הפרופיל ההתפתחותי של ילדים אשר נחשפו לתרופות אנטי-אפילפטיות במהלך ההריון: תפקוד סנסורי, תפקוד מוטורי והשתתפות
THE DEVELOPMENTAL PROFILE OF CHILDREN EXPOSED TO ANTI-EPILEPTIC DRUGS IN UTERO: SENSORY FUNCTION, MOTOR FUNCTION AND PARTICIPATION
Tanya Rihtman1, Shula Parush1, Asher Ornoy2
טניה ריכטמן1, שולה פרוש1, אשר אור-נוי2
1. School of Occupational Therapy, Hebrew University Hadassah Medical School, Jerusalem
2. Hebrew University Hadassah Medical School, Jerusalem
Introduction: Epilepsy is the most common neurological condition requiring continuous treatment during pregnancy. Anti-epileptic drugs (AEDs) are human teratogens yet seizures may be detrimental to the fetus, thus most practitioners continue prescribing AEDs during pregnancy. The longer-term developmental effects of intra-uterine exposure to specific AEDs have not been adequately delineated. This prospective study was designed to comprehensively assess the longer-term developmental effects of intra-uterine exposure to AED monotherapy.
Materials & Methods: Four groups of children aged 3 years-6 years 11 months were identified: sodium valproate (SV) exposed (n=30; mean age 52.00[15.22] months; 16 males), lamotrigine (LT) exposed (n=42; mean age 50.12[12.77]; 18 males) and control (n=52; mean age 59.96[14.51]; 25 males). A wide assessment battery was used to investigate intelligence, motor function, sensory function, behavior and participation in different environments. Parents and teachers completed questionnaires and children were invited for occupational therapy and psychological assessments at one of four locations.
Results: Significant group differences were found for most measures; AED-exposed children performed worse than controls. For sensory function, SV and LT exposure predicted deficits; while SV dosage was not predictive, LT dosage showed a trend. For motor function, both SV and LT exposure predicted deficits; SV dosage was predictive yet LT dosage was not. The participation profile of children exposed to AEDs will also be presented.
Conclusions: A lack of physical deficits after AED exposure should not prevent close monitoring of these children at later stages of development, from a multi-disciplinary perspective, with the provision of suitable services where necessary.