OACS Charity

What is F.A.C.S

 

Fetal Anti-Convulsant Syndrome is caused when a mother uses anti-convulsant medication during pregnancy (also known as Anti-Epileptic Drugs, or AEDs:  AEDs are not only used to treat epilepsy but are also used to treat pain, migraine, bi-polar and other mental health conditions).

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One of the challenges that can occur for the pregnant mother with epilepsy is that some mothers tend to have more severe seizures during pregnancy. 

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It is because of this that some doctors will up the dosage during the pregnancy which can make the fetus more susceptible to problems during pregnancy.

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The risk of disability varies according to the specific drug taken; however, there are some patterns to be seen in them all.

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Fetal anticonvulsant syndrome(s) are/is not a 'genetic' condition in the usual sense but current opinion is that it is in the way these drugs are metabolised by some pregnant women, and/or their affected children, predisposes the unborn baby to damage.

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Many side effects of the fetal anticonvulsant syndromes involve the following areas:

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• Spina bifida

• Cleft lip and palate

• Facial and skull

• Limb defects

• Ear malformations

• Skeletal malformation

• Heart, kidney, urinary tract

• Sexual organ malformations

• Developmental delay

• Autism Spectrum Disorders (ASDs)

• Attention Deficit Hyperactivity Disorder (ADHD)

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Current opinion of Fetal Anti-Convulsant Syndromes:

Not only one Anti-Convulsant Drug causes Fetal Anti-Convulsant Syndromes,

But the majority of Anti- Convulsant Drugs (AED’s), around 10 of which, includes the newer drugs, that may cause the condition Foetal Anticonvulsant Syndromes in various degrees.

Low Dosage:
The lowest possible dose of anti-convulsant medication is recommended along with constant monitoring of the amount of the drug (serum concentration).

Today it is recognised FACS affects males and females in equal numbers. Epilim (sodium valproate) effects 30–40% of children with major or minor malformations, including autism with a 55% chance of a mother on Epilim having a second child born with Foetal Valproate Syndrome (FACS).

Studies Indicate:
That Fetal Valproate Syndrome is associated with a greater risk of neurological and cognitive abnormalities than other anti-convulsant medications

Neuropsychological Assessment
A neuropsychological assessment will determine if there are learning or behavioral difficulties. Basic genetic tests may be carried out to rule any other non-related medical conditions.

Children diagnosed with FACS
Should have a full medical investigation, including heart, kidney scans, along with hearing and vision assessments

Anti-Epileptic Drugs, or AEDs. are not only used to treat epilepsy but are also used to treat pain, migraine, bipolar, mental health and other conditions.

One of the challenges that can occur for the pregnant mother with epilepsy is that some mothers tend to have more severe seizures during pregnancy.  As a result of this, some doctors will up the dosage during the pregnancy which can make the foetus more susceptible to problems during pregnancy.

The risk of disability varies according to the specific drug taken; however, there are some patterns to be seen in all cases. 

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The risk for any one drug is about 6 out of 100 (that is double the background level of risk). The risk increases with the number of drugs. This means that babies of women taking two or more AEDs have between 10-14 out of 100 risk of being born with a problem. For those taking the combination of valproate, carbamazepine and phenytoin, the risk can be as high as 50 out of 100.

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There is also evidence that taking a larger dose of antiepileptic medication carries a greater risk for the baby. Babies of mothers taking more than 1 g per day of valproate have more than twice the risk of congenital malformations, compared with those exposed to 600 mg or less.

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In relation to FVSD/ FVS is a rare condition that occurs when a baby is exposed to VPA (brand names include Epilim Depakene, Convulex, Depakote, Encorate, Valpakine, etc) during the first trimester VPA crosses the placenta and interferes with normal development causing developmental abnormalities in the fetus and malformations. Fetal valproate syndrome (FVS) may occur if a developing baby is exposed to valproic acid during pregnancy. Valproic acid, also known as valproate, is a medication that is often used to treat epilepsy, bipolar disorder, and migraines. Many babies who are exposed to this medication during pregnancy are born healthy with normal growth and development. However, studies have found that women who take valproate during pregnancy have a greater chance of having a baby with a major birth defect or other health problem. Symptoms of FVS vary but may include characteristic facial features, spina bifida, congenital heart defects, cleft lip and/or cleft palate, genital abnormalities, skeletal abnormalities, and developmental delay. A child exposed to valproic acid may be at a higher risk for learning and behavioral problems which include ADHD, Autism. Although there is no cure for FVS, FVSD and/or FACS, many of the possible signs and symptoms of FVS do have treatments or therapies available. Early intervention programs may also be helpful

Please remember there is NO SAFE dose-effect of Epilim (Valproate) in pregnancy!

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Some History -

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Epilim (Sodium Valproate) has a history of adverse developmental effects. The drug is unusual in that its teratogenicity in humans was predicted from animal studies, without any knowledge of mechanism (Brown et al., 1980; Kao etal., 1981).

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Valproic acid, first marketed in Europe in 1967, appeared to be without adversity to development over the initial 13 years following marketing. Then, in the early 1980s, Dalen’s and her associates made the initial association of VPA to birth defects (Dalen’s et al., 1980; Dalen’s, 1981). They reported an infant who died at 19 days of age, was growth retarded, and who had multiple malformations of the face and brain, heart, and skeleton, among other defects. The mother of the infant had taken 1000 mg/day of VPA throughout gestation. These observations were followed by several case reports and other publications attesting to the malformation effects of the drug when administered to a pregnant mother during gestation.

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Some characteristics of foetal anticonvulsant syndrome involve the following areas: spina bifida; cleft lip and palate; facial and skull; limb defects; ear malformations; skeletal malformation; heart, kidney, urinary tracts, and sexual organ malformations, developmental delay, facial features, low muscle tone, Social Communication Disorder, Autism Spectrum Disorder, Attention deficit hyperactivity disorder (ADHD) Speech and Language, Growth and general health, Joint hypermobility, Genitourinary defects. 

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