According to study results published in JAMA Neurology, speech development in children of women with epilepsy (WWE) who take anti-epileptic drugs does not differ from that of children of healthy women by the age of 2 years.
The prospective observational study “Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs” (MONEAD) (ClinicalTrials.gov Identifier: NCT01730170) evaluated the pregnancy outcomes of healthy women from 2012 to 2016 in 20 epilepsy centers in the USA.
A total of 292 WWE children (median age 2.1 years) and 90 children of healthy women (median age 2.1 years) took part in this study. The researchers tracked children from birth to 6 years of age and made assessments of the children at 2 years of age.
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Ratings focused on improvements in the language domain score based on the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). This score spans 5 domain scores including those involved in language, motor skills, cognitive, socio-emotional, and general adaptability.
There was no significant difference between the children of WWE and those of healthy women in terms of the language domain score at 2 years of age (parameter estimate, -0.5; 95% CI, -4.1 to 3.2; P = 0, 81). In the adjusted analysis, there was no difference between the 2 groups with regard to the other 4 BSID-III domains at the age of 2 years.
The majority of WWE received lamotrigine and / or levetiracetam during the study period. Investigators found no association between exposure to anti-epileptic drugs and language domain in WWE children.
Secondary analyzes showed higher maximum observed blood levels of anti-epileptic drugs during the third trimester, which correlated with significantly lower BSID-III scores for the motor domain (-5.6; 95% CI, -10.7 to -0.5; P = 0 , 03). There was also a relationship between a higher maximum ratio of the defined daily dose of anti-epileptic drugs in the third trimester and lower values in the general adaptive range (-1.4; 95% CI, -2.8 to -0.05; P = 0.049) .
One limitation of this study was the lack of randomization (a randomized protocol has ethical concerns when used in pregnancy). Additionally, the study’s researchers note that the associations that emerge from cognitive and behavioral assessments at age 2 are not as strong as those created when used at an older age.
The study researchers concluded that additional research is needed in the “Cohort in Older Children and in other cohorts to assess the effects of [antiseizure medication] Exposure to the immature brain. “
reference
Meador KJ, Cohen MJ, Loring DW et al. Two-year-old cognitive outcomes in children of pregnant women with epilepsy in maternal outcomes and the effects of anti-epileptic drugs on neurological development. Published online June 7, 2021. JAMA Neurol. doi: 10.1001 / jamaneurol.2021.1583
