Long-term neuropsychological consequences of maternal epilepsy and anticonvulsant treatment during pregnancy for school-age children and adolescents

Purpose: Antiepileptic drugs (AEDs) are potential teratogenic agents. The p urpose of this study was to examine the long-term effects of intrauterine A ED exposure on neurologic and psychological functioning. Methods: Of a prospective study, "Epilepsy, pregnancy, and child developmen t," children could be retraced at school age and adolescence. Sixty-seven w ere born to mothers with epilepsy [no drugs during pregnancy (n = 13), mono therapy (n = 31), polytherapy (n = 23)]; 49 were nonafflicted control child ren. Assessments included an intelligence test (Wechsler), a neurologic exa mination (Touwen), and an EEG. Data analyses were performed, controlling fo r parental social status, type of maternal drug therapy and drug dosage, ty pe of epilepsy, frequency of seizures during pregnancy, the original subgro ups, and specific drug effects. Results: Type of maternal epilepsy and type and kind of AED therapy, but no t maternal seizures during pregnancy correlated with an increase in abnorma l EEG patterns. Minor neurologic dysfunction was diagnosed, with increased frequency from the control to the risk/no drug or monotherapy to the polyth erapy group. The compromised intelligence score of the polytherapy group wa s primarily due to those children who had been exposed to primidone (PRM). Level of IQ was negatively associated with PRM dosage. Conclusions: Maternal epilepsy and AED therapy during pregnancy appear to h ave long-term effects on the offspring well into adolescence, as evinced in EEG patterns, minor neurologic dysfunction, and intellectual performance. Severity of effects increased from control group to epilepsy/no-drug group to monotherapy group and was most marked in the polytherapy group. These gr oup differences are assumed to reflect differential neural vulnerability to social and family factors.