Bromley RL, Calderbank R, Cheyne CP, Rooney C, Trayner P,
Clayton-Smith J,
García-Fiñana M, Irwin B, Morrow JI, Shallcross R, Baker GA;
UK Epilepsy and
Pregnancy Register. Cognition in school-age children exposed
to levetiracetam,
topiramate, or sodium valproate. Neurology. 2016 Aug 31.
pii:
10.1212/WNL.0000000000003157. [Epub ahead of print]
Abstract
OBJECTIVE:
To investigate the effects of prenatal exposure to
monotherapy levetiracetam, topiramate, and valproate on child cognitive
functioning.
METHODS:
This was a cross-sectional observational study. Children
exposed to monotherapy levetiracetam (n = 42), topiramate (n = 27), or
valproate (n = 47) and a group of children born to women who had untreated
epilepsy (n = 55) were enrolled retrospectively from the UK Epilepsy and
Pregnancy Register. Assessor-blinded neuropsychological assessments were
conducted between 5 and 9 years of age. Information was collected on
demographic and health variables and adjusted for in multiple regression
analyses.
RESULTS:
In the adjusted analyses, prenatal exposure to levetiracetam
and topiramate were not found to be associated with reductions in child
cognitive abilities, and adverse outcomes were not associated with increasing
dose. Increasing dose of valproate, however, was associated with poorer
full-scale IQ (-10.6, 95% confidence interval [CI] -16.3 to -5.0, p <
0.001), verbal abilities (-11.2, 95% CI -16.8 to -5.5, p < 0.001), nonverbal
abilities (-11.1, 95% CI -17.3 to -4.9, p < 0.001), and expressive language
ability (-2.3, 95% CI -3.4 to -1.6, p < 0.001). Comparisons across
medications revealed poorer performance for children exposed to higher doses of
valproate in comparison to children exposed to higher doses of levetiracetam or
topiramate.
CONCLUSIONS:
Preconception counseling should include discussion of
neurodevelopmental outcomes for specific treatments and their doses and women
should be made aware of the limited nature of the evidence base for newer
antiepileptic drugs.
Courtesy of: http://www.medscape.com/viewarticle/868278
___________________________________________________________________
Teens whose moms took valproate and other antiepileptic
drugs (AEDs) during pregnancy lag behind their classmates in math and reading
skills, according to preliminary results of a new study.
Previous studies looked at the cognitive effect of being
exposed to these drugs prenatally but only up to about preschool age.
The new results were reported here by Lars S. Elkjær,
research year student, Department of Neurology, Aarhus University Hospital,
Aarhus, Denmark,at the 2nd Congress of the European Academy of Neurology…
The researchers adjusted the results for many possible
confounders, including family income and the educational level of the mother,
which, according to Elkjær, is one of the most important factors influencing
how well kids perform in the school setting. They also adjusted for calendar
year and the child's gender.
At the meeting here, Elkjær reported only the results from the
sixth grade testing.
"Overall, the AED-exposed children performed
significantly worse, especially the children exposed to valproate,"
compared with an unexposed reference group of children (who after
standardization, performed at the mean of 0), said Elkjær.
For valproate, the adjusted mean z-score was –0.28 (95%
confidence interval [CI], –0.41 to –0.14).
Interestingly, children exposed to clonazepam also performed
significantly worse on these school tests than did unexposed kids.
However, lamotrigine-exposed children "are performing
almost identically to the unexposed children," said Elkjær. The adjusted
mean z-score for lamotrigine was 0.01 (95% CI, –0.01 to 0.04).
The children whose mothers took an AED during pregnancy did
worse than unexposed children, whether or not the mother took the drug because
of epilepsy. Elkjær later told delegates that it would be "a good
idea" to learn what other diagnoses these women might have had…
Session co-chair Reeta Kälviäinen, MD, PhD, professor of
clinical epileptology, University of Eastern Finland, Kuopio, Finland,
commented that it's because of the Danish registries that such a study could be
carried out. She also emphasized the importance of investigating the effect of
prenatal valproate exposure in the teenage years.
"That is very important because, at the moment, we only
know the effect of valproate at the preschool age, and there might be some
catching up going on" among exposed children, she said.
Asked if a high dose of valproate had an even larger effect
on cognitive skills in exposed children, Elkjær noted that not many children in
the cohort were exposed to a high level of valproate. His research group has
not yet done such an analysis but hopes to do so, he said.
2nd Congress of the European Academy of Neurology. Abstract
O1109. Presented May 28, 2016.
http://www.medscape.com/viewarticle/864000
No comments:
Post a Comment