Developmental neurotoxicity and anticonvulsant drugs: A possible link

- Avoid anticonvulsants as valproic acid, phenobarbital and phenytoin during pregnancy for risk of cognitive impairment in the offspring.
- Anticonvulsant drug monotherapy should be preferred during pregnancy to reduce possible adverse effects.
- It is important to use the lowest efficacy dose of anticonvulsant drugs during pregnancy.
- More researches are needed for the safety of newer anticonvulsant drugs for epileptic women during pregnancy.

In utero exposure to antiepileptic drugs (AEDs) may affect neurodevelopment causing postnatal cognitive and behavioral alterations. Phenytoin and phenobarbital may lead to motor and learning dysfunctions in the pre-exposed children. These disorders may reflect the interference of these AEDs with the development of hippocampal and cerebellar neurons, as suggested by animal studies. Exposure to valproic acid may result in inhibition of neural stem cell proliferation and/or immature neuron migration in the cerebral cortex with consequent increased risk of neurodevelopmental impairment, such as autistic spectrum disorders. A central issue in the prevention of AED-mediated developmental effects is the identification of drugs that should be avoided in women of child-bearing potential and during pregnancy. The aim of this review is to explore the possible link between AEDs and neurodevelopmental dysfunctions both in human and in animal studies. The possible mechanisms underlying this association are also discussed.