Lamotrigine

MONDAY, Dec. 2, 2024 -- For decades, it's been known that certain older medications women use to control epilepsy seizures can pose risks to a fetus. However, data now suggests that no such risk exists for newer-generation anti-seizure meds. “We need to balance making sure there is enough medicine on board to protect the mother and her developing fetus from seizures, but not too much where we're creating risk for the child,” explained study co-lead investigator Dr. Kimford Meador , a professor of neurology at Stanford University. Older medications such as valproate have been strongly linked to birth defects and cognitive issues in offspring. So, women with epilepsy have long been warned to stay off of these drugs while pregnant. However, seizure control is important, since seizures can also pose risks to the fetus and mother-to-be. New anti-seizure medications have been developed -- but do they pose any risk to the fetus? To find out, Meador's team tracked the language development of 387 children. Kids were tracked up to the age of 6. Of those, 298 had been born to women with epilepsy who took newer antiseizure medications while pregnant -- typically lamotrigine , levetiracetam or a combination of both drugs. "Children were tested on a variety of verbal abilities, including vocabulary and matching spoken words to pictures," according to a news release from the National Institute of Neurological Disorders and Stroke (NINDS), which funded the study. The result: No difference in language scores between kids exposed to the drugs in the womb and those who were not exposed. “What makes this study meaningful is that when you assess a child at 6, the tests are a lot more sensitive than at earlier ages, especially 2-year-olds," Meador noted in the news release. "There’s measurable impact on school performance and results are more predictive of adult cognitive ability." The new findings should reassure parents, since prior studies that had followed kids only up to age 2 or 3 had suggested that fetal exposure to high doses of levetiracetam might impair a child's cognitive skills. However, by 6 years of age, no differences were found, according to the new research. “Controlling seizures during pregnancy is an important part of prenatal care for women with epilepsy, but for years, the effects of newer antiseizure medications on their children was unknown,” noted Dr. Adam Hartman , program director at NINDS. “One major component of this study was correlating the cognitive abilities of children with maternal blood levels of the drugs. This opens the door to future work and might inform better dosing strategies," said Hartman, who wasn't involved in the study. Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

*仅供医学专业人士阅读参考抗癫痫药物是精神疾病患者控制病情稳定的重要管理方式。但是，由于孕期情况复杂，药物使用受到需要限制，某些抗癫痫药物（比如丙戊酸）是公认的致畸剂，同时，越来越多的证据表明一些抗癫痫药物与胎儿畸形和后代长期神经发育障碍有关，提示了丙戊酸之外其他抗癫痫药物的潜在风险。来自布里斯托大学的研究人员讨论了其他抗癫痫药物在妊娠期间长期安全性证据。结果显示，与孕期未接触过抗癫痫药物的儿童相比，接触过丙戊酸的儿童更有可能患自闭症、智力障碍和注意缺陷多动障碍（ADHD）。此外，托吡酯与儿童患智力障碍风险增加148%有关，卡马西平与儿童自闭症风险增加25%有关，与儿童智力障碍风险增加30%有关。研究发表在《自然·通讯》杂志上。研究数据来自英国CPRD GOLD的初级保健数据和瑞典健康和疾病发展起源（DOHaD）队列，主要暴露是胎儿在怀孕期间接触抗癫痫药物单药或多药治疗，主要结果为自闭症、智力障碍和ADHD，混杂因素包括母亲特征、母亲神经发育状况等。最终的分析队列包括英国的518047名活产儿童和瑞典的2664726名活产儿童。在3182773名儿童中，有17495名接触过抗癫痫药物，78442名儿童诊断有自闭症，26787名被诊断有智力障碍，155329名诊断有ADHD。调整混杂因素进行分析，未接触过抗癫痫药物儿童12岁时患自闭症、智力障碍和ADHD的预期绝对风险分别为3.01%、0.92%和2.50%。对于接触过抗癫痫药物的儿童来说，不同药物的神经发育障碍的绝对风险不同。丙戊酸单药治疗的儿童，三种神经发育障碍的预期绝对风险都最高，分别为4.85%、2.36%和6.34%。除此之外，加巴喷丁单药治疗的儿童自闭症预期绝对风险为3.67%，托吡酯单药治疗的儿童智力障碍预期绝对风险为2.14%，苯妥英单药治疗的儿童ADHD预期绝对风险为6.30%。与未接触抗癫痫药物的儿童相比，丙戊酸与自闭症风险增加78%有关，与智力障碍风险增加156%有关，与ADHD风险增加20%有关；卡马西平与自闭症风险增加25%有关、与智力障碍风险增加30%有关；托吡酯与智力障碍风险增加148%有关；多药治疗与自闭症风险增加51%有关、与智力障碍风险增加102%有关。总的来说，这项大规模研究支持先前的研究结果，孕期使用丙戊酸，或其他抗癫痫药物，托吡酯、卡马西平，与后代的神经发育疾病有关。几乎没有证据表明孕期接触拉莫三嗪会增加神经发育疾病的风险。研究作者表示，“对任何抗癫痫药物都应该进行积极监测，确保安全性和有效性，尤其是在怀孕期间，应根据患者的具体情况作出相应决定”。参考文献：Madley-Dowd P, Ahlqvist VH, Forbes H, et al. Antiseizure medication use during pregnancy and children's neurodevelopmental outcomes. Nat Commun. 2024;15(1):9640. Published 2024 Nov 15. doi:10.1038/s41467-024-53813-1本文作者丨王雪宁