Prevention If possible, VPA should be avoided during pregnancy. If the use of antiepileptic medications during pregnancy cannot be avoided, they should be administered as a single drug. The lowest possible dose of the antiepileptic medication should be used as well as constant monitoring of the amount of the drug (serum concentration) should be performed.
Also, it is recommended that women taking valproate take folic acid supplements, both before conception and during pregnancy to reduce the risk of malformations.
However, most women with epilepsy have healthy children. While some infants exposed to an anticonvulsant drug in utero have abnormalities, others do not. Genetic differences in the fetal response to medications probably play a role. The risk of recurrence of FVS in a subsequent pregnancy exposed to VPA would therefore appear to be high, possibly due to inherent problems with the metabolism of VPA in the mothers concerned. Regular counseling is recommended for women with epilepsy to discuss the risks that seizures present for both the developing fetus and the expectant mother.
Treatment The treatment of FVS is directed toward the specific symptoms that are apparent in the child. Treatment may require the coordinated efforts of a team of specialists. Pediatricians, oral surgeons, plastic surgeons, neurologists, psychologists, and other healthcare professionals may need to systematically and comprehensively plan an affect child’s treatment.
Infants with FVS can benefit from early developmental intervention to ensure that affected children reach their potential. Affected children may benefit from occupational, physical and speech therapy. Various methods of rehabilitative and behavioral therapy may be beneficial. Additional medical, social and/or vocational services may be necessary. Psychosocial support for the entire family is essential as well.
Some children with mild spina bifida may not require treatment, but surgery may be considered for children with moderate to severe spina bifida. Surgery may help prevent the worsening of the condition in some children, but cannot restore the lost muscle function. In those extreme cases where the sac (meningocele) breaks or appears about to break, immediate surgery becomes essential. Individuals with severe spina bifida may develop contractures (shortening of the muscles) and abnormalities of posture. This is due to the paralysis of muscles in the legs. A child with spina bifida should have the necessary therapy (orthopedic and physical) beginning at an early age to prevent contractures. (For more information on this disorder choose “spina bifida” as your search term in the Rare Disease Database).
Surgery may be necessary to correct heart defects as well as other physical abnormalities that may be present.