Neurodevelopment After In Utero Exposure to Phenytoin and Carbamazepine-Reply

Gideon Koren, MD
JAMA. 1994;272(11):851. doi:10.1001/jama.1994.03520110028019.
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In Reply.  —Careful reading of our study would have revealed to Dr Jeret that separate analysis of only the epileptic cases did not result in an outcome different from those treated with carbamazepine for nonepileptic indications (top of page 769). Careful reading would have revealed to him also that there was no correlation between the daily dose per kilogram of either phenytoin or carbamazepine and global IQ (page 769). Last, careful reading would have disclosed that this study did not compare the two AEDs with each other, but rather with tightly matched controls. That "full dose" phenytoin is associated with serious neurotoxicity to fetuses is certainly concerning and should be communicated to mothers to be.Drs Loring, Meador, and Thompson believe that we should have conducted a different analysis than we have done. The essence of their complaint is that we should have compared the phenytoin and carbamazepine cohorts with


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