Failure of periconceptual folic acid to prevent a neural tube defect in the offspring of a mother taking sodium valproate
1999; Elsevier BV; Volume: 8; Issue: 4 Linguagem: Inglês
10.1053/seiz.1999.0283
ISSN1532-2688
AutoresJohn Craig, Patrick J. Morrison, Jim Morrow, Victor Patterson,
Tópico(s)Metabolism and Genetic Disorders
Resumo, it has been suggested that women on VPAshould take a similar high-dose periconceptually. Wereport the case of a woman exposed to VPA who gavebirthtoaninfantwithanNTD,amongothermalforma-tions, despite taking high-dose folic acid periconceptu-ally and emphasize there is no evidence that folic acidin any dose protects against NTDs caused by VPA.Case ReportA baby boy was delivered to a 26 year old womanfollowing a planned pregnancy. The child had a lum-bosacral NTD, small ventricular and atrial septal de-fects, a cleft of the soft palate, bilateral talipes and fea-tures consistent with foetal valproate syndrome. Chro-mosomal analysis demonstrated a normal male kary-otype. The NTD and cleft palate were subsequentlyrepaired.The mother, who was otherwise well, had presentedaged 16 years with a 2 year history of prolonged ab-senceseizuresandanEEGshowingfeaturesinkeepingwith primary generalized epilepsy. She was prescribedVPA500mgBD(twicedaily)andbecameseizurefree.Four years later the seizures returned and the dose ofVPA was increased to 1000 mgs twice daily. The mar-ried woman, who at the age of 23 had been seizurefree for 4 years, was prescribed 4mg/day folic acid.She remained seizure free and 18 months later becamepregnant. She stopped the folic acid at the end of thefirst trimester. There was no family history of birthabnormalities. Foetal ultrasound during the pregnancyhad raised no concerns.DiscussionSodium valproate was the probable cause of the mal-formations, as all have been described with this drug
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