Abstracts

There is growing evidence that exposure to anti-epileptic drugs (AED[apos]s) in utero may increase the risk of major malformations, however little research has focused on the neuropsychological impact of AED exposure to the developing brain. Results of neuropsychological assessment at 12-20 months in a prospective cohort are reported., 408 children were assessed blinded using the Griffiths Developmental Scale, 229 children acted as a control group and were not exposed to medication in utero. 142 children were exposed to AED treatment (sodium Valproate (VPA) n= 35, carbamazepine (CBZ) n= 40, lamotrigine (LTG) n=27, polytherapy n=28, other monotherapy n= 12) and 37 children were born to mothers with epilepsy but were not exposed to AED[apos]s in utero. Each mother completed the National Adult Reading Test a surrogate measure of intellectual functioning., Children exposed to AED[apos]s in utero scored significantly lower overall on developmental skills than control children (exposed m=96.16 vs 100.22, p=0.008). Analysis of the subscales indicates that children exposed to AED[apos]s performed significantly lower than controls on language, (exp m= 101.10 vs 104.84, p=0.035), hand and eye co-ordination (exp m=93.18 vs 100.28, p[lt]0.01), and performance (exp m= 96.41 vs 101.04, p=0.006) skills. There was a strong trend that children exposed to AED[apos]s in utero performed poorer on tasks involving motor skills (p=0.056). Specific drug effects highlighted that children exposed to polytherapy performed significantly poorer on motor tasks when compared to LTG (P=0.009), personal and social in comparison to CBZ (p=0.054), LTG (p=0.035) and controls (p=0.059). On hand and eye co-ordination tasks there was a significant difference between the performance of polytherapy group and controls (p=0.047). There was also a strong trend for children exposed to VPA to be poorer than controls on hand [amp] eye co-ordination tasks (p=0.066). With the exception of motor and hand and eye tasks children exposed to polytherapy and VPA had lower group means consistently than the other groups. A multiple regression analysis indicated that both maternal IQ and AED treatments were predictive of the child[apos]s overall performance on the Griffiths Developmental Scale., Children exposed to AED[apos]s in utero may be at greater risk of developmental delay when compared to controls at 12-20 months. The results further suggest that exposure to both polytherpy and VPA may carry an increased risk. The children will be re-assessed at ages 3 and 6 to inform on the neurodevelopment of this cohort further and allow comparison of differential drug effects more reliably., (Supported by National Institute for Health (NIH).)