The Long-Term Neuropsychological Development of Children Exposed to Antiepileptic Drugs In Utero (the Liverpool and Manchester Neurodevelopmental Study Group).
Abstract number :
3.244
Submission category :
Year :
2001
Submission ID :
2726
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
J. Vinten, BSc, Neurological Science, University of Liverpool, Liverpool, Merseyside, United Kingdom; J. Gorry, BSc, Neurological Science, University of Liverpool, Liverpool, Merseyside, United Kingdom; G.A. Baker, BA, MSc, PhD, Neurological Science, Univ
RATIONALE: Prenatal exposure to specific antiepileptic drugs (AEDs) in utero may have a detrimental effect on cognition and behaviour, resulting in a lowering of intelligence scores and an increase in additional educational support. The purpose of this study was to examine the long-term effects of intrauterine AED exposure on neurodevelopment and psychological functioning in school-age children.
METHODS: Mothers with epilepsy who had attended clinics over the last ten years were contacted. 161 mothers with epilepsy and 251 offspring were assessed in a retrospective study. Assessments included: structured interviews with parents to assess the child[ssquote]s behaviour and schooling, psychometric tests to assess maternal IQ (NART), the child[ssquote]s IQ (Wechsler) and memory functioning (Rivermead). In addition, a full medical history was taken which included maternal epilepsy type, maternal drug therapy and frequency of seizures during pregnancy.
RESULTS: Of the 251 children: 40 were exposed to Sodium Valproate monotherapy (VPA), 47 Carbamazepine monotherapy (CBZ), Polytherapy with VPA (n=23), other Polytherapies (n=23) and 72 were unexposed. Those children exposed to VPA had a significantly lower mean verbal IQ (82.26) than CBZ (94.63) and the non-exposed group (91.81) at the p[lt]0.05 level. Children exposed to VPA monotherapy had the lowest full scale IQ when compared to all groups. Memory impairment and Special Educational Needs (SEN) were more likely to be associated with the VPA group, with only 41% having normal memory functioning and 42% registered as having SEN, compared to the other drug exposed groups.
CONCLUSIONS: These group differences may indicate that VPA therapy during pregnancy appears to have more detrimental long-term effects on the offspring than other AEDs. Exposure to VPA in utero, while confounded by seizure type and epilepsy syndrome, appears to be associated with increased cognitive impairment, an increased number of reported behavioural problems and a higher number of children with SEN. This has significant clinical implications for the management of women with epilepsy.
Support: The Epilepsy Research Foundation (A Charitable Organisation).