Abstracts

Rationale: There is limited data regarding the neurodevelopment of children exposed to widely used antiepileptic drugs such as lamotrigine or levetriacetam. Such a lack of data reduces the ability to provide evidence based counseling regarding medication use during pregnancy. A prospective observational study was undertaken in order to provide this important information.  Methods: Pregnant women (n=396) were recruited prior to 21 weeks gestation from 21 hospitals in the UK and from new registrants to the UK Epilepsy and Pregnancy Register. Demographic and medical details were recorded from maternal report and hospital records. Postnatal development was assessed using the Vinelands Adaptive Behavior Scale, 2nd edition at one year of age. A blinded face-to-face assessment using the Bayley Scales of Infant and Toddler Development, 3rd edition was undertaken at two years of age in the child’s home. Maternal IQ was measured blinded using the Wechsler Abbreviated Intelligence Scale, 2nd edition. Results: In total 278 children were assessed at 2 years of age. There was no significant difference in the early cognitive development of either the children exposed to monotherapy lamotrigine (n=75; mean 102 SD 11.7) or those exposed to monotherapy levetiracetam (n=50; mean 103 SD 16.7) in comparison to women who weren’t on medication during pregnancy (n=54; mean 102 SD 12.7). In a regression model adjusting for maternal IQ, socio-economic status and gestational age, exposure to either lamotrigine (-.22 95% CI -4.5 to 4.1, p=.917) or levetiracetam (.23 95% CI -4.6-5.1, p=.927) were not associated with altered development at two years of age. Similar results were seen for the language and motor development indexes. No association between increasing dose of either lamotrigine or levetiracetam and poorer child cognitive, language, or motor development was demonstrated.   Conclusions: This data provides reassuring evidence regarding the early developmental outcome of children exposed in utero to lamotrigine or levetiracetam. Longer term follow up is required to inform on the development of more complex cognitive functioning in children exposed to these medications.  Funding: National Institute for Health Research UK