Developmental outcomes at age four following maternal antiepileptic drug use

Richards, Noni; Reith, David; Stitely, Michael L.; Smith, Alesha

doi:10.1016/j.yebeh.2019.01.018

Cited by 11 publications

(17 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, in utero exposure to VPA showed statistically more children below average range (score <84) for overall early development in comparison to control group (8%, p < 0.001). Similar results on neurocognitive development have been found in other studies where VPA and lamotrigine led to a statistically significant increased risk of having abnormal emotional and behavioral development (11). Conversely, carbamazepine was not associated with increased risk of emotional or behavioral development.…”

Section: Neurocognitive Considerationssupporting

confidence: 88%

“…Recent data from the EURAP registry has shown that in fact these new practices have led to a statically significant reduction in MCM worldwide (7). With this change in practice, other impacts need to be considered and discussed with patients regarding children exposed to ASMs in utero such as lamotrigine, even though they may have a relatively low MCM rates (i.e., abnormal emotional and behavioral development) (11,18).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Principles of Epilepsy Management for Women in Their Reproductive Years

Spiegel

Merius

2020

Front. Neurol.

View full text Add to dashboard Cite

In the United States, there are over one million women with epilepsy (WWE) in their childbearing years. Pregnancy can be challenging for this population. A number of international registries have documented that children born to these women are at increased risk for major congenital malformations (MCM), lower intelligence quotient scores and neurodevelopmental disorders, when the mother is managed on antiseizure medications (ASMs). To prevent poor neonatal outcomes for this population, safe and thoughtful management strategies are necessary. We propose to divide these management strategies into five principles. These include (I) choosing suitable ASMs for the patient's seizure type, (II) choosing an ASM with the least teratogenic and cognitive side effects, (III) dosing at the lowest possible effective dosage, (IV) selecting the best ASM regimen as promptly as possible, even before a woman has her first menses, and (V) supplementing these patients with folic acid in order to try to enhance cognition and reduce neural tube defects.

show abstract

Section: Neurocognitive Considerationssupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Principles of Epilepsy Management for Women in Their Reproductive Years

Spiegel

Merius

2020

Front. Neurol.

View full text Add to dashboard Cite

show abstract

“…Contrasting research citing comparable outcomes for lamotrigine‐ and valproate‐exposed children was confounded by lower mean ASM dosages, 22,37 with one study failing to observe well‐established impacts of valproate on cognition, indicating limited methodologies.…”

Section: Resultsmentioning

confidence: 98%

“…A prospective cohort study noted higher proportions of parent‐rated autistic traits in lamotrigine‐exposed children relative to the unexposed cohort at 3 and 4 years 15,31 . Richards et al 37 reported poorer outcomes for lamotrigine‐exposed children ( n = 149) on routinely administered developmental and emotional/behavioral measures, as reported by parents, and comparisons to population norms indicated lamotrigine‐exposed children ( n = 88) as having significantly higher parent‐rated proportions of autistic behavior symptoms and defiance/conduct difficulties at 6–8 years 38 . However, rates of referrals for clinical intervention were low at 6%, and therefore the clinical significance of these ratings remains to be determined.…”

Section: Resultsmentioning

confidence: 99%

“…Data for early neurodevelopmental conditions were less clear. Parent‐rated traits/symptoms of autism were increased in lamotrigine‐exposed children, 15,31 but this did not translate into elevated rates of diagnosis 13,34,36 or clinical referrals 37 . Further work should investigate whether there are subdiagnostic levels of social communication difficulties in lamotrigine‐exposed children that are being highlighted via parental report, or whether these results have arisen from aspects of uncontrolled biases.…”

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Neurodevelopmental outcomes in children exposed to newer antiseizure medications: A systematic review

2021

View full text Add to dashboard Cite

As prenatal exposure to certain older antiseizure medications (ASMs) has been linked with poorer neurodevelopmental outcomes in children, the use of newer ASMs throughout pregnancy has increased. The current review aimed to delineate the impact of in utero exposure to these newer ASMs on child neurodevelopment. A systematic search of MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature Plus, and PsycINFO was conducted, limiting results to articles available in English and published after the year 2000. Studies investigating neurodevelopmental outcomes following in utero exposure to the following ASMs were eligible for inclusion in the review: eslicarbazepine, gabapentin, lacosamide, lamotrigine, levetiracetam, oxcarbazepine, perampanel, topiramate, and zonisamide. Thirty‐five publications were identified, and a narrative synthesis was undertaken. Methodological quality was variable, with distinct patterns of strengths/weaknesses attributable to design. Most studies examined lamotrigine exposure and reported nonsignificant effects on child neurodevelopment. Comparatively fewer high‐quality studies were available for levetiracetam, limiting conclusions regarding findings to date. Data for topiramate, gabapentin, and oxcarbazepine were so limited that firm conclusions could not be drawn. Concerningly, no studies investigated eslicarbazepine, lacosamide, perampanel, or zonisamide. Exposure to certain newer ASMs, such as lamotrigine and levetiracetam, does not thus far appear to impact certain aspects of neurodevelopment, but further delineation across the different neurodevelopmental domains and dosage levels is required. A lack of data cannot be inferred to represent safety of newer ASMs, which are yet to be investigated.

show abstract