Neonates
with fetal alcohol syndrome are usually jittery. Seizures are not frequent
except in neonates with midline prosencephalic abnormalities. Midline
prosencephalic abnormalities are agenesis of the corpus callosum, septo-optic
dysplasia, and holoprosencephaly. Other brain malformations that occur
in fetal alcohol syndrome are errors in neuronal and glial proliferation
and neuronal migration. Intelligence quotient tends to correlate with
dysmorphic features—the more dysmorphic, the more delayed. An EEG pattern
characterized by excessive hypersynchronicity has been reported. Cardiac
septal defect occurs in about half of these patients.
Anticonvulsant
Fetal Syndrome
The maternal
use of anticonvulsant drugs during pregnancy, especially phenytoin, phenobarbital,
or primidone, may produce congenital microcephaly. Carbamezapine and valproic
acid have been involved in producing fetal malformation syndromes, but
microcephaly is not one of their major features. Neonates with fetal exposure
to anticonvulsant drugs often have characteristic facies. Their most salient
features include large fontanelles, metopic suture ridging, ocular hypertelorism,
epicanthal folds, broad nasal bridge, and hypoplasia of the distal phalanges
and nails. Bifid or shawl scrotum, cardiac abnormalities, and cleft lip
and palate may also occur. The teratogenic effect of these drugs may be
related to their conversion to their epoxide compounds and the inability
of the fetal liver to transform them. Patients with fetal anticonvulsant
syndrome are developmentally delayed. The diagnosis is made by maternal
history of anticonvulsant drug intake during pregnancy.
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