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Published on: June 4, 2020
Children (10-12 years age) of women with epilepsy have lower intelligence, attention and memory: Observations from a
Neelima Gopinath1, Anila K Muneer1, Syam Unnikrishnan1
1Kerala Registry of Epilepsy and Pregnancy, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, India.
Insights
Children of women with epilepsy (CWE) show lower IQ, attention, and memory compared to controls. Maternal epilepsy medication dosage, maternal IQ, and parental education are key predictors of cognitive outcomes in CWE.
Area of Science:
- Neuroscience
- Developmental Psychology
- Clinical Neurology
Background:
- Epilepsy affects women of childbearing age, necessitating understanding of potential neurodevelopmental impacts on offspring.
- Cognitive outcomes in children exposed to antiepileptic drugs (AEDs) in utero require thorough investigation.
- Existing research presents varied findings, highlighting the need for studies with robust methodologies and matched controls.
Purpose of the Study:
- To compare the cognitive performance of children of women with epilepsy (CWE) against age- and sex-matched children of women without epilepsy (CWO).
- To identify predictors of cognitive function, specifically Full Scale IQ (FSIQ), in children of women with epilepsy.
Main Methods:
- A cohort of 190 children of women with epilepsy (CWE) aged 10-12 years was assessed using WISC-IV, Trail Making Test (TMT), and Rey Auditory Verbal Learning Test (RAVLT).
- A control group of 149 age- and sex-matched children of women without epilepsy (CWO) from the same region participated.
- AED dosage was standardized using the prescribed daily dose/daily-defined dose (PDD/DDD) ratio for comparative analysis.
Main Results:
- Children of women with epilepsy (CWE) exhibited a statistically significant lower Full Scale IQ (FSIQ) (77.9 ± 14.6) compared to controls (CWO) (86.4 ± 13.4), a difference of 8.5 points (p=0.001).
- CWE performed significantly lower on measures of attention (TMT Part A & B) and memory (RAVLT) compared to CWO.
- Phenobarbital exposure was associated with significantly lower FSIQ compared to other AEDs. Predictors of lower FSIQ included low maternal education, low maternal IQ, high AED dosage, low paternal education, and low body mass index.
Conclusions:
- Children of women with epilepsy (CWE) demonstrate significantly impaired IQ, attention, and memory compared to their peers without epilepsy (CWO).
- Antiepileptic drug dosage, maternal IQ, and parental educational background are critical predictors influencing cognitive outcomes in children of women with epilepsy.
- These findings underscore the importance of optimizing AED treatment and considering maternal and paternal factors to support neurodevelopment in offspring.
Objective:
To compare the cognitive outcome of children of women with epilepsy (CWE) with matched controls (CWO).
Methods:
CWE (10-12 years) under follow up in Kerala Registry of Epilepsy and Pregnancy (n=190) were evaluated with WISC-IV, Trail Making Test (TMT), Rey Auditory Verbal Learning Test (RAVLT) and compared with age and sex matched children of women without epilepsy - CWO (n=149) drawn from schools in the same region. The dosage was expressed as prescribed daily dose/daily-defined dose (PDD/DDD) ratio in order to make comparisons.
Results:
The Full Scale IQ of CWE (77.9 ± 14.6) was 8.5 points lower than that of CWO (86.4 ± 13.4), which was statistically significant (p=0.001). They performed lower on TMT Part A & B and RAVLT. The FSIQ mean ± SD; PDD/DDD ratio and number of monotherapy exposure for different anti-epileptic drugs were phenobarbital: (74.5 ± 14; 1.1 ± 0.8; 22), valproate: (82.8 ± 12.4; 0.3 ± 0.1; 36), carbamazepine: (82.2 ± 13.9; 0.6 ± 0.3; 41), phenytoin: (82.6 ± 13.5; 0.8±0.3; 11). The FSIQ for those exposed to phenobarbital was significantly (p=0.01) lower than others. The significant predictors of FSIQ differed at lower and higher ends of its spectrum. These predictors were low body mass index and low maternal education for FSIQ<80 and low maternal education, low maternal IQ and high anti-epileptic drug dosage for FSIQ<86. High anti-epileptic drug dosage, low maternal IQ, and low paternal education were the predictors for FSIQ<92.
Significance:
The IQ, attention and memory were significantly lower for 10-12 year old CWE when compared to CWO. The important predictors of low FSIQ were antiepileptic drug dosage, maternal IQ, and parental education.
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