Antiepileptic medication (AEDs), mostly lamotrigine (Lamictal) and valproic acid (Depakote), have grow to be broadly used medicines for the remedy of sufferers with bipolar dysfunction. There’s appreciable knowledge to help the reproductive security of lamotrigine; nonetheless, different antiepileptic medication — particularly valproic acid — carry important dangers throughout being pregnant and thus must be averted. A number of years in the past, researchers raised considerations about using topiramate (Topamax) and increased risk for oral clefts. A brand new research signifies that prenatal publicity to topiramate may additionally improve danger for neurodevelopmental problems.
To look at danger for neurodevelopmental problems in youngsters uncovered prenatally to AEDs, researchers analyzed knowledge from a Nordic register-based research of antiepileptic medication in being pregnant (SCAN-AED). It is a population-based cohort research amassing well being register and social register knowledge from Denmark, Finland, Iceland, Norway, and Sweden (1996-2017). The cohort consists of about 4.5 million pregnancies with livebirths.
Neurodevelopmental outcomes had been in contrast throughout totally different teams decided by publicity to a selected AED or mixture of AEDs. The management group consisted of kids born to moms with epilepsy who didn’t take AEDs throughout being pregnant (n=21,634). The medical information had been used to establish youngsters with autism spectrum dysfunction (ASD), mental incapacity (ID), or any neurodevelopmental dysfunction (ASD and/or ID). The median (IQR) age on the finish of follow-up was 8 (4.0-12.1) years.
Among the many 21,634 unexposed youngsters born to moms with epilepsy, 1.5% had a analysis of ASD and 0.8% of a analysis of mental incapacity (ID) by 8 years of age. In same-aged youngsters uncovered to topiramate monotherapy, the prevalence of ASD was 4.3% and the prevalence of ID was 3.1%. Related charges of ASD and ID had been noticed in youngsters uncovered to valproate monotherapy: 2.7% and a pair of.4%, respectively.
Accounting for potential confounders, the researchers calculated adjusted hazards ratios. Kids uncovered to topiramate monotherapy had a 2.8-fold improve in danger for ASD (aHR 2.5, 95% CI, 1.4-5.7) and a 3.5-fold improve in danger for ID (aHR 3.5, 95% CI, 1.4-8.6). Kids uncovered to valproate monotherapy had been additionally at elevated danger for ASD (aHR 2.4; 95% CI, 1.7-3.3) and ID (aHR 2.5; 95% CI, 1.7-3.7). Lamotrigine publicity was not related to elevated danger of ASD or different neurodevelopmental problems. The aHRs had been elevated with increased AED doses in comparison with youngsters within the basic inhabitants.
Topiramate and Neurodevelopmental Outcomes (Bjork et al,2022) by Ruta Nonacs, MD PhD
Whereas earlier research have proven increased charges of ASD and neurodevelopmental problems in youngsters with prenatal publicity to valproate, that is to our data the primary research to boost considerations about publicity to topiramate. Particularly alarming is the discovering that topiramate is just like valproate by way of danger of neurodevelopmental problems. Fortuitously, it’s a treatment that we don’t use that usually to deal with psychiatric sufferers, however many women of reproductive age use topiramate for migraine prophylaxis and weight discount (Qsymia is a mix of phentermine and topiramate used to deal with weight problems).
Ruta Nonacs, MD PhD
Bjørk MH, Zoega H, Leinonen MK, Cohen JM, Dreier JW, Furu Okay, Gilhus NE, Gissler M, Hálfdánarson Ó, Igland J, Solar Y, Tomson T, Alvestad S, Christensen J. Association of Prenatal Exposure to Antiseizure Medication With Risk of Autism and Intellectual Disability. JAMA Neurol. 2022 Jul 1;79(7):672-681.
