Letter to the Editor

Concerning the November issue of Neurology Alert and the article "Antiepileptics During Pregnancy," one point that was not emphasized in the study performed in Iceland was that the incidence of major congenital malformations in epileptic mothers not treated with anti-epileptics was still greater than two-fold over the general population without epilepsy. I do think that this point was not made.

When dealing with epilepsy in general, we see a higher incidence of congenital malformations as opposed to the general population. The point was well made that with multiple anti-epileptics, there is a higher risk of malformation. The question must be raised as to whether the anti-epileptics add to the risk of major congenital malformations that may not by themselves increase the risk. The epilepsy itself may be a risk factor.

This point has been touched on in the past and women with epilepsy need to be aware of this fact since there is always a question as to whether it would be safer to be off the medication.


Felix Brizuela, Jr., DO
Neurological Institute of Western Pennsylvania
Greensburg, PA

Response from Dr. Plum:

Thank you for your letter to the publishers of Neurology Alert pointing out that epileptic mothers not treated with anti-epileptics was greater than two times over the general population. As you might expect, I can’t bring out all of the points from the literature in one small report and I must adhere to what the authors themselves have addressed. Nevertheless, I think it is quite clear by well carried out drug studies that anti-convulsants as a group not only increase the risk of malformations in epileptic mothers, but even more, some have a more grave influence than others.

I’m delighted that you’re interested in reading Neurology Alert. We do our best to keep important things at our readers’ fingertips.


Fred Plum, MD