to cause cerebral atrophy similar to hazardous alcohol use in some patients and failed to carry out larger and more rigorous studies. the independent on sunday reported allegations that "scores" of the 1.5 million members of the uk public who use benzodiazepines long-term have symptoms that are consistent with brain damage. it has been described as a "huge scandal" by jim dobbin, and legal experts and mps have predicted a class action lawsuit. a solicitor said she was aware of the past failed litigation against the drug companies and the relevance the documents had to that court case and said it was strange that the documents were kept 'hidden' by the mrc. professor lader, who chaired the mrc meeting, declined to speculate as to why the mrc declined to support his request to set up a unit to further research benzodiazepines and why they did not set up a special safety committee to look into these concerns. professor lader stated that he regrets not being more proactive on pursuing the issue, stating that he did not want to be labeled as the guy who pushed only issues with benzos. professor ashton also submitted proposals for grant-funded research using mri, eeg, and cognitive testing in a randomized controlled trial to assess whether benzodiazepines cause permanent damage to the brain, but similarly to professor lader was turned down by the mrc. the mrc spokesperson said they accept the conclusions of professor lader's research and said that they fund only research that meets required quality standards of scientific research, and stated that they were and continue to remain receptive to applications for research in this area. no explanation was reported for why the documents were sealed by the public records act. jim dobbin, who chaired the all-party parliamentary group for involuntary tranquilliser addiction, stated that: many victims have lasting physical, cognitive and psychological problems even after they have withdrawn. we are seeking legal advice because we believe these documents are the bombshell they have been waiting for. the mrc must justify why there was no proper follow-up to professor lader's research, no safety committee, no study, nothing to further explore the results. we are talking about a huge scandal here. the legal director of action against medical accidents said urgent research must be carried out and said that, if the results of larger studies confirm professor lader's research, the government and mrc could be faced with one of the biggest group actions for damages the courts have ever seen, given the large number of people potentially affected. people who report enduring symptoms post-withdrawal such as neurological pain, headaches, cognitive impairment, and memory loss have been left in the dark as to whether these symptoms are drug-induced damage or not due to the mrc's inaction, it was reported. professor lader reported that the results of his research did not surprise his research group given that it was already known that alcohol could cause permanent brain changes. class-action lawsuit benzodiazepines spurred the largest-ever class-action lawsuit against drug manufacturers in the united kingdom, in the 1980s and early 1990s, involving 14,000 patients and 1,800 law firms that alleged the manufacturers knew of the potential for dependence but intentionally withheld this information from doctors. at the same time, 117 general practitioners and 50 health authorities were sued by patients to recover damages for the harmful effects of dependence and withdrawal. this led some doctors to require a signed consent form from their patients and to recommend that all patients be adequately warned of the risks of dependence and withdrawal before starting treatment with benzodiazepines. the court case against the drug manufacturers never reached a verdict; legal aid had been withdrawn, leading to the collapse of the trial, and there were allegations that the consultant psychiatrists, the expert witnesses, had a conflict of interest. this litigation led to changes in british law, making class-action lawsuits more difficult. special populations neonatal effects benzodiazepines have been found to cause teratogenic malformations. the literature concerning the safety of benzodiazepines in pregnancy is unclear and controversial. initial concerns regarding benzodiazepines in pregnancy began with alarming findings in animals but these do not necessarily cross over to humans. conflicting findings have been found in babies exposed to benzodiazepines. a recent analysis of the swedish medical birth register found an association with preterm births, low birth weight and a moderate increased risk for congenital malformations. an increase in pylorostenosis or alimentary tract atresia was seen. an increase in orofacial clefts was not demonstrated, however, and it was concluded that benzodiazepines are not major teratogens. neurodevelopmental disorders and clinical symptoms are commonly found in babies exposed to benzodiazepines in utero. benzodiazepine-exposed babies have a low birth weight but catch up to normal babies at an early age, but smaller head circumferences found in benzo babies persists. other adverse effects of benzodiazepines taken during pregnancy are deviating neurodevelopmental and clinical symptoms including craniofacial anomalies, delayed development of pincer grasp, deviations in muscle tone and pattern of movements. motor impairments in the babies are impeded for up to 1 year after birth. gross motor development impairments take 18 months to return to normal but fine motor function impairments persist. in addition to the smaller head circumference found in benzodiazepine-exposed babies mental retardation, functional deficits, long-lasting behavioural anomalies, and lower intelligence occurs. benzodiazepines, like many other sedative hypnotic drugs, cause apoptotic neuronal cell death. however, benzodiazepines do not cause as severe apoptosis to the developing brain as alcohol does. the prenatal toxicity of benzodiazepines is most likely due to their effects on neurotransmitter systems, cell membranes and protein synthesis. this, however, is complicated in that neuropsychological or neuropsychiatric effects of benzodiazepines, if they occur, may not become apparent until later childhood or even adolescence. a review of the literature found data on long-term follow-up regarding neurobehavioural outcomes is very limited. however, a study was conducted that followed up 550 benzodiazepine-exposed children, which found that, overall, most children developed normally. there was a smaller subset of benzodiazepine-exposed children who were slower to develop, but by four years of age most of this subgroup of children had normalised. there was a small number of benzodiazepine-exposed children who had continuing developmental abnormalities at 4-year follow-up, but it was not possible to conclude whether these deficits were the result of benzodiazepines or whether social and environmental factors explained the continuing deficits. concerns regarding whether benzodiazepines during pregnancy cause major malformations, in particular cleft palate, have been hotly debated in the literature. a meta analysis of the data from cohort studies found no link but meta analysis of case–control studies did find a significant increase in major malformations. (however, the cohort studies were homogenous and the case–control studies were heterogeneous, thus reducing the strength of the case–control results). there have also been several reports that suggest that benzodiazepines have the potential to cause a syndrome similar to fetal alcohol syndrome, but this has been disputed by a number of studies. as a result of conflicting findings, use of benzodiazepines during pregnancy is controversial. the best available evidence suggests that benzodiazepines are not a major cause of birth defects, i.e. major malformations or cleft lip or cleft palate. elderly significant toxicity from benzodiazepines can occur in the elderly as a result of long-term use. benzodiazepines, along with antihypertensives and drugs affecting the cholinergic system, are the most common cause of drug-induced dementia affecting over 10 percent of patients attending memory clinics. long-term use of benzodiazepines in the elderly can lead to a pharmacological syndrome with symptoms including drowsiness, ataxia, fatigue, confusion, weakness, dizziness, vertigo, syncope, reversible dementia, depression, impairment of intellect, psychomotor and sexual dysfunction, agitation, auditory and visual hallucinations, paranoid ideation, panic, delirium, depersonalisation, sleepwalking, aggressivity, orthostatic hypotension and insomnia. depletion of certain neurotransmitters and cortisol levels and alterations in immune function and biological markers can also occur. elderly individuals who have been long-term users of benzodiazepines have been found to have a higher incidence of post-operative confusion. benzodiazepines have been associated with increased body sway in the elderly, which can potentially lead to fatal accidents including falls. discontinuation of benzodiazepines leads to improvement in the balance of the body and also leads to improvements in cognitive functions in the elderly benzodiazepine hypnotic users without worsening of insomnia. a review of the evidence has found that whilst long-term use of benzodiazepines impairs memory, its association with causing dementia is not clear and requires further research. a more recent study found that benzodiazepines are associated with an increased risk of dementia and it is recommended that benzodiazepines be avoided in the elderly. a later study, however, found no increase in dementia associated with long-term usage of benzodiazepine.