open access: Nature Reviews: Key Advances in Medicine

Key advances
■ Early‑onset refractory symptomatic
epilepsy, frequent generalized tonic–
clonic seizures, and use of antiepileptic
drug (AED) polytherapy are all significant
risk factors for sudden unexpected death
in epilepsy 2
■ A cell‑free extract from human adipose
stem cells has antiseizure and
antiepileptogenic effects in mice 3
■ The HLA‑A*3101 allele is associated with
carbamazepine‑induced hypersensitivity
reactions among Europeans 6
■ The risk of malformation in offspring of
woman taking AEDs depends not only
on the type of medication, but also on
the AED dose and the parental history of
congenital malformation 7
■ Interictal high‑frequency oscillations
measured with scalp electrodes can
reliably delineate the seizure‑onset zone
in patients with focal epilepsy 9
In a recent important publication, Tomson
et al. 7 compared the relative teratogenicity
of four common AEDs—carbamazepine,
pheno barbital, valproic acid and lamotrigine—on
the basis of data from the EURAP
epilepsy and pregnancy registry. The authors
showed that the risk of major congenital malformations
increased in a dose-dependent
manner with all four assessed AEDs. Particularly
high malformation rates were observed
with valproic acid doses >1,500 mg per day. 7
The treatment associ ated with the lowest rate
of malforma tions—lamotrigine at a dose of
1,000 mg per day). Valproic acid doses of