EEC 2022 | The effect of prenatal anti-seizure medication exposure on children: monotherapy versus dual therapy

Marte-Helene Bjork, MD, PhD, Haukeland University Hospital, Bergen, Norway, outlines a large study (SCAN-AED) of population registries from the Nordic countries, in total combining 30 registries from 5 countries, to investigate the occurrence of neurodevelopmental disorders in children exposed to anti-seizure medication during pregnancy. The study followed the children for an average of eight years, to identify neurodevelopmental disorders such as autism spectrum disorders or intellectual disabilities. They found that children exposed to topiramate or valproate monotherapy had two-to-four times increased hazard ratio of having neurodevelopmental disorders. Further, they looked at the risk associated with use of the most common dual therapies. The most common combination therapy is levetiracetam and lamotrigine, which was not associated with an increase in neurodevelopmental disorders. Nevertheless, the other common combinations (lamotrigine and valproate, levetiracetam and carbamazepine, and lamotrigine and topiramate) were associated with increased risk of neurodevelopmental disorders in the same range as valproate. Investigations into congenital malformations showed the same result. Therefore, Dr Bjork thinks levetiracetam plus lamotrigine should be researched more for safety and efficacy as it could become an alternative for women who need more than one drug during pregnancy. This interview took place at the 14th European Epilepsy Congress (EEC) 2022 in Geneva, Switzerland.