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Epilepsy and pregnancy

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    Epilepsy and pregnancy. Edited by t tomson, l gram, m sillanpaa, and s i johannessen. (Pp 215; £38.00.) Published by Wrightson biomediacal publishing, Petersfield. 1997. ISBN 1 871816 36 X.

    The use of antiepileptic drugs in women of childbearing age is one of the most thorny issues regularly facing neurologists. The stakes are high but there is no universally agreed approach to management. This book explores various aspects of the problem, including teratogenicity, epilepsy control in pregnancy, and the consequence of seizures to mother and child in pregnancy and at delivery. There are valuable chapters describing increasing knowledge of the mechanisms of teratogenicity of antiepileptic drugs and the minor developmental and cognitive consequences of anticonvulsant exposure in utero; an area of increasing concern. Breast feeding is also covered. I suspect that most readers would expect to discover a detailed review of current evidence in relation to teratogenicity. This section is really the nub of the book but it lacks sufficiently detailed statistics for a text devoted to this subject and I think that it is just a gateway to the source literature. There are also several key issues in relation to new drugs: how and when they should be used in women of child bearing age; how to manage their pregnancies; and how to coordinate postmarketing surveillance. These matters are not considered; nor is there any information on the most recent antiepileptic drugs, even though some data are available from postmarketing surveillance and from animal studies. This book covers a broad range of issues competently in a series of brief chapters with good literature citations but lacks a sufficiently detailed analysis of teratogenicity of antiepileptic drugs to be of real help to the clinician in making decisions in this potential minefield.