Alsfouk Bshra A
Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O Box 84428, Riyadh 11671, Saudi Arabia.
Ther Adv Drug Saf. 2022 Mar 29;13:20420986221088419. doi: 10.1177/20420986221088419. eCollection 2022.
Some old antiseizure medications (ASMs) pose teratogenic risks, including major congenital malformations and neurodevelopmental delay. Therefore, the use of new ASMs in pregnancy is increasing, particularly lamotrigine and levetiracetam. This is likely due to evidence of low risk of anatomical teratogenicity for both lamotrigine and levetiracetam. Regarding neurodevelopmental effects, lamotrigine is the most frequently investigated new ASM with information available for children up to 14 years of age. However, fewer data are available for the effects of levetiracetam on cognitive and behavioral development, with smaller cohorts and shorter follow-up. The aim of the present review was to explicate neurodevelopmental outcomes in children exposed prenatally to levetiracetam to support clinical decision-making. The available data do not indicate an increased risk of abnormal neurodevelopmental outcomes in children exposed prenatally to levetiracetam. Findings demonstrated comparable outcomes for levetiracetam controls and favorable outcomes for levetiracetam valproate on global and specific cognitive abilities, and behavioral problems. In addition, the available evidence shows no significant dose-effect association for levetiracetam on neurodevelopmental outcomes. However, this evidence cannot be determined definitively due to the limited numbers of exposures with relatively short follow-up. Therefore, further research is required.
Antiseizure medications (ASMs) are medicines that inhibit the occurrence of seizures. Levetiracetam is a new ASM. Some old ASMs are linked with an increased risk of physical birth abnormalities and adverse effects on the child's brain development. Therefore, the use of new ASMs in pregnancy is increasing, especially lamotrigine and levetiracetam. This is likely due to evidence of low risk of birth abnormalities for both lamotrigine and levetiracetam. Regarding effects on development of the brain, lamotrigine is the most frequently examined new ASM with information available for children up to 14 years of age. However, fewer data are available for the effects of levetiracetam on cognitive and behavioral development. Also, levetiracetam studies were smaller and shorter compared with studies investigating lamotrigine effects. The aim of this article was to review the child's brain development effects after exposure to levetiracetam during pregnancy. The available data do not suggest an increased risk of the child having learning or thinking difficulties. Findings demonstrated comparable outcomes for levetiracetam controls (i.e. children unexposed to levetiracetam), and favorable outcomes for levetiracetam valproate. In addition, the available evidence shows no link between the higher dose of levetiracetam and an increased risk of adverse effects on the child's brain development. However, this evidence cannot be determined definitively due to the limited numbers of children exposed to levetiracetam with relatively short duration of follow-up. Therefore, further research is required.
一些旧的抗癫痫药物（ASMs）存在致畸风险，包括严重先天性畸形和神经发育迟缓。因此，孕期使用新的抗癫痫药物的情况正在增加，尤其是拉莫三嗪和左乙拉西坦。这可能是由于有证据表明拉莫三嗪和左乙拉西坦的解剖致畸风险较低。关于神经发育影响，拉莫三嗪是研究最频繁的新型抗癫痫药物，有针对14岁以下儿童的可用信息。然而，关于左乙拉西坦对认知和行为发育影响的数据较少，研究队列较小且随访时间较短。本综述的目的是阐明产前暴露于左乙拉西坦的儿童的神经发育结局，以支持临床决策。现有数据并未表明产前暴露于左乙拉西坦的儿童出现异常神经发育结局的风险增加。研究结果表明，左乙拉西坦组与对照组在整体和特定认知能力以及行为问题方面结果相当，左乙拉西坦与丙戊酸盐组相比有良好结果。此外，现有证据表明左乙拉西坦的剂量与神经发育结局之间无显著剂量效应关联。然而，由于暴露数量有限且随访时间相对较短，这一证据不能确定。因此，需要进一步研究。
抗癫痫药物（ASMs）是抑制癫痫发作的药物。左乙拉西坦是一种新型抗癫痫药物。一些旧的抗癫痫药物与身体出生异常风险增加以及对儿童大脑发育的不良影响有关。因此，孕期使用新的抗癫痫药物的情况正在增加，尤其是拉莫三嗪和左乙拉西坦。这可能是由于有证据表明拉莫三嗪和左乙拉西坦的出生异常风险较低。关于对大脑发育的影响，拉莫三嗪是研究最频繁的新型抗癫痫药物，有针对14岁以下儿童的可用信息。然而，关于左乙拉西坦对认知和行为发育影响的数据较少。此外，与研究拉莫三嗪影响的研究相比，左乙拉西坦的研究队列较小且随访时间较短。本文的目的是综述孕期暴露于左乙拉西坦后对儿童大脑发育的影响。现有数据并未表明儿童出现学习或思维困难的风险增加。研究结果表明，左乙拉西坦组与对照组（即未暴露于左乙拉西坦的儿童）结果相当，左乙拉西坦与丙戊酸盐组相比有良好结果。此外，现有证据表明较高剂量的左乙拉西坦与对儿童大脑发育的不良影响风险增加之间无关联。然而，由于暴露于左乙拉西坦的儿童数量有限且随访时间较短，这一证据不能确定。因此，需要进一步研究。
