Language, intelligence, and educational outcomes of adolescents with antenatal exposure to antiseizure medications: prospective data from the Kerala Registry of epilepsy and pregnancy

• Published in: Seizure (London, England) England), 2022-08, Vol.100, p.76-81
• Main Authors: Thomas, Sanjeev V, Salim, Salma, Jacob, Nikita Susan, Jose, Manna, Salini, Reshma A, Selvaraj, Sajith, Gomez, Treasa Stemy, Sreedharan, Hema, Jeemon, Panniyammakal
• Format: Article
• Language: English
• Subjects: academics, education; Epilepsy, pregnancy, antiepileptic drug
• ISSN: 1059-1311; 1532-2688
• DOI: 10.1016/j.seizure.2022.06.005

•Children of women with epilepsy (CWWE) with antenatal exposure to antiseizure medicines (ASM) have impaired language and intelligence than CWWE without exposure.•CWWE with exposure to ASM experience difficulties in education as compared to their counterparts in the same geographic area in terms of delayed initiation of formal education, more dropout from schools, and need for special assistance in examinations.•University attendance rate is lower in CWWE when compared to the state average in the corresponding age group. In a prospective cohort of children (13-21 years) of women with epilepsy (CWWE), we compared those exposed to antiseizure medications (ASM) in utero to those without exposure to ASM regarding their language proficiency and intelligence. We also compared their educational performance with state-wide averages. Research staff blinded to the ASM exposure of CWWE administered the Clinical Evaluation of Language Fundamentals IV and the Wechsler Intelligence Scale for Children IV to test their language proficiency and intelligence. We assessed their educational performance with a questionnaire. CWWE without antenatal exposure to ASM served as comparators for language and intelligence tests. The educational performance of CWWE (regardless of ASM exposure) was compared with the state-wide averages published by the government. In total, 446 children (mean age 16.5±2.2 years; 236 girls) participated in the study. Their ASM exposure involved monotherapy for 272 (61%), polytherapy for 133 (29.8%) and none for 41 (9.2%). The commonly used ASMs (mono & polytherapy) were carbamazepine (n=192), valproate (n=124), phenobarbitone (n=95), and phenytoin (n=73). The full-scale intelligence quotient of CWWE (n=146) with antenatal exposure to ASM (89.2 ±21.5) was significantly lower (p=0.03) than that of CWWE (n=11) unexposed to ASM (96.9 ±8.8). The CELF core language scaled score for the exposed CWWE (n=132) was significantly lower than that of unexposed children (n=12; 99.2±19.9). Compared with state-wide averages, CWWE (n=386) had delayed initiation of education (2.6% vs.1%), increased dropout rates (1% vs.11%), increased usage of special assistance during examinations (4.4% vs.1%) and a lower rate (19.9% vs. 37%) of enrolment in universities. The language and intelligence functions of CWWE with exposure to older ASMs were lower than those of unexposed CWWE. Compared to state-wide averages, a significantly higher proportion of CWWE had difficulties with educat