Mechanisms of Teratogenic Effects of AEDs

Despite the fact that second-generation antiepileptic drugs (AEDs) are already in use, much remains unknown with respect to the mechanisms underlying the teratogenicity of even first-generation AEDs. While many studies have targeted specific mechanisms as potential targets, including epoxidation, oxidative stress, altered folate metabolism, and histone deacetylase inhibition, just how the teratogenicity of these drugs is exerted remains largely unknown. This problem is exacerbated by the fact that many of the newer AEDs have very limited published information available regarding their effects and mechanisms of action. Based on the limited information available, physicians must make informed decisions on the best way to manage pregnant epileptic women without putting the developing embryo at increased risk.