Newer Epileptic Drugs in Pregnant Women Not Associated With Lower IQ Levels in Children

A research team from the University of Manchester in United Kingdom investigated the effects of two newer epileptic medications taken during pregnancy with IQ levels of children. The research study was published in the online issue Neurology, the medical journal of American Academy of Neurology.

Research Study on Epileptic Medications:

The Food and Drug Administration (FDA) has approved drugs like valproate, topiramate and levetiracetam for the treatment of convulsions and seizures. However valproate being the commonly used drug for seizures may lead to birth defects. Therefore newer drugs like levetiracetam and topiramate were studied to know about their effects on thinking ability and developmental problems in children.

Rebecca Bromley, PhD, University of Manchester in the United Kingdom said that "As doctors move away from prescribing valproate, we need to know about the alternatives for pregnant women with epilepsy"

"Lower IQs early on can harm a child's educational success for years to come and so it is important that we gain a full understanding about any impact on development these medications may have." she added.

According to the data collected from the UK Epilepsy and Pregnancy Register, scientists identified 171 women with epilepsy and who had a child between the age of 5 and 9 years old. Out of which 42 women took levetiracetam, 27 women took topiramate and 47 took valproate. And a control group of 55 women did not take any drug for epilepsy during pregnancy.

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The IQ levels, verbal and nonverbal comprehension and the speed of processing visual information by their children were measured by performing appropriate tests.

The findings of the study reported that children of women who took levetiracetam or topiramate during pregnancy were not associated with low IQ levels when compared with the control group. While the children of women who took valproate during pregnancy were associated with lowest IQ levels.

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Out of 100 points, children of mothers who took valproate scored an average of 11 points in the IQ test and 19% of the children were found to be below the average IQ score when compared to 6% of children whose mothers belonged to the control group.

Bromley said, "While our findings represent a promising start, larger studies need to be done to ensure that these drugs will not change the thinking abilities of children"

It is noted that the research study which was performed represented only a small proportion of women from pregnancy registry and is not associated with all women affected by epilepsy.

Epilepsy and Its Treatment:

Epilepsy is a neurological disorder characterized by seizures, behavioral changes and sometimes loss of consciousness. There are various forms of epilepsy like generalized seizures, absence seizures, atonic seizures, partial seizures which may produce effects ranging from half a minute to two minutes. The cause of epilepsy is mostly unknown. It may be caused due to genetic factors or brain injury and accidents.

Symptoms like unusual cry, nodding of the head, rapid blinking of the eyes, jerking, shock-like contractions of the muscle, behavioral problems and loss of consciousness may occur.

It is estimated that about 70 million people in the world are affected by epilepsy. Out of which around 12 million people from India and 2.9 million people in the United States are found to have epilepsy.

Anti-epileptic drugs or anti-convulsant drugs like phenobarbitone, carbamazepine, phenytoin, valproate, ethosuximide, clonazepam are used to control seizures. Newer epileptic drugs like levetiracetam, topiramate, vigabatrin  and zonisamide  are also used for the treatment of epilepsy. Proper diet and counselling are required and sometimes surgery may also be initiated as a treatment option.

Adverse Effects of Anti-Epileptic Drugs:

Anti-epileptic drugs are prescribed based on the type of epilepsy, age and medical conditions.

Most of the anti-epileptic drugs are associated with side effects like nausea, vomiting, vertigo, nystagmus (involuntary eye movements), ataxia (lack of voluntary coordination of muscle movements), vertigo, dizziness, sedation and birth defects when taken during pregnancy.

Phenytoin may result in overgrowth of gum fibers in the teeth, coarsening of facial features, allergic reactions, anemia, osteomalacia (softening of the bones) and behavioral problems. Use of phenytoin during pregnancy may result in fetal hydantoin syndrome resulting in cleft palate, hare lip (opening in the roof of the mouth) and microcephaly (abnormal small head of the baby).

Valproate and carbamazepine are also capable of causing neural tubular defects like spina bifida ( incomplete closing of the backbone).

Newer epileptic drugs like topiramate may also result in birth defects like cleft lip and palate. Therefore prescribing antiepileptic drugs for controlling seizures should be done with caution.

References:

1. Overview -Epilepsy - (http://www.mayoclinic.org/diseases-conditions/epilepsy/home/ovc-20117206)
2. Epilepsy Fast Facts - (http://www.cdc.gov/epilepsy/basics/fast-facts.htm)
3. Epilepsy in India I: Epidemiology and public health - (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4564458/)

Source-Medindia