Digit effects produced by prenatal exposure to antiepileptic drugs

The hypothesis tested was that digit anomalies among individuals exposed in utero to antiepileptic drugs (AED) are best identified by a systematic sea rch, including radiographs and dermatoglyphics, rather than relying only on visual inspection, A systematic search was made for five types of digit ab normalities in 46 AED-exposed individuals ages 5-29 years in comparison wit h controls: visible anomalies, size of fingernails, dermal ridge patterns, length of metacarpals and phalanges, and qualitative changes in the distal phalanges. Among the AED-exposed, nail size was not decreased. However, the re was a 10.8% frequency of digit anomalies, a 12% frequency of three or mo re arch patterns, and significant shortening and qualitative changes in the distal phalanges, all of which are consistent with the fetal effects of AE D. Among the 42 individuals who underwent all evaluations, 14.3% had two or more of these abnormalities, most of which would not be identified by clin ical inspection. This frequency is much higher in these AED-exposed individ uals than in the general population. Radiographs in 13 individuals over a p eriod of several years showed that the changes in the phalanges and metacar pals persisted. (C) 2000 Wiley-Liss, Inc.