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Fetal antiepileptic drug exposure: motor, adaptive, and emotional/behavioral functioning at age 3 years

Morris J Cohen1, Kimford J Meador, Nancy Browning

  • 1Neurology, Georgia Health Sciences University, Augusta, GA 30912, USA. mcohen@georgiahealth.edu

Epilepsy & Behavior : E&B
|July 26, 2011
PubMed

Insights

Antiepileptic drugs (AEDs) like valproate and carbamazepine may impact child development. Valproate exposure in utero showed dose-related declines in motor and adaptive skills, and increased ADHD risk in children.

Area of Science:

  • Neuroscience
  • Developmental Pediatrics
  • Pharmacology

Background:

  • The Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) Study is a prospective, multicenter observational study.
  • Pregnant women with epilepsy on monotherapy were enrolled between 1999-2004 in the US and UK.

Purpose of the Study:

  • To determine if different antiepileptic drugs (AEDs) have varying long-term neurodevelopmental effects.
  • To examine fetal AED exposure effects on motor, adaptive, and emotional/behavioral functioning at age 3.

Main Methods:

  • Evaluated 229 children who completed neurodevelopmental tests at 3 years of age.
  • Analyzed motor, adaptive, and emotional/behavioral functioning across four AED groups: carbamazepine, lamotrigine, phenytoin, and valproate.
  • Assessed dose-related effects and specific functional domains.

Main Results:

  • Mean scores for all AED groups were in the low average to average range.
  • Significant dose-related declines in motor functioning were observed for valproate and carbamazepine.
  • Valproate exposure was linked to dose-related declines in adaptive functioning, social skills, and increased risk for ADHD symptoms (attention, hyperactivity). Carbamazepine showed marginal declines in adaptive functioning.

Conclusions:

  • Valproate and carbamazepine, particularly at higher doses, may negatively impact neurodevelopment.
  • Children exposed to valproate in utero may face higher risks for attention-deficit/hyperactivity disorder.
  • Further research is needed to confirm findings, explore other AEDs, neonatal risks, and underlying mechanisms.

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