Swansea, UK—By the time they reach the age of 7 years, children exposed to epilepsy drugs in the womb score lower on school test results.

That’s according to a study published in the Journal of Neurology, Neurosurgery & Psychiatry. A study team from the Neurology Research Group in the Swansea University Medical School urges that women with epilepsy who seek to become pregnant be warned of the risks of treatment. They point out, however, the importance of seizure control during pregnancy.

Current guidelines advise that women with epilepsy who need drugs to control their seizures continue taking them during pregnancy. The rationale is that both mother and child could be harmed by convulsions. 

“Women with epilepsy should be informed of this risk and alternative treatment regimens should be discussed before their pregnancy with a physician that specializes in epilepsy,” suggested lead researcher Owen Pickrell PhD.

Researchers note that epilepsy drugs, especially sodium valproate, have been linked to neurodevelopmental disorders in unborn children when taken during pregnancy. Yet few of the studies were based on real-world population data, they write.

In response, study authors employed routinely-collected healthcare data from the Secure Anonymous Information Linkage (SAIL) databank, as well as the national school test (key stage 1) data, to analyze the academic performance of children aged 7 years born to mothers with epilepsy. The anonymized primary care records of 80% of Welsh family physicians are included in the SAIL database, which has data on about 77% of the country’s population.

The measurement used—the Key Stage 1 (KS1) test—assesses math, language (English/Welsh), and science among 7-year-olds, scoring them from levels 1 to 3. Overall, researchers had access to test results for 440 children whose mothers had been diagnosed with epilepsy before their pregnancy from 2003 to 2008.

Prescription patterns were divided into five categories: 
• Treatment with carbamazepine, 
• Treatment with lamotrigine,
• Treatment with sodium valproate, 
• A combination of several drugs, and 
• No drug treatment. 

While 54% of the expectant mothers were taking sodium valproate among other medications, 15 different drug combinations were prescribed.

Results showed no difference in performance between children born to mothers prescribed carbamazepine, lamotrigine, or nothing versus those without epilepsy.

Offspring of those whose mothers had been prescribed sodium valproate during their pregnancy had 10.5% to 13% lower scores on all KSI tests than those in the comparison group. Results were even worse in children of mothers prescribed a combination of epilepsy drugs—19% to 22% lower.

“While this study highlights the risk of cognitive effects in the children of mothers prescribed sodium valproate or multiple [anti-epilepsy drugs], it is important to acknowledge that some epilepsies are difficult to manage without these treatment regimens,” explained coauthor Mark Rees, PhD, professor of neurology and molecular neuroscience research.
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