Life threatening toxicities

Lamotrigine has caused skin rashes and lifethreatening Stevens-Johnson syndrome or toxic epidermal necrolysis. Children are at higher risk (1–2% incidence), especially if they are also taking valproic acid. Zonisamide may also cause severe skin reactions. Reports of aplastic anemia and acute hepatic failure have limited the use of felbamate to severe, refractory seizure states. Neural tube defects (eg, spina bifida) are associated with the use of valproic acid; carbamazepine has been implicated as a cause of craniofacial anomalies and spina bifida; and a fetal hydantoin syndrome has been described after phenytoin use by pregnant women.