Department of Neurology, Kerala Registry of Epilepsy and Pregnancy, Trivandrum, India.
Achutha Menon Center for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
Epilepsia. 2020 Nov;61(11):2442-2451. doi: 10.1111/epi.16685. Epub 2020 Oct 14.
Exposure to certain intrauterine antiepileptic drugs (AEDs) can negatively influence the language skills and intelligence of young children. It remains unanswered whether these deficits are transient or persist as children grow up. This study aims to evaluate the language function of children of women with epilepsy (CWE) aged 9-13 years in comparison with their peers, and its relationship with intrauterine AED exposure.
We included 191 CWE in our study from the Kerala Registry of Epilepsy and Pregnancy. Children in the same age group (n = 144) and without maternal epilepsy or antenatal AED exposure served as controls. We used Clinical Examination for Language Function version IV to assess language in both groups. Relevant data related to maternal epilepsy and AED use were obtained from the registry records.
The average Core Language Scaled Score (CLSS) was significantly lower in CWE as compared to controls (83.19 vs 90.18, P = .001). Similarly, the mean scaled scores in other language parameters were also significantly lower in CWE. In the multivariate analysis, compared to control children, the average CLSS in CWE was 4.5 units lower (95% confidence interval [CI] = -8.8 to -0.2, P = .04) with AED monotherapy exposure and 7.3 units lower with exposure to AED polytherapy (95% CI = -13.8 to -0.8, P = .03). Intrauterine exposure to phenobarbitone (n = 61) and valproate (n = 55) as either monotherapy or polytherapy showed a negative effect on CLSS in CWE as compared to control children. However, carbamazepine (n = 75) and phenytoin (n = 37) use was not associated with significant variation of CLSS. In head-to-head comparisons between AED monotherapies in CWE, phenobarbitone showed a negative effect on CLSS (-14.7, 95% CI = -23.1 to -6.4, P = .001) as compared to carbamazepine.
Intrauterine exposure to phenobarbitone and valproate impairs language development in CWE, with effects persisting into the second decade.
接触某些宫内抗癫痫药物（AEDs）会对幼儿的语言技能和智力产生负面影响。这些缺陷是否是暂时的，还是随着孩子的成长而持续存在，目前仍不清楚。本研究旨在评估患有癫痫的女性（CWE）的 9-13 岁儿童的语言功能，并将其与宫内 AED 暴露进行比较。
我们从喀拉拉邦癫痫与妊娠登记处纳入了 191 名 CWE。同年龄组（n=144）且无母体癫痫或产前 AED 暴露的儿童作为对照。我们使用语言功能临床检查第四版（Clinical Examination for Language Function version IV）来评估两组的语言功能。从登记处记录中获取与母体癫痫和 AED 使用相关的相关数据。
与对照组相比，CWE 的平均核心语言量表评分（CLSS）明显较低（83.19 对 90.18，P=0.001）。同样，CWE 中其他语言参数的平均评分也明显较低。在多变量分析中，与对照组儿童相比，CWE 的平均 CLSS 低 4.5 个单位（95%置信区间 [CI] = -8.8 至 -0.2，P=0.04），AED 单药治疗暴露低 7.3 个单位（95% CI = -13.8 至 -0.8，P=0.03）。宫内暴露于苯巴比妥（n=61）和丙戊酸钠（n=55）作为单药或多药治疗与对照组儿童相比，对 CWE 的 CLSS 有负面影响。然而，卡马西平（n=75）和苯妥英（n=37）的使用与 CLSS 无显著变化无关。在 CWE 中单药治疗的 AED 之间进行头对头比较时，与卡马西平相比，苯巴比妥对 CLSS 有负面影响（-14.7，95% CI = -23.1 至 -6.4，P=0.001）。
宫内暴露于苯巴比妥和丙戊酸钠会损害 CWE 的语言发育，其影响持续到第二个十年。
