title: Antiepileptic drugs: a case report in a pregnancy with a neural tube defect.
abstract: While receiving lamotrigine, a patient pregnant with triplets suffered a double fetal neural tube defect. Plasma homocysteine, folate, vitamins B12 and B6 (pyridoxal phosphate), and red cell folate levels were measured in samples while she was receiving folic acid therapy for 1 month during the second trimester of pregnancy. Some mutations were sought, involved in homocysteine metabolism and linked with the folate metabolism. Her results were compared with those of a pregnant woman with normal triplets and with those of 58 pregnant women, with a normal pregnancy. Results indicated a decrease in vitamin B12 and B6 values in plasma in the patient, and a genotype AG (polymorphism A66G) was observed, but was not found in the pregnant woman with normal triplets. Even if lamotrigine therapy is not known to be associated with significant changes in red cells or in serum folate, periconceptional folic acid supplementation is counseled for women, along with periconceptional B12 and B6 vitamin supplementation when their plasma values are decreased.
authors.affiliation: Inserm UI 145 and Biochemistry, Hôpital Pasteur, Nice, France. candito.m@chu-nice.fr
authors.forename: Mirande
authors.initials: M
authors.lastname: Candito
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Guéant
authors.forename: Mourad
authors.initials: M
authors.lastname: Naimi
authors.forename: Alain
authors.initials: A
authors.lastname: Bongain
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Van Obberghen
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D005260:Female; D005492:Folic Acid / Q000097:blood / Q000627:therapeutic use; D006710:Homocysteine / Q000097:blood; D006801:Humans; D000077213:Lamotrigine; D020190:Myoclonic Epilepsy, Juvenile / Q000097:blood / Q000188:drug therapy*; D009436:Neural Tube Defects / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000188:drug therapy*; D011272:Pregnancy, Multiple; D014227:Triazines / Q000627:therapeutic use*; D014310:Triplets; D014803:Vitamin B Complex / Q000097:blood / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D014227:Triazines; D006710:Homocysteine; D014803:Vitamin B Complex; D005492:Folic Acid; D000077213:Lamotrigine