Novel Epilepsy Drugs Not Seen to Impact Fetal Cognition

A recent study suggests that a pair of new epilepsy treatments, levetiracetam and topirimate, may not alter the intelligence of children whose mothers received the drugs while pregnant.

However, an older drug has shown the potential to cause cognitive deficits in children, especially if their mothers took high doses of the drug. This drug, valproate, is known to cause birth defects and developmental problems.

“Over the past few years, doctors have been moving away from prescribing valproate to pregnant women, shifting them to the 2 newer antiepileptic drugs,” said lead researcher Rebecca Bromley, PhD. “But, until now, there hasn't been any definitive research to understand what implications for IQ and development these 2 drugs may have.”

Included in the study, which was published in Neurology, were 171 mothers from the UK Epilepsy and Pregnancy Register, who had a child between 5- and 9-years-old. There were 42 patients who took levetiracetam, 27 who had taken topirimate, and 47 who had taken valproate while pregnant.

Also included in the study was a control group of women who had not taken anti-epileptic drugs during pregnancy. Scientists conducted tests on the children to measure IQ, verbal and non-verbal comprehension, and the speed at which they process visual information, according to the study.

They discovered no difference in IQ or thinking skills among children whose mothers took levetiracetam or topirimate during pregnancy compared with the control group. Children whose mothers took valproate during pregnancy had an average IQ of 11 points lower than children from other groups.

Other studies have shown that polytherapy pregnancies, including those taking levetiracetam and topirimate, increases the rate of fetal malformation. Despite the current findings, scientists note that larger follow-up studies are needed to ensure that levetiracetam and topirimate do not harm cognitive abilities in the future.

“Expectant mothers with epilepsy may need to continue their drug regime during pregnancy,” Dr Bromley concluded. “This research may give them some reassurance that, provided they are prescribed topirimate and levetiracetam, they will a statistically good chance of normal, healthy development in their children.”