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Association of Prenatal Exposure to Antiseizure Medications With Creative and Executive Function at Age 4.5 Years

Kimford J Meador1, Morris J Cohen1, David W Loring1

  • 1From the Stanford University (K.J.M.), Palo Alto, CA; Pediatric Neuropsychology International (M.J.C.), Augusta; Emory University School of Medicine (D.W.L., E.G.), Atlanta, GA; The Emmes Company (A.G.M., C.A.B., C.R., A.C.), Rockville, MD; Piedmont University (S.S.), Athens, GA; University of Minnesota (A.K.B.), Minneapolis; University of Southern California (L.A.K.), Los Angeles; Brigham and Women's Hospital (P.E.V.), Harvard Medical School, Boston, MA; Northwestern University (E.E.G.), Chicago, IL; Minnesota Epilepsy Group (J.H.), Roseville; University of Cincinnati (J.C.), OH; Wake Forest University (M.S.), Winston-Salem, NC; Northwell Health (S.T.H.), Great Neck; Columbia University (A.M.P.), New York, NY; University of Washington (J.J.T.), Seattle; and University of Pittsburgh (P.B.P.), PA.

Neurology
|May 29, 2024
PubMed

Insights

Fetal exposure to newer antiseizure medications (ASMs) in women with epilepsy (WWE) did not affect child creativity. However, executive functions showed exposure-dependent effects, particularly with levetiracetam, suggesting careful ASM dosing is crucial for fetal development.

Area of Science:

  • Neuroscience
  • Developmental Psychology
  • Pharmacology

Background:

  • Fetal exposure to antiseizure medications (ASMs) can impact neurodevelopment, but effects of newer ASMs on creativity and executive functions are not well understood.
  • Previous research indicated adverse effects of valproate on these functions.
  • This study investigates the impact of newer ASMs on creativity and executive functions in children exposed prenatally.

Purpose of the Study:

  • To compare creativity and executive functions in children of women with epilepsy (WWE) exposed to ASMs versus children of healthy women (HW).
  • To examine exposure-dependent effects of ASMs during the third trimester on these neurodevelopmental outcomes.
  • To assess the impact of specific ASMs, including levetiracetam, on executive functions.

Main Methods:

  • Prospective observational cohort study (Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs).
  • Assessment of creativity (Torrance Test of Creative Thinking) and executive functions (Behavior Rating Inventory of Executive Function-Preschool Version) in 4.5-year-old children.
  • Analysis of ASM exposure using concentration and defined daily dose ratios, with adjustments for confounding factors.

Main Results:

  • No significant differences in creativity or executive function were observed between children of WWE and HW.
  • No ASM exposure-dependent effects were found for creativity measures.
  • Exposure-dependent effects on executive function were identified in children of WWE, particularly with levetiracetam, based on ASM concentration and defined daily dose ratios.

Conclusions:

  • Fetal exposure to newer ASMs does not appear to affect creative thinking at 4.5 years.
  • Executive function in children exposed to ASMs in utero shows dependency on ASM exposure levels.
  • Optimizing ASM dosing to balance seizure control and minimize fetal risks, especially with medications like levetiracetam, is essential.
Abstract

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