RT Journal Article
SR Electronic
T1 Cognition in school-age children exposed to levetiracetam, topiramate, or sodium valproate
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 1943
OP 1953
DO 10.1212/WNL.0000000000003157
VO 87
IS 18
A1 Bromley, Rebecca L.
A1 Calderbank, Rebecca
A1 Cheyne, Christopher P.
A1 Rooney, Claire
A1 Trayner, Penny
A1 Clayton-Smith, Jill
A1 García-Fiñana, Marta
A1 Irwin, Beth
A1 Morrow, James Irvine
A1 Shallcross, Rebekah
A1 Baker, Gus A.
YR 2016
UL http://n.neurology.org/content/87/18/1943.abstract
AB Objective: To investigate the effects of prenatal exposure to monotherapy levetiracetam, topiramate, and valproate on child cognitive functioning.Methods: This was a cross-sectional observational study. Children exposed to monotherapy levetiracetam (n = 42), topiramate (n = 27), or valproate (n = 47) and a group of children born to women who had untreated epilepsy (n = 55) were enrolled retrospectively from the UK Epilepsy and Pregnancy Register. Assessor-blinded neuropsychological assessments were conducted between 5 and 9 years of age. Information was collected on demographic and health variables and adjusted for in multiple regression analyses.Results: In the adjusted analyses, prenatal exposure to levetiracetam and topiramate were not found to be associated with reductions in child cognitive abilities, and adverse outcomes were not associated with increasing dose. Increasing dose of valproate, however, was associated with poorer full-scale IQ (−10.6, 95% confidence interval [CI] −16.3 to −5.0, p < 0.001), verbal abilities (−11.2, 95% CI −16.8 to −5.5, p < 0.001), nonverbal abilities (−11.1, 95% CI −17.3 to −4.9, p < 0.001), and expressive language ability (−2.3, 95% CI −3.4 to −1.6, p < 0.001). Comparisons across medications revealed poorer performance for children exposed to higher doses of valproate in comparison to children exposed to higher doses of levetiracetam or topiramate.Conclusions: Preconception counseling should include discussion of neurodevelopmental outcomes for specific treatments and their doses and women should be made aware of the limited nature of the evidence base for newer antiepileptic drugs.AED=antiepileptic drug; CI=confidence interval; FSIQ=full-scale IQ; UK-EPR=United Kingdom Epilepsy and Pregnancy Register