Portal de Periódicos da CAPES

Effects of fetal antiepileptic drug exposure

2012; Lippincott Williams & Wilkins; Volume: 78; Issue: 16 Linguagem: Inglês

10.1212/wnl.0b013e318250d824

1526-632X

Kimford J. Meador, Gus A. Baker, N. Andrew Browning, Morris J. Cohen, Rebecca Bromley, Jill Clayton‐Smith, Laura A. Kalayjian, Andrés M. Kanner, Joyce Liporace, Page B. Pennell, Michael Privitera, David W. Loring, David M. Labiner, Jennifer Moon, Scott J. Sherman, Deborah T Combs Cantrell, Cheryl H. Silver, Monisha Goyal, Mike R. Schoenberg, Alison Pack, Christina A. Palmese, Joyce Echo, Kimford J. Meador, David W. Loring, Page B. Pennell, Daniel L. Drane, Eugene Moore, Megan E. Denham, Charles M. Epstein, Jennifer L. Gess, Sandra L. Helmers, Thomas R. Henry, Gholam K. Motamedi, Erin Flax, Edward B Bromfield, Katrina Boyer, Barbara A. Dworetzky, Andrew Cole, Lucila Halperin, Sara Shavel‐Jessop, Gregory L. Barkley, Barbara Moir, Cynthia L. Harden, Tara Tamny-Young, Gregory Lee, Morris J. Cohen, Patricia Penovich, D. Minter, Layne Moore, Kathryn Murdock, Joyce Liporace, Kathryn Wilcox, Andrés M. Kanner, Michael N. Nelson, William E. Rosenfeld, M. Renée Umstattd Meyer, Jill Clayton‐Smith, George Mawer, Usha Kini, Roy C. Martin, Michael Privitera, Jennifer Bellman, David M. Ficker, Lyle E. Baade, Kore Liow, Gus A. Baker, Alison Booth, Rebecca Bromley, Miranda Casswell, C. Barrie, Eugene Ramsay, Patricia L. Arena, Laura A. Kalayjian, Christianne Heck, Sonia C. Orozco P., John W. Miller, Gail Rosenbaum, Alan J. Wilensky, Tawnya Constantino, Julien T. Smith, Naghme Adab, Gisela Veling-Warnke, Maria Sam, Cormac A. O’Donovan, Cecile E. Naylor, Shelli Nobles, Cesar S. Santos, Gregory L. Holmes, Maurice L. Druzin, Martha J. Morrell, Lorene M. Nelson, Richard H. Finnell, Mark S. Yerby, Khosrow Adeli, Peter G. Wells, N. Andrew Browning, Temperance Blalock, Todd C. Crawford, L. Hendrickson, Bernadette Jolles, Meghan Kunchai, Hayley Loblein, Yinka Ogunsola, Steve Russell, Jamie Winestone, Mark Wolff, Phyllis Zaia, Thad Zajdowicz,

Pregnancy and Medication Impact

To examine outcomes at age 4.5 years and compare to earlier ages in children with fetal antiepileptic drug (AED) exposure.The NEAD Study is an ongoing prospective observational multicenter study, which enrolled pregnant women with epilepsy on AED monotherapy (1999-2004) to determine if differential long-term neurodevelopmental effects exist across 4 commonly used AEDs (carbamazepine, lamotrigine, phenytoin, or valproate). The primary outcome is IQ at 6 years of age. Planned analyses were conducted using Bayley Scales of Infant Development (BSID at age 2) and Differential Ability Scale (IQ at ages 3 and 4.5).Multivariate intent-to-treat (n = 310) and completer (n = 209) analyses of age 4.5 IQ revealed significant effects for AED group. IQ for children exposed to valproate was lower than each other AED. Adjusted means (95% confidence intervals) were carbamazepine 106 (102-109), lamotrigine 106 (102-109), phenytoin 105 (102-109), valproate 96 (91-100). IQ was negatively associated with valproate dose, but not other AEDs. Maternal IQ correlated with child IQ for children exposed to the other AEDs, but not valproate. Age 4.5 IQ correlated with age 2 BSID and age 3 IQ. Frequency of marked intellectual impairment diminished with age except for valproate (10% with IQ <70 at 4.5 years). Verbal abilities were impaired for all 4 AED groups compared to nonverbal skills.Adverse cognitive effects of fetal valproate exposure persist to 4.5 years and are related to performances at earlier ages. Verbal abilities may be impaired by commonly used AEDs. Additional research is needed.