The neurodevelopmental outcomes of treatment with newer anti-seizure medications in pregnancy

Prenatal exposure to certain antiseizure medications is associated with an increased risk of both congenital anomalies and longer-term neurodevelopmental difficulties. There is evidence that phenobarbital, valproate, carbamazepine and topiramate are associated with higher levels of physical and/or neurodevelopmental risk, highlighting that this is a class of medications to be carefully investigated.This presentation focuses on the neurodevelopmental aspects of child outcome following in utero exposure to ‘newer’ antiseizure medications. Neurodevelopment is a term which refers to a set of skills which include cognitive, motor, social and behavioural functioning that expand over the childhood and adolescent years. An increased risk of significant and lifelong disruption to these neurodevelopmental trajectories was observed following exposure to valproate in utero, highlighting the importance of in-depth neurodevelopmental investigation.In infancy children exposed to lamotrigine or levetiracetam appear to reach developmental milestones appropriately and perform better than those exposed to valproate, but studies investigating development beyond the pre-school years are more limited across certain neurodevelopmental areas in comparison to unexposed children. Additionally, data from children exposed to higher doses of these two medications are also more limited. Despite evidence regarding an increased risk of reduced fetal growth and increased risk of cleft anomalies, there is a lack of conclusive data regarding topiramate exposure and child neurodevelopmental outcome. Data are even fewer for other antiseizure medications and absent for others, which undermines preconceptual care for women with epilepsy. Methods of data collection in this context and aims for an improved focus on these outcomes are discussed.