Epilepsy is a medical condition that induces seizures, which are kind of like electric currents flowing through the body. Extreme seizures, otherwise known as grand mal seizures, cause the body to convulse and too many seizures can actually cause brain damage. For this reason, may epileptics take medication to control their seizures; one of four medications may be prescribed: valproate (Depakote), carbamazepine (Tegretol), lamotrigine (Lamictal), or phenytoin (Dilantin). This medication is generally taken for life – this includes during pregnancy.
While almost any medication can carry a risk from mother to fetus, some medications are worse than others. In a recent study, when compared to other seizure medications, researchers found that valproates were the worst for women to take during pregnancy because of the potentially lasting effects it can have on the fetus’s IQ.
For their study, researchers followed the pregnancies and outcomes of 305 pregnant women from the United States and United Kingdom. Those women took only one of the four drugs used to treat epilepsy. When their children reached the age of six, their IQs were tested. What was found has changed the way that the medical community looks at treatment for neurological conditions like epilepsy during pregnancy.
Overall, children whose mothers had taken valproate during pregnancy scored seven to 10 points lower than the children whose mothers had taken another antiepileptic drug. Additionally, children born to mothers on valproates were found to have poorer speaking skills and memory abilities. The higher the medication dosage, the worse the effect seemed to be.
“These results build on our earlier work to show that valproate usage during pregnancy has a significant negative effect on children’s IQ, which lasts beyond their earliest years,” study leader Kimford Meador, a professor in the neurology department at Emory University in Atlanta said in a journal news release.
That earlier work consisted of IQ testing children at the age of 3. In that study, the results were the same; children born to mothers on valproate had lower IQ scores. Back then, the U.S. Food and Drug Administration issued a warning that valproate exposure in the womb is associated with impaired mental function in children. But children can recover from a low IQ score at age three. Researchers on this study say that it is less likely for a six-year-old to recover from a low IQ score at age six.
“IQ at age 6 is strongly predictive of adult IQ and school performance, so our research suggests that valproate use during pregnancy is likely to have long0term negative effects on a child’s IQ and other cognitive [mental] abilities,” Meador said.
Because of this particular study, many neurologists have changed the way they handle epilepsy in their pregnant patients. Dr. Cynthia Harden, chief of the division of epilepsy and electroencephalography at the Cushing Neuroscience Institute in Manhasset, NY explains.
“This important work has changed the way we practice neurology, leading us to conclude that valproate should not be used, if at all possible, in women of child-bearing potential,” Harden told US News Health. “The risks of valproate during pregnancy are clearly demonstrated, as the children in this research cohort continue to grow.”
Unfortunately, there are many cases in which only one type of medication works. This means that some expecting epileptics may not have any other option as far as medication is concerned. This is what makes another portion of the study extremely important. Researchers found that, over time, IQ could improve if their mothers had taken a folic acid supplement. Harden called this portion of the study “reassuring and fascinating since the mechanism of how intrauterine valproate exposure can cause cognitive and behavioral problems in children is unknown.”
Meador stressed that more research in this area is still needed, however, because at this point, there is not enough evidence to support the continued use of valproates, even when folic acid is taken. So, for now, neurologists continue to hope for a better solution for their pregnant epileptic patients.
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