Whereas a lot knowledge focuses on the danger of prenatal publicity to antiepileptic medicine (AEDs) and the danger of congenital malformations, there’s a rising physique of literature to point that that publicity to sure antiepileptic medicine, most notably valproic acid (VPA, Depakote) throughout crucial intervals of growth could also be related to long-lasting neurodevelopmental deficits throughout a number of domains. In distinction, different research recommend that prenatal publicity to the newer AEDs (e.g., lamotrigine, leviceteram) seem to pose little danger by way of neurodevelopmental outcomes.
Launched in 2012, the Maternal Outcomes and Neurodevelopmental Results of Antiepileptic Medicine (MONEAD) research is a potential, observational investigation of neurodevelopmental outcomes within the kids of moms with epilepsy. On this research, pregnant girls had been recruited from 20 US epilepsy facilities, and their kids have been adopted prospectively from start to 6 years of age. A latest report particulars the assessments of kids at two years of age.
The Bayley Scales of Toddler and Toddler Growth, Third Version (BSID-III) was used to evaluate neurodevelopmental outcomes. The evaluation included BSID-III assessments from 292 kids of ladies with epilepsy and 90 kids of wholesome girls. Amongst girls with epilepsy most acquired monotherapy with both lamotrigine (n=97 ) or levetiracetam (n=70). Twenty-five of 55 utilizing polytherapy used lamotrigine plus levetiracetam.
The researchers discovered no variations between the 2 teams throughout the 5 BSID-III domains (language, motor, cognitive, social-emotional, and common adaptive). Maternal nervousness, melancholy, and perceived stress had been all related to worse outcomes for the cognitive, social-emotional, and common adaptive domains. In a secondary evaluation the place they appeared on the affiliation between third trimester antiepileptic drug (AED) blood ranges and BSID-III scores, they did observe that greater AED ranges had been related to decrease scores of motor and common adaptive functioning.
These findings are encouraging and recommend that the newer AEDs, particularly lamotrigine and levetiracetam, are usually not related to worse neurodevelopmental outcomes, though there could also be some shifts in motor and common adaptive functioning in kids uncovered to greater doses of those medicines. The authors do level out that these findings, whereas reassuring, have to be interpreted cautiously, with the understanding that neuropsychological assessments carried out at two years of age are usually not as strongly related to adolescent and grownup functioning as assessments carried out in older kids.
Even with these limitations, we are able to clearly see that lamotrigine is a a lot safer various than valproic acid (Depakote) which has been related to antagonistic neurodevelopmental sequelae, together with decrease IQ, developmental delays and elevated danger of autism spectrum issues, autistic traits and/or attentional issues in uncovered kids.
Ruta Nonacs, MD PhD
Meador KJ, Cohen MJ, Loring DW, Could RC, Brown C, Robalino CP, Matthews AG, Kalayjian LA, Gerard EE, Gedzelman ER, Penovich PE, Cavitt J, Hwang S, Sam M, Pack AM, French J, Tsai JJ, Pennell PB; Maternal Outcomes and Neurodevelopmental Results of Antiepileptic Medicine Investigator Group. Two-Yr-Outdated Cognitive Outcomes in Kids of Pregnant Girls With Epilepsy within the Maternal Outcomes and Neurodevelopmental Results of Antiepileptic Medicine Examine. JAMA Neurol. 2021 Aug 1;78(8):927-936.