Thomas Sanjeev V, Ajaykumar B, Sindhu K, Nair M K C, George Babu, Sarma P S
Kerala Registry of Epilepsy and Pregnancy, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
Epilepsy Behav. 2008 Jul;13(1):229-36. doi: 10.1016/j.yebeh.2008.01.010. Epub 2008 Mar 17.
We prospectively evaluated the mental (MeDQ) and motor (MoDQ) developmental quotients of 395 (67.5% of the eligible) infants of mothers with epilepsy (IME) (mean age: 15 months) enrolled in the Kerala Registry of Epilepsy and Pregnancy between 1998 and 2004. The same developmental pediatricians, blinded to antiepileptic drug (AED) exposure, evaluated the children using the Indian adaptation of the Bayley Scale of Infant Development: Their mean MeDQ was 89.1+/-29.9 and mean MoDQ was 90.7+/-26.9. The MeDQ and MoDQ were impaired (<84) for 150 (37.6%) and 133 (33.5%) IME, respectively. Maternal age, type of epilepsy, seizure frequency, or use of folic acid did not correlate with the mean MeDQ or MoDQ. Maternal education was significantly correlated with the MoDQ, but not with the MeDQ, of the infants. Infants not exposed to AEDs (n=32) had a higher MeDQ (mean: 92.3, 95% CI: 81.4-103.2) and MoDQ (mean 94.7; 95% CI 84.9-104.5) than those exposed to AEDs (MeDQ--mean: 88.6, 95% CI: 85.5-91.6; MoDQ--mean: 90.0, 95% CI: 87.3-92.8). Those exposed to polytherapy had significantly lower developmental quotients than those exposed to monotherapy. Cumulative AED scores during pregnancy had an inverse relationship with developmental quotients. On multiple regression analysis, polytherapy was a stronger predictor of lower developmental quotients than dosage. Compared with carbamazepine monotherapy, valproate monotherapy was associated with significantly lower MeDQ and MoDQ in IME (93.1 and 95 vs 86.9 and 86.1), but the differences between other AEDs were not significant for IME exposed to valproate monotherapy. A limitation of the study is that the influence of maternal intelligence on developmental quotients was not evaluated.
我们前瞻性地评估了1998年至2004年间纳入喀拉拉邦癫痫与妊娠登记处的395名（占符合条件者的67.5%）癫痫母亲所生婴儿（IME）（平均年龄：15个月）的智力发育商数（MeDQ）和运动发育商数（MoDQ）。同一位发育儿科医生在对婴儿是否接触抗癫痫药物（AED）不知情的情况下，使用贝利婴儿发育量表的印度改编版对这些儿童进行了评估：他们的平均MeDQ为89.1±29.9，平均MoDQ为90.7±26.9。150名（37.6%）IME的MeDQ受损（<84），133名（33.5%）IME的MoDQ受损。母亲年龄、癫痫类型、癫痫发作频率或叶酸使用情况与平均MeDQ或MoDQ均无相关性。母亲的教育程度与婴儿的MoDQ显著相关，但与MeDQ无关。未接触AEDs的婴儿（n = 32）的MeDQ（平均：92.3，95%可信区间：81.4 - 103.2）和MoDQ（平均94.7；95%可信区间84.9 - 104.5）高于接触AEDs的婴儿（MeDQ - 平均：88.6，95%可信区间：85.5 - 91.6；MoDQ - 平均：90.0，95%可信区间：87.3 - 92.8）。接受联合治疗的婴儿的发育商数显著低于接受单一疗法的婴儿。孕期累积AED评分与发育商数呈负相关。在多元回归分析中，联合治疗比剂量更能预测较低的发育商数。与卡马西平单一疗法相比，丙戊酸单一疗法与IME中显著更低的MeDQ和MoDQ相关（93.1和95对86.9和86.1），但对于接受丙戊酸单一疗法的IME，其他AEDs之间的差异不显著。该研究的一个局限性是未评估母亲智力对发育商数的影响。
