Language, intelligence, and educational outcomes of adolescents with antenatal exposure to antiseizure medications: Prospective data from the Kerala Registry of epilepsy and pregnancy

Sanjeev V Thomas; Salma Salim; Nikita Susan Jacob; Manna Jose; Reshma A Salini; Sajith Selvaraj; Treasa Stemy Gomez; Hema Sreedharan; Panniyammakal Jeemon

doi:10.1016/j.seizure.2022.06.005

Language, intelligence, and educational outcomes of adolescents with antenatal exposure to antiseizure medications: Prospective data from the Kerala Registry of epilepsy and pregnancy

Seizure. 2022 Aug:100:76-81. doi: 10.1016/j.seizure.2022.06.005. Epub 2022 Jun 17.

Authors

Sanjeev V Thomas¹, Salma Salim², Nikita Susan Jacob², Manna Jose², Reshma A Salini², Sajith Selvaraj², Treasa Stemy Gomez², Hema Sreedharan², Panniyammakal Jeemon³

Affiliations

¹ Kerala Registry of Epilepsy and Pregnancy, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, Kerala State, India. Electronic address: sanjeev.v.thomas@gmail.com.
² Kerala Registry of Epilepsy and Pregnancy, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, Kerala State, India.
³ Achutha Menon Centre for Health Sciences, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India. Electronic address: jeemon@sctimst.ac.in.

PMID: 35780605
DOI: 10.1016/j.seizure.2022.06.005

Abstract

Objective: In a prospective cohort of children (13-21 years) of women with epilepsy (CWWE), we compared those exposed to antiseizure medications (ASM) in utero to those without exposure to ASM regarding their language proficiency and intelligence. We also compared their educational performance with state-wide averages.

Methods: Research staff blinded to the ASM exposure of CWWE administered the Clinical Evaluation of Language Fundamentals IV and the Wechsler Intelligence Scale for Children IV to test their language proficiency and intelligence. We assessed their educational performance with a questionnaire. CWWE without antenatal exposure to ASM served as comparators for language and intelligence tests. The educational performance of CWWE (regardless of ASM exposure) was compared with the state-wide averages published by the government.

Results: In total, 446 children (mean age 16.5 ± 2.2 years; 236 girls) participated in the study. Their ASM exposure involved monotherapy for 272 (61%), polytherapy for 133 (29.8%) and none for 41 (9.2%). The commonly used ASMs (mono & polytherapy) were carbamazepine (n = 192), valproate (n = 124), phenobarbitone (n = 95), and phenytoin (n = 73). The full-scale intelligence quotient of CWWE (n = 146) with antenatal exposure to ASM (89.2 ± 21.5) was significantly lower (p = 0.03) than that of CWWE (n = 11) unexposed to ASM (96.9 ± 8.8). The CELF core language scaled score for the exposed CWWE (n = 132) was significantly lower than that of unexposed children (n = 12; 99.2 ± 19.9). Compared with state-wide averages, CWWE (n = 386) had delayed initiation of education (2.6% vs. 0.1%), increased dropout rates (1% vs. 0.11%), increased usage of special assistance during examinations (4.4% vs. 0.1%) and a lower rate (19.9% vs. 37%) of enrolment in universities.

Conclusion: The language and intelligence functions of CWWE with exposure to older ASMs were lower than those of unexposed CWWE. Compared to state-wide averages, a significantly higher proportion of CWWE had difficulties with education, and only a smaller proportion enrolled in higher education.

Keywords: Academics; Antiepileptic drug; Education; Epilepsy; Pregnancy.

MeSH terms

Adolescent
Anticonvulsants / adverse effects
Child
Epilepsy* / drug therapy
Female
Humans
Intelligence
Language
Pregnancy
Pregnancy Complications* / drug therapy
Prenatal Exposure Delayed Effects* / epidemiology
Prospective Studies
Registries

Substances

Anticonvulsants