As speech-language pathologists, we are dedicated to leveraging evidence-based practices to optimize outcomes for the children we serve. One recent study, "Neurocognition after prenatal levetiracetam, lamotrigine, carbamazepine or valproate exposure," offers crucial insights into how prenatal exposure to different antiepileptic drugs (AEDs) affects neurocognitive development. This blog will discuss the study's findings and how they can inform our practice, as well as encourage further research.
Study Overview
The study examined the neurocognitive functioning of children aged 6 or 7 who were prenatally exposed to one of four common AEDs: carbamazepine (CBZ), lamotrigine (LTG), levetiracetam (LEV), or valproate (VPA). Researchers assessed 161 children using standardized neuropsychological measures, including the Wechsler Intelligence Scale for Children and the developmental neuropsychological assessment. Maternal IQ was also measured, and assessors were blinded to the specific AED exposures.
Key Findings
The study found significant differences in neurocognitive outcomes based on the type of AED exposure:
- Children exposed to VPA scored significantly lower on all six neurocognitive domains, particularly in language skills, compared to those exposed to CBZ, LTG, or LEV.
- After controlling for maternal IQ and drug dose, the verbal IQ of VPA-exposed children was on average 9.1 points lower than those exposed to CBZ, 10.3 points lower than LTG-exposed children, and 13.4 points lower than LEV-exposed children.
- No significant dose-effect relationship was found for CBZ, LTG, or LEV, while some neurocognitive measures showed a dose-effect for VPA.
Implications for Practice
Understanding these findings can help us tailor our interventions and advocacy efforts more effectively:
- Early Identification and Intervention: Children prenatally exposed to VPA may benefit from early screening and intervention, particularly in language development.
- Informed Counseling: When working with families planning for or currently in pregnancy, it is essential to provide evidence-based information on the potential impacts of different AEDs.
- Collaboration with Healthcare Providers: Encourage multidisciplinary collaboration to ensure that mothers with epilepsy receive comprehensive care, including considerations for the long-term neurocognitive development of their children.
Encouraging Further Research
While this study provides valuable insights, it also highlights the need for further research:
- Larger Sample Sizes: Future studies should aim to include larger sample sizes, particularly for less commonly prescribed AEDs like LEV.
- Longitudinal Studies: Long-term studies tracking neurocognitive development over time can provide more comprehensive data on the lasting impacts of prenatal AED exposure.
- Broader Populations: Including diverse populations in terms of socioeconomic status and educational background can help generalize findings to a broader demographic.
To read the original research paper, please follow this link: Neurocognition after prenatal levetiracetam, lamotrigine, carbamazepine or valproate exposure.
