1
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Keuler N, Johnson Y, Coetzee R. A description of sodium valproate, lamotrigine and levetiracetam consumption in the Western Cape public sector. S Afr Fam Pract (2004) 2022; 64:e1-e7. [PMID: 35695446 PMCID: PMC9257847 DOI: 10.4102/safp.v64i1.5402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 03/16/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background The rational use of medicine is fundamental to ensure effective and safe patient medicine treatment, and hence, should be monitored. Undisputable evidence exists for the teratogenic risk factors associated with sodium valproate. Consequently, the Western Cape Department of Health introduced a policy (2019) recommending alternatives for valproate in women of childbearing age, including lamotrigine or levetiracetam as alternatives for patients on antiretrovirals. This study aimed to describe the change in the consumption of valproate, lamotrigine and levetiracetam after a policy implementation in public sector health facilities of the Western Cape, South Africa. Methods This observational study followed a quasi-experimental design. Consumption data from the Cape Medical Depot over the period 01 April 2018 to 31 March 2020 were analysed retrospectively. Consumption was presented as a defined daily dose (DDD) per 1000 population per quarter for sodium valproate, levetiracetam and lamotrigine for the Western Cape province, urban and rural areas. Consumption 12 months before was compared with consumption 12 months after policy implementation. Results Post-policy implementation, valproate consumption remained unchanged provincially (3.3%; p = 0.255), in urban (7.8%; p = 0.255) and rural (1.5%; p = 0.701) areas. Lamotrigine consumption increased significantly provincially (30.7%; p = 0.020) and in urban areas (54.5%; p = 0.002); however, rural (26.1%; p = 0.108) areas did not show significant change. Provincially, valproate consumption remained substantially higher (209 DDDs/1000 population per quarter) compared with lamotrigine consumption (32.22 DDDs/1000 population per quarter). Conclusion In the Western Cape public sector, the consumption of sodium valproate remained unchanged 12 months after policy implementation. Although there were significant increases in lamotrigine and levetiracetam consumption, the consumption was considerably less compared with sodium valproate consumption.
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Affiliation(s)
- Nicole Keuler
- School of Pharmacy, Faculty of Natural Science, University of the Western Cape, Bellville.
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2
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Alsfouk BA. Neurodevelopmental outcomes in children exposed prenatally to levetiracetam. Ther Adv Drug Saf 2022; 13:20420986221088419. [PMID: 35387387 PMCID: PMC8977694 DOI: 10.1177/20420986221088419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/02/2022] [Indexed: 11/15/2022] Open
Abstract
Some old antiseizure medications (ASMs) pose teratogenic risks, including major
congenital malformations and neurodevelopmental delay. Therefore, the use of new
ASMs in pregnancy is increasing, particularly lamotrigine and levetiracetam.
This is likely due to evidence of low risk of anatomical teratogenicity for both
lamotrigine and levetiracetam. Regarding neurodevelopmental effects, lamotrigine
is the most frequently investigated new ASM with information available for
children up to 14 years of age. However, fewer data are available for the
effects of levetiracetam on cognitive and behavioral development, with smaller
cohorts and shorter follow-up. The aim of the present review was to explicate
neurodevelopmental outcomes in children exposed prenatally to levetiracetam to
support clinical decision-making. The available data do not indicate an
increased risk of abnormal neurodevelopmental outcomes in children exposed
prenatally to levetiracetam. Findings demonstrated comparable outcomes for
levetiracetam versus controls and favorable outcomes for
levetiracetam versus valproate on global and specific cognitive
abilities, and behavioral problems. In addition, the available evidence shows no
significant dose-effect association for levetiracetam on neurodevelopmental
outcomes. However, this evidence cannot be determined definitively due to the
limited numbers of exposures with relatively short follow-up. Therefore, further
research is required.
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Affiliation(s)
- Bshra A. Alsfouk
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O Box 84428, Riyadh 11671, Saudi Arabia
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3
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Tokariev A, Breakspear M, Videman M, Stjerna S, Scholtens LH, van den Heuvel MP, Cocchi L, Vanhatalo S. Impact of In Utero Exposure to Antiepileptic Drugs on Neonatal Brain Function. Cereb Cortex 2021; 32:2385-2397. [PMID: 34585721 PMCID: PMC9157298 DOI: 10.1093/cercor/bhab338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/18/2021] [Accepted: 08/22/2021] [Indexed: 12/27/2022] Open
Abstract
In utero brain development underpins brain health across the lifespan but is vulnerable to physiological and pharmacological perturbation. Here, we show that antiepileptic medication during pregnancy impacts on cortical activity during neonatal sleep, a potent indicator of newborn brain health. These effects are evident in frequency-specific functional brain networks and carry prognostic information for later neurodevelopment. Notably, such effects differ between different antiepileptic drugs that suggest neurodevelopmental adversity from exposure to antiepileptic drugs and not maternal epilepsy per se. This work provides translatable bedside metrics of brain health that are sensitive to the effects of antiepileptic drugs on postnatal neurodevelopment and carry direct prognostic value.
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Affiliation(s)
- Anton Tokariev
- Baby Brain Activity Center (BABA), Department of Clinical Neurophysiology, New Children's Hospital, HUS Imaging, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Michael Breakspear
- School of Psychology, College of Engineering, Science and the Environment, University of Newcastle, Callaghan, New South Wales, Australia.,School of Medicine and Public Health, College of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Mari Videman
- Baby Brain Activity Center (BABA), Department of Clinical Neurophysiology, New Children's Hospital, HUS Imaging, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Pediatric Neurology, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Susanna Stjerna
- Baby Brain Activity Center (BABA), Department of Clinical Neurophysiology, New Children's Hospital, HUS Imaging, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Lianne H Scholtens
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Martijn P van den Heuvel
- Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands.,Department of Child Psychiatry, Amsterdam University Medical Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Luca Cocchi
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Sampsa Vanhatalo
- Baby Brain Activity Center (BABA), Department of Clinical Neurophysiology, New Children's Hospital, HUS Imaging, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
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4
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Dupont S, Vercueil L. Epilepsy and pregnancy: What should the neurologists do? Rev Neurol (Paris) 2021; 177:168-179. [PMID: 33610349 DOI: 10.1016/j.neurol.2021.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 02/08/2023]
Abstract
Epilepsy is one of the most common chronic disorders affecting women of childbearing age. Unfortunately, many women with epilepsy (WWE) still report not receiving key information about pregnancy. They obviously need information about epilepsy and pregnancy prior to conception with a particular emphasis on effective birth control (i.e. contraception), necessity to plan pregnancy, antiepileptic drugs optimization, and folate supplementation. The risks associated with use of antiepileptic drugs during pregnancy have to be balanced against fetal and maternal risks associated with uncontrolled seizures. This report reviews evidence-based counseling and management strategies concerning maternal and fetal risks associated with seizures, teratogenic risks associated with antiepileptic drug exposure with a special emphasis on developmental and behavioural outcomes of children exposed to intra utero antiepileptic drugs.
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Affiliation(s)
- S Dupont
- Epilepsy and Rehabilitation Unit, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France; Centre de Recherche de l'Institut du Cerveau et de la Moëlle Épinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 INSERM, Paris, France; Université Paris Sorbonne, Paris, France.
| | - L Vercueil
- EFSN, University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences (GIN), 38000 Grenoble, France
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5
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Understanding and Responding to Prescribing Patterns of Sodium Valproate-Containing Medicines in Pregnant Women and Women of Childbearing Age in Western Cape, South Africa. Drug Saf 2020; 44:41-51. [PMID: 32844313 PMCID: PMC7813724 DOI: 10.1007/s40264-020-00987-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Growing evidence of the teratogenic potential of sodium valproate (VPA) has changed prescribing practices across the globe; however, the impact of this research and the consequent dissemination of a Dear Health Care Professional Letter (DHCPL) in December 2015, recommending avoidance of the teratogen VPA in women of childbearing age (WOCBA) and pregnant women in South Africa, is unknown. We explored trends and reasons for VPA use among pregnant women and WOCBA in the public sector in Western Cape Province from 1 January 2015 to 31 December 2017. METHODS Using the provincial health information exchange that collates routine electronic health data via unique patient identifiers, we analysed clinical and pharmacy records from 2015 to 2017 to determine prescription patterns of VPA and other antiepileptic drug (AED) and mood-stabilising medicine (MSM) use in WOCBA and pregnant women. Senior clinicians and policy makers were consulted to understand the determinants of VPA use. RESULTS At least one VPA prescription was dispensed to between 8205 (0.79%) and 9425 (0.94%) WOBCA from a cohort of approximately 1 million WOCBA attending provincial health care facilities per year. Prescriptions were more likely in HIV-infected women compared with HIV-uninfected women (1.1-1.3% vs. 0.7-0.9%; p < 0.001). VPA use in WOCBA remained stable at 0.8-0.9% over the review period despite the 2016 DHCPL. VPA was the most prescribed AED/MSM, constituting 43.2-45.5% of all WOCBA taking at least one such agent, while lamotrigine, the other recommended first-line agent, was only prescribed in 7.8-8.9% of WOCBA. Over 3 years, approximately 663 pregnancies were exposed to VPA, with a steady rise in the number of exposures each year (n = 204, 214 and 245, respectively). CONCLUSION Despite warnings, VPA remained the most frequently prescribed AED or MSM in WOCBA. Contributing factors are described.
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6
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Zhu L, Chen L, Xu P, Lu D, Dai S, Zhong L, Han Y, Zhang M, Xiao B, Chang L, Wu Q. Genetic and molecular basis of epilepsy-related cognitive dysfunction. Epilepsy Behav 2020; 104:106848. [PMID: 32028124 DOI: 10.1016/j.yebeh.2019.106848] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/06/2019] [Accepted: 12/06/2019] [Indexed: 02/02/2023]
Abstract
Epilepsy is a common neurological disease characterized by recurrent seizures. About 70 million people were affected by epilepsy or epileptic seizures. Epilepsy is a complicated complex or symptomatic syndromes induced by structural, functional, and genetic causes. Meanwhile, several comorbidities are accompanied by epileptic seizures. Cognitive dysfunction is a long-standing complication associated with epileptic seizures, which severely impairs quality of life. Although the definitive pathogenic mechanisms underlying epilepsy-related cognitive dysfunction remain unclear, accumulating evidence indicates that multiple risk factors are probably involved in the development and progression of cognitive dysfunction in patients with epilepsy. These factors include the underlying etiology, recurrent seizures or status epilepticus, structural damage that induced secondary epilepsy, genetic variants, and molecular alterations. In this review, we summarize several theories that may explain the genetic and molecular basis of epilepsy-related cognitive dysfunction.
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Affiliation(s)
- Lin Zhu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Lu Chen
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Puying Xu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Di Lu
- Biomedicine Engineering Research Center, Kunming Medical University, 1168 Chun Rong West Road, Kunming, Yunnan 650500, PR China
| | - Shujuan Dai
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Lianmei Zhong
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Yanbing Han
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Mengqi Zhang
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiang Ya Road, Changsha, Hunan 410008, PR China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiang Ya Road, Changsha, Hunan 410008, PR China
| | - Lvhua Chang
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China.
| | - Qian Wu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China.
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7
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Bansal R, Jain G, Kharbanda P, Goyal M, Suri V. Maternal and neonatal complications during pregnancy in women with epilepsy. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.ijep.2016.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractEpilepsy is the commonest serious neurological problem faced by obstetricians and gynaecologists. Epidemiological studies estimate epilepsy to complicate 0.3–0.7% of all pregnancies.1 2 The importance of epilepsy in pregnancy lies in the fact that many women with epilepsy (WWE) have to go through their pregnancy while taking antiepileptic (AED) drugs. Both the seizures and AEDs can have harmful effects on the mother as well the foetus. Thus, during pregnancy, the clinician faces dual challenge of controlling seizures as well as preventing teratogenicity of AEDs.1 In this review we discuss the possible impact of seizures as well as AEDs on mother as well as the child. We try to answer some of the commonest questions which are relevant to successful management of pregnancy and ensuring birth of a healthy baby.
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Affiliation(s)
- R. Bansal
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - G. Jain
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - P. Kharbanda
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - M. Goyal
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - V. Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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8
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Haskey C, Galbally M. Mood stabilizers in pregnancy and child developmental outcomes: A systematic review. Aust N Z J Psychiatry 2017; 51:1087-1097. [PMID: 28825316 DOI: 10.1177/0004867417726175] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Research suggests that maintaining treatment during pregnancy for women with bipolar affective disorder reduces the risk of relapse. However, one of the key questions for women and clinicians during pregnancy is whether there are implications of exposure to mood stabilizers for longer term child development. Despite these concerns, there are few recent systematic reviews comparing the impact on child developmental outcomes for individual mood-stabilizing agents to inform clinical decisions. OBJECTIVES To examine the strengths and limitations of the existing data on child developmental outcomes following prenatal exposure to mood stabilizers and to explore whether there are any differences between agents for detrimental effects on child development. METHOD Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a rigorous systematic search was carried out of four electronic databases from their respective years of inception to September 2016 to identify studies which examined the effects of mood stabilizers including sodium valproate, carbamazepine, lamotrigine, lithium and second-generation antipsychotics on child developmental outcomes. RESULTS We identified 15 studies for critical review. Of these, 10 examined antiepileptic drugs, 2 studied lithium and 3 studied second-generation antipsychotics. The most consistent finding was a dose-response relationship for valproate with higher doses associated with poorer global cognitive abilities compared to other antiepileptic drugs. The limited data available for lithium found no adverse neurodevelopmental outcomes. The limited second-generation antipsychotic studies included a report of a transient early neurodevelopmental delay which resolved by 12 months of age. CONCLUSION This review found higher neurodevelopmental risk with valproate. While the existing data on lithium and second-generation antipsychotics are reassuring, these data are both limited and lower quality, indicating that further research is required. The information from this review is relevant for patients and clinicians to influence choice of mood-stabilizing agent in childbearing women. This must be balanced against the known risks associated with untreated bipolar affective disorder.
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Affiliation(s)
- Carolyn Haskey
- 1 Peel and Rockingham Kwinana Mental Health Service, Rockingham, WA, Australia
| | - Megan Galbally
- 2 School of Psychology and Exercise Science, Murdoch University, Murdoch, WA, Australia.,3 School of Medicine, The University of Notre Dame Australia, Fremantle, WA, Australia.,4 Fiona Stanley Hospital, Murdoch, WA, Australia
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9
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Zucker I. Risk mitigation for children exposed to drugs during gestation: A critical role for animal preclinical behavioral testing. Neurosci Biobehav Rev 2017; 77:107-121. [DOI: 10.1016/j.neubiorev.2017.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/08/2017] [Indexed: 12/13/2022]
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10
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McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, Green L, Gregoire A, Howard LM, Jones I, Khalifeh H, Lingford-Hughes A, McDonald E, Micali N, Pariante CM, Peters L, Roberts A, Smith NC, Taylor D, Wieck A, Yates LM, Young AH. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol 2017; 31:519-552. [PMID: 28440103 DOI: 10.1177/0269881117699361] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Decisions about the use of psychotropic medication in pregnancy are an ongoing challenge for clinicians and women with mental health problems, owing to the uncertainties around risks of the illness itself to mother and fetus/infant, effectiveness of medications in pregnancy and risks to the fetus/infant from in utero exposure or via breast milk. These consensus guidelines aim to provide pragmatic advice regarding these issues. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders.
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Affiliation(s)
- R Hamish McAllister-Williams
- 1 Institute of Neuroscience, Newcastle University, Newcastle, UK.,2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David S Baldwin
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,4 University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Abby Easter
- 6 Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eilish Gilvarry
- 2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.,7 Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Vivette Glover
- 8 Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Lucian Green
- 9 Ealing, Hounslow, Hammersmith & Fulham Perinatal Mental Health Service, West London Mental Health Trust, London, UK
| | - Alain Gregoire
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,10 Hampshire Perinatal Mental Health Service, Winchester, UK
| | - Louise M Howard
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | - Ian Jones
- 13 National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Hind Khalifeh
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Elizabeth McDonald
- 15 Royal College of Psychiatrists, London, UK.,16 East London Foundation Trust, London, UK.,17 Tavistock and Portman NHS Foundation Trust, London, UK
| | - Nadia Micali
- 18 Behavioural and Brain Sciences Unit, GOSH Institute of Child Health, University College London, London, UK
| | - Carmine M Pariante
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Ann Roberts
- 20 St Martin's Healthcare Services CIC, Leeds, UK.,21 Hertfordshire Partnership University NHS Foundation Trust, Hatfield, Hertfordshire, UK.,22 Postgraduate School of Medicine, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Natalie C Smith
- 23 Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, County Durham, UK
| | - David Taylor
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,24 Institute of Pharmaceutical Science, King's College London, London, UK
| | - Angelika Wieck
- 25 Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,26 University of Manchester, Manchester, UK
| | - Laura M Yates
- 27 UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,28 Institute of Genetic Medicine, Newcastle University, Newcastle, UK
| | - Allan H Young
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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11
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Kasradze S, Gogatishvili N, Lomidze G, Ediberidze T, Lazariashvili M, Khomeriki K, Mamukadze S, Metreveli M, Gagoshidze T, Tatishvili N, Tomson T. Cognitive functions in children exposed to antiepileptic drugs in utero - Study in Georgia. Epilepsy Behav 2017; 66:105-112. [PMID: 28038386 DOI: 10.1016/j.yebeh.2016.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/07/2016] [Accepted: 10/08/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The cognitive teratogenicity of antiepileptic drugs (AEDs) has gained increasing attention in the last decade. The objective of the current study was to assess the effects of AED fetal exposure on the cognitive development of children of mothers with epilepsy from Georgia in a controlled study taking into consideration major confounding factors. METHODS A prospective cohort group was formed from children and mothers registered in the Georgian National AED-Pregnancy Registry. The study group's age- and gender-matched control children without fetal AED exposure were selected retrospectively. The Intelligence Quotient (IQ) using the Wechsler Adult Intelligence Scale - revised (WAIS-R) was assessed in mothers. The Wechsler Preschool and Primary Scale of Intelligence (WPPSI-4) were used to assess intellectual functioning for children of both study and control groups. Linear regression analysis was performed to detect association of AED exposure on the cognitive performance of children. RESULTS In total, 100 children aged 36 to 72months were evaluated. The IQ of WWE was significantly lower compared to women without epilepsy in all modalities. Exposure to valproate (VPA) (n=18) was associated with lowest cognitive performance regarding Full Scale IQ (FSIQ) (β, -12.04; p=0.006) and verbal comprehension (VCI) (β, -8.89; p=0.019). Maternal FSIQ, maternal performance IQ (PIQ), and child's age at first phrases were independent factors associated with the cognitive development of children. CONCLUSIONS Multivariate analysis showed VPA to be an independent predictor for decreased cognitive performance. Maternal FSIQ, PIQ, and child developmental achievements were significant confounders for cognitive performance in children.
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Affiliation(s)
- Sofia Kasradze
- Epilepsy Prevention and Control Centre, Institute of Neurology and Neuropsychology, 83/11, Vazha-Pshavela Ave. 0186, Tbilisi, Georgia.
| | - Nino Gogatishvili
- Epilepsy Prevention and Control Centre, Institute of Neurology and Neuropsychology, 83/11, Vazha-Pshavela Ave. 0186, Tbilisi, Georgia.
| | - Giorgi Lomidze
- Epilepsy Prevention and Control Centre, Institute of Neurology and Neuropsychology, 83/11, Vazha-Pshavela Ave. 0186, Tbilisi, Georgia.
| | - Tamar Ediberidze
- Epilepsy Prevention and Control Centre, Institute of Neurology and Neuropsychology, 83/11, Vazha-Pshavela Ave. 0186, Tbilisi, Georgia.
| | - Marine Lazariashvili
- Epilepsy Prevention and Control Centre, Institute of Neurology and Neuropsychology, 83/11, Vazha-Pshavela Ave. 0186, Tbilisi, Georgia.
| | - Ketevan Khomeriki
- Epilepsy Prevention and Control Centre, Institute of Neurology and Neuropsychology, 83/11, Vazha-Pshavela Ave. 0186, Tbilisi, Georgia.
| | - Shorena Mamukadze
- Epilepsy Prevention and Control Centre, Institute of Neurology and Neuropsychology, 83/11, Vazha-Pshavela Ave. 0186, Tbilisi, Georgia; Iv. Javakhishvili Tbilisi State University, 1, I. Chavchavadze Ave. 0179, Tbilisi, Georgia.
| | - Mariam Metreveli
- Epilepsy Prevention and Control Centre, Institute of Neurology and Neuropsychology, 83/11, Vazha-Pshavela Ave. 0186, Tbilisi, Georgia; Iv. Javakhishvili Tbilisi State University, 1, I. Chavchavadze Ave. 0179, Tbilisi, Georgia.
| | - Tamar Gagoshidze
- Epilepsy Prevention and Control Centre, Institute of Neurology and Neuropsychology, 83/11, Vazha-Pshavela Ave. 0186, Tbilisi, Georgia; Iv. Javakhishvili Tbilisi State University, 1, I. Chavchavadze Ave. 0179, Tbilisi, Georgia.
| | - Nino Tatishvili
- Department of Neuroscience of the Central Children Hospital, 2/6, Lubliana Str. 0159, Tbilisi, Georgia.
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institutet, 18A, Tomtebodavägen, 17177 Stockholm, Sweden.
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12
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Bergemann N, Paulus WE. [Affective disorders during pregnancy : Therapy with antidepressants and mood stabilizers]. DER NERVENARZT 2016; 87:955-66. [PMID: 27573672 DOI: 10.1007/s00115-016-0194-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND It is not rare that the first manifestation or relapse of an affective disorder occurs during pregnancy. Should a pharmacological treatment be indicated, the selection of a suitable substance should be made on a basis which is as safe as possible. Even when treating women of childbearing age it should be assured that the psychotropic drug selected is safe to use during pregnancy as a high percentage of pregnancies are unplanned. OBJECTIVE When assessing the risks and benefits of psychopharmacotherapy in women who are or wish to get pregnant, not only the exposure of the child to potentially teratogenic drug effects but also potential complications during or after pregnancy and long-term neuropsychological issues need to be addressed. METHODS This article provides an overview of the currently available literature on the use of antidepressants and mood stabilizers during pregnancy. RESULTS A growing body of increasingly reliable data for many antidepressants and mood stabilizers are available, which allow a good prediction of their suitability for use during pregnancy and lactation. CONCLUSION When treating affective disorders during pregnancy an individual assessment of the benefits and risks for mother and child is required. The benefit of an appropriate treatment for the mother by including medication which may be potentially harmful to the child versus the risk of an insufficient treatment for the mother by excluding medication which may be potentially harmful to both the mother and the child need to be weighed up. When a suitable psychopharmacotherapy during pregnancy has been selected, the risk for mother and child can be minimized by incorporation of therapeutic drug monitoring.
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Affiliation(s)
- N Bergemann
- Sächsisches Krankenhaus Rodewisch, Zentrum für Psychiatrie, Psychotherapie, Psychosomatik und Neurologie, Bahnhofstraße 1, 08228, Rodewisch, Deutschland.
| | - W E Paulus
- Institut für Reproduktionstoxikologie, Krankenhaus St. Elisabeth, Ravensburg, Deutschland
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