Abstracts

Rationale: Literature suggests that children born to women with epilepsy may be at an increased risk of maladaptive behaviour. However, research completed to date has involved small numbers of children or has often been retrospective in nature, increasing the chance of biased reporting. Methods: As part of the Liverpool and Manchester Neurodevelopment Group s prospective study, data has been collected on the maladaptive behaviour of children born to mothers with epilepsy. This cohort is prospectively recruited prior to birth and monitored until six years of age. The Behavioural Assessment System for Children (BASC-II) was administered to mothers of children assessed at six years of age, by a researcher blinded to the exposure type. Results: Seventy nine percent (n=272) of questionnaires were returned (48 exposed to carbamazepine, 48 to valproate, 23 to lamotrigine, 24 to polytherapy and 129 control children). No significant differences were found in the externalising difficulties of hyperactivity and aggression but children exposed to polytherapy treatments scored significantly higher for conduct difficulties in comparison to control children (p=0.012) and children exposed to valproate (p=0.023). No significant differences were found for the internalising difficulties of anxiety, depression or somatisation. Children exposed to valproate showed a trend towards significance for atypicality (p=0.055) and reached a significant level of difference for attentional problems (p=0.005) in comparison to the control children. Significantly more children exposed to polytherapy fell within the at risk (>60) or clinical range (>70) for hyperactivity (27%, p=0.012), aggression (27%, p=0.028), conduct difficulties(27%, p=0.008) and attention (33%, p=0.002) in comparison to control children. Children exposed to valproate fell more frequently within the at risk or clinical range, and this reached significance for withdrawal (21%, p=0.019) and attention (31%, p<0.001). There was also an increase in at risk scores for the children exposed to carbamazepine in utero for conduct difficulties (18%, p=0.33), depression (18%, p=0.017) and attention (21%, p=0.027). No increase in maladaptive behaviours was found for children exposed to lamotrigine. Gestational age at birth and intellectual abilities were strongly associated with attentional deficits and higher levels of withdrawal. Conclusions: Children exposed in utero to polytherapy treatment or monotherapy valproate show a higher incidence of maladaptive behaviour as a group. Increased rates of at risk and clinical levels of maladaptive behaviour were more frequent in all antiepileptic drug groups with the exception of lamotrigine.