Because of the potential for malformations, the couple expecting a child exposed to AEDs in utero should be counseled about the risks and offered appropriate screening. This is especially true if either parent has a history of an inherited disorder. An ultrasound at 10-12 weeks of gestation should be performed to detect neural tube defects early in the pregnancy. Women with epilepsy also should have prenatal testing with measurements of maternal a-fetoprotein levels by 14 to 16 weeks of gestation and high-level ultrasonography at 16 to 20 weeks of gestation to evaluate the fetus further for any major structural abnormalities. Depending on the results, amniocentesis with measurement of a-fetoprotein and acetylcholinesterase levels should be considered.30,38,41

Adapted from: Klein P and Herzog AG. Endocrine aspects of partial seizures. In: Schachter SC, Schomer DL, eds. The comprehensive evaluation and treatment of epilepsy. San Diego, CA: Academic Press; 1997. p. 207-232.
With permission from Elsevier (www.elsevier.com).
Reviewed February 2004 by Cynthia Harden, MD, Weill Cornell Medical College.