The longer term outcome of children born to mothers with epilepsy
The longer term outcome of children born to mothers with epilepsy
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DOI：
10.1136/jnnp.2003.029132
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发表时间：
2004-11-01
影响因子：
11
通讯作者：
Chadwick, DW
中科院分区：
文献类型：
--
作者：
Adab, N;Kini, U;Chadwick, DW
目的：确定宫内暴露于抗癫痫药物（AEDs）的儿童中认知延迟和可能相关的畸形特征的患病率。设计：对癫痫母亲所生儿童的回顾性研究。设置：英国利物浦和曼彻斯特的地区癫痫诊所。参与者：癫痫母亲所生年龄在6个月至16岁之间的儿童。主要结局指标：采用结构化访谈、医院记录、临床检查和心理测试（韦氏测验）来评估暴露和智商（IQ）。盲法评估的照片被用来评分儿童的特征dysmorphic features.Results：共249名6岁及以上的儿童进行了研究：41人暴露于丙戊酸钠，52卡马西平，21苯妥英钠，49多药治疗，80未暴露。丙戊酸盐组的平均言语智商显著低于未暴露组和其他单药治疗组。多元回归分析显示，尽管调整了其他混杂因素，但妊娠期丙戊酸盐暴露和频繁强直阵挛性癫痫发作均与言语智商较低显著相关。有一个显着的负相关性畸形的功能和言语智商的儿童暴露于丙戊酸盐。结论：本研究确定丙戊酸盐作为一种药物携带的潜在风险，发育迟缓和认知障碍，是第一个表明，频繁的强直阵挛性癫痫发作有类似的效果。我们的研究结果需要谨慎解释，因为它们具有追溯性。癫痫妇女在怀孕前需要仔细咨询AED治疗的个人风险获益。
Objectives: To determine the prevalence of cognitive delay and possible associated dysmorphic features in children exposed to antiepileptic drugs (AEDs) in utero.Design: Retrospective study of children born to mothers with epilepsy.Setting: Regional epilepsy clinics in Liverpool and Manchester, UK.Participants: Children aged between 6 months and 16 years born to mothers with epilepsy.Main outcome measures: Structured interviews, hospital records, clinical examination, and psychometric tests ( Wechsler) were used to assess exposure and intelligence quotient ( IQ). Blinded assessment of photographs was used to score children with characteristic dysmorphic features.Results: A total of 249 children aged 6 and over were studied: 41 were exposed to sodium valproate, 52 to carbamazepine, 21 to phenytoin, 49 to polytherapy, and 80 were unexposed. Mean verbal IQ was significantly lower in the valproate group compared to unexposed and other monotherapy groups. Multiple regression analysis showed that both valproate exposure and frequent tonic-clonic seizures in pregnancy were significantly associated with a lower verbal IQ despite adjusting for other confounding factors. There was a significant negative correlation between dysmorphic features and verbal IQ in children exposed to valproate.Conclusions: This study identifies valproate as a drug carrying potential risks for developmental delay and cognitive impairment and is the first to suggest that frequent tonic-clonic seizures have a similar effect. Our results need to be interpreted with caution given their retrospective nature. Women with epilepsy need careful counselling about individual risk benefit of AED treatment before pregnancy.