to increase in medication during pregnancy. This happens if it be suspected that the mother is at risk of having epileptic fits, as there is also a risk to the fetus if the mother should have an epileptic fit during the pregnancy. Medscape multispecialty; Therapeutic Advances in Drug Safety Antiepileptic Drugs in Women With Epilepsy during Pregnancy

There is evidence that women who have had one child diagnosed with fetal anti-convulsant syndrome, the risk of having a second affected baby may be as high as 55%. The risk of anti-convulsant syndrome is believed to be higher when the mother takes more than one AED. http://jmg.bmj.com/content/37/7/489.full  It is believed that taken folic acid during the first four months of pregnancy may have some preventative value.

It is well documented that anticonvulsant medication causes congenital abnormalities. The figures of this are given as between 6 – 12%, depending upon the source of information. These abnormalities include spina bifida, cleft and lip palette, heart defects, kidney and liver problems. Recent research has now shown that there is a 35-40% chance of neurodevelopmental delay in sodium valproate Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. Christensen J1, Grønborg TK, Sørensen MJ, Schendel D, Parner ET, Pedersen LH, Vestergaard M. Many of the new drugs have yet to be tested for neurodevelopmemntal delay, however this does appear to be an underlying trend in those with anticonvulsant syndromes.

recommendations It is also recommended that the baby is given 1mg of vitamin K at birth. Those with dysmorphic features should be noted and be followed up by the new-born hearing screening programme.

'''It is extremely important to keep taking your epilepsy medicine during pregnancy. It is important to seek medical advice, as you may be able to take a safer drug. Stopping medication can bring about a greater number of seizures. In some circumstances, this could put you and your baby’s life at risk.'''

The following are just some of the challenges that have been associated with fetal anti convulsant syndrome:

New-born jaundice	                               Perinatal distress	                  Low apgar scores Natal withdrawl	                               Respiratory distress	                  Natal withdrawal hypoglycaemia	                               Decreased fetal weight	                  Sleeping too much in day

Dysmorphic Features Full cheeks with small chin	                epicanthic folds	                   Thin upper lip anteverted nose (nostrils tipped upwards)	 infraorbital grooves (under eye socket)  prominent and/or low set ears abnormal philtrum (below nose)	                Thin upper lip	                           Trigonocephaly (triangular shaped skull Cleft and lip pallet	                         Broad nasal bridge	                   wide fontanel

Physical Malformations''' Congenital heart problems	                Problems with wrists and hands  	   Problems with their feet direct hyperbilirubinemia	                Problems with gastronomical system	   Short sighted and other eye more serious eye problems Problems with the ears	                        Male genitalia problems	           Congenital kidney defects hypertonia	                                teeth problems                            Spina bifida Glutton and lactose intolerance. Cyanosis, low oxygen levels in blood     Bowel problems

Neurodevelopmental Depression	                                apathy	                                   Suicidal thoughts Excessively aggressive	                        Learning Difficulties	                   Autism/Asperger’s ADHD	                                        Dyslexia/dyspraxia 	                   Poor language memory