Abstract Details

Title Fetal Antiseizure Medication Effects on Neuropsychological Outcomes at Age 3 Years in the MONEAD Study

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S1 - Epilepsy and Clinical Neurophysiology (EEG) 1 (2:00 PM-2:08 PM)

Poster/Presentation
Number 001

Background Adverse neurodevelopmental effects of ASM exposures remain uncertain for many ASMs. Teratogens act in an exposure-dependent manner, but clearance changes occur during pregnancy for many ASMs so that dose-dependent effects may not accurately reflect actual fetal ASM exposure.

Objective To examine the neurodevelopmental effects of fetal antiseizure medication (ASM) exposures on age 3 year-old neuropsychological outcomes.

Design/Methods The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONEAD) study is a prospective, observational, multi-center investigation of pregnancy outcomes. Women with epilepsy (WWE) and healthy women (HW) were enrolled during pregnancy. The primary outcome for children at age 3 was a Verbal Index score calculated by averaging the Differential Ability Scales-II (DAS-II) Naming Vocabulary and Verbal Comprehension subtests, Preschool Language Scale-5 Expressive Communication and Auditory Comprehension subscales, and Peabody Picture Vocabulary Test-4. Children of WWE vs. HW were compared using ANCOVA. Association with maximum ASM blood levels (ABLs) in the 3rd trimester was assessed with multiple linear regression. Models were adjusted for maternal IQ, education, and ASM group (ABL model only).

Results

At enrollment, most pregnant WWE were on monotherapy (74%) which were primarily lamotrigine (LTG, 43%) or levetiracetam (LEV, 37%). Dual therapy LTG+LEV was the most prevalent polytherapy (44%). Age 3 Verbal Index scores did not differ for children of WWE (n=275, LS Mean (95% CI)= 103.4 (102.1, 104.6)) vs HW (n=77, 102.7 (100.2, 105.1)) in adjusted analyses. ASM exposure effects were not seen for maximum 3^rd trimester ABLs (n=251, adjusted parameter estimate (95% CI)= -1.2 (-6.2, 3.8)). In secondary analyses of DAS-II Non-Verbal Index and General Conceptual Ability scores, children of WWE and HW did not differ, nor did the ASM exposure effects in children of WWE.

Conclusions In these preliminary analyses, neurodevelopmental outcomes did not differ between children of WWE vs. HW, and exposure-dependent ASM effects were not seen.

Authors/Disclosures
Kimford J. Meador, MD, FAAN (Stanford University School of Medicine) PRESENTER	The institution of Dr. Meador has received research support from NIH. The institution of Dr. Meador has received research support from Eisai. The institution of Dr. Meador has received research support from Medtronics. The institution of Dr. Meador has received research support from The Epilepsy Consortium.
Morris Cohen (Pediatric Neuropsychology International)	No disclosure on file
David W. Loring, PhD, FAAN (Emory Univ, Dept of Neurology)	Dr. Loring has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. Dr. Loring has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ILAE. The institution of Dr. Loring has received research support from NIH. Dr. Loring has received publishing royalties from a publication relating to health care.
Carrie Brown (Emmes)	No disclosure on file
Chelsea Robalino (Emmes)	No disclosure on file
Page B. Pennell, MD, FAAN (University of Pittsburgh School of Medicine)	The institution of Dr. Pennell has received research support from NIH. The institution of an immediate family member of Dr. Pennell has received research support from Department of Defense. The institution of an immediate family member of Dr. Pennell has received research support from Environmental Protection Agency. The institution of an immediate family member of Dr. Pennell has received research support from NIH. The institution of an immediate family member of Dr. Pennell has received research support from Advanced Energy Consortium. Dr. Pennell has received publishing royalties from a publication relating to health care.