Antiepileptic Drugs and Neurodevelopment: An Update
- 407 Downloads
In utero exposure to some antiepileptic drugs (AEDs) is associated with an increased risk of impaired cognitive development. Specifically, valproate and polytherapy exposure are each associated with an increased risk of cognitive impairment in children compared with other antiepileptic medications. The data regarding the risk to neurocognitive development imposed by maternal use of other AEDs are conflicting or insufficient at this time to draw definitive conclusions. Behavioral dysfunction including autistic spectrum disorder is also associated with maternal use of AEDs during pregnancy. Whether treatment with AEDs during childhood permanently affects cognitive neurodevelopment is yet to be determined.
KeywordsAntiepileptic drugs Cognition Neurodevelopment Epilepsy Pregnancy
K.J. Meador has received a grant from the National Institutes of Health (NIH); has been a consultant on grants for NIH; has been a Primary Investigator for a grant from NIH/National Institute of Neurological Disorders and Stroke; has been a Co-investigator on a grant from NIH/National Center on Minority Health and Health Disparities; and has been a Co-investigator on a grant from NIH.
Conflicts of interest: S. Palac: none; K.J. Meador: has been a Co-investigator on a grant from Epilepsy Foundation of America; has been a Primary Investigator for a grant from Pfizer Pharmaceuticals; has been a Primary Investigator and Co-investigator for grants from UCB Pharma; has been a Co-investigator on grants from Neuropace, Inc.; has been a Primary Investigator for a grant from GlaxoSmithKline; has been a Primary Investigator for a grant from Schwartz Biosciences (UCB Pharma); has been a Co-investigator on a grant from Marinus Pharmaceuticals, Inc.; has been a Co-investigator on a grant from Myriad Pharmaceuticals, Inc.; has traveled to speak for Sanofi Aventis; is on the editorial board for the journal Epilepsy Currents; and is a member of the professional advisory board for the Epilepsy Foundation of America.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 12.• Nicolai J, Vles JSH, Aldenkamp AP. Neurodevelopmental delay in children exposed to antiepileptic drugs in utero: a critical review directed at structural study-bias. J Neurol Sci. 2008;271:1–14. In this literature review, studies of the cognitive effects of in utero exposure are summarized and critically reviewed. Methodologies that should limit interpretation of study results are highlighted. PubMedCrossRefGoogle Scholar
- 13.Adab N, Tudur Smith C, Vinten J, et al. Common antiepileptic drugs in pregnancy in women with epilepsy (Review). Cochrane Database of Systematic Reviews 2010, Issue 1.Google Scholar
- 14.•• Meador KJ, Baker GA, Browning N, et al. Cognitive function at 3 years of age after fetal exposure to antiepileptic drugs. NEJM. 2009;360:1597–605. This is the first prospective study of the long-term cognitive effects of in utero exposure to AEDs. It is also one of the few studies of this subject that analyzes factors that could confound the data. PubMedCrossRefGoogle Scholar
- 20.•• Vinten J, Bromley RL, Taylor J, et al. The behavioral consequences of exposure to antiepileptic drugs in utero. Epilepsy Behav. 2009;14:197–2001. This study examines long-term behavior consequences of in utero exposure to AEDs. The cognitive tools used are scales that evaluate life skills and parental stress. PubMedCrossRefGoogle Scholar