1
|
Meador KJ, Cohen MJ, Loring DW, Matthews AG, Brown CA, Robalino C, Carmack A, Sumners S, Birnbaum AK, Kalayjian LA, Gedzelman E, Voinescu PE, Gerard EE, Hanna J, Cavitt J, Sam M, Hwang ST, Pack AM, Tsai JJ, Pennell PB. Association of Prenatal Exposure to Antiseizure Medications With Creative and Executive Function at Age 4.5 Years. Neurology 2024; 102:e209448. [PMID: 38810172 DOI: 10.1212/wnl.0000000000209448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Neurodevelopmental effects of fetal antiseizure medication (ASM) exposure on creativity and executive functions are poorly understood. We previously found fetal valproate exposure to adversely affect measures of creativity and executive functions. In this study, we examine fetal exposure of newer ASMs on these functions in children of women with epilepsy (WWE) compared with children of healthy women (HW). METHODS The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs study is a multicenter NIH-funded prospective observational cohort study of WWE and HW enrolled in pregnancy and their offsprings. This report examines blindly assessed creativity and executive functions in 4.5-year-old children of WWE vs HW. In addition, exposure-dependent ASM effects during the third trimester were examined in children of WWE, using a ratio of maximum observed ASM concentrations and ratio of defined daily dose (ratio DDD). For polytherapy, ratios were summed across ASMs. Linear regression models adjusted for multiple potential confounding factors were conducted for all analyses. The primary outcome for 4.5-year-old children was the Torrance Test of Creative Thinking-Figural Creativity Index. Secondary outcomes included the Global Executive Composite Score from the Behavior Rating Inventory of Executive Function-Preschool Version and subscales and other indexes of both measures. RESULTS The primary analysis included 251 children of WWE and 73 of HW. No differences in creativity or executive function were found between children of WWE vs HW. No ASM exposure-dependent effects were found for the creativity measures, but exposure-dependent effects for executive function were present for ratio ASM concentration and ratio DDD. DISCUSSION Our findings at 4.5 years show no differences in creative thinking between children of WWE vs HW (-3.2 [-9.0 to 2.7], p = 0.286) or associations with fetal exposure to ASMs (-2.6 [-11.0 to 5.7], p = 0.530). Secondary analyses revealed fetal exposure-dependent effects for executive function in children of WWE (7.0 [2.9-11.2], p = 0.001), which are most marked for levetiracetam (12.9 [4.2-21.6], p = 0.004). Our findings suggest that even for relatively safe ASMs, dosing needs to be adjusted to concentrations that prevent seizures, but balance risks to the fetus that high concentrations may pose. TRIAL REGISTRATION INFORMATION The study is registered at ClinicalTrials.gov as NCT01730170.
Collapse
Affiliation(s)
- Kimford J Meador
- From 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
| | - Morris J Cohen
- From 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
| | - David W Loring
- From 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
| | - Abigail G Matthews
- From 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
| | - Carrie A Brown
- From 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
| | - Chelsea Robalino
- From 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
| | - Andrea Carmack
- From 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
| | - Sarah Sumners
- From 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
| | - Angela K Birnbaum
- From 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
| | - Laura A Kalayjian
- From 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
| | - Evan Gedzelman
- From 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
| | - Paula E Voinescu
- From 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
| | - Elizabeth E Gerard
- From 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
| | - Julie Hanna
- From 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
| | - Jennifer Cavitt
- From 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
| | - Maria Sam
- From 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
| | - Sean T Hwang
- From 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
| | - Alison M Pack
- From 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
| | - Jeffrey J Tsai
- From 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
| | - Page B Pennell
- From 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
| |
Collapse
|