Epilepsy Drug May Raise Autism Risk in
Offspring
2008-Dec-03
WEDNESDAY, Dec. 3 (HealthDay News) -- Women taking the epilepsy
drug valproate while pregnant are at increased risk of delivering a
child who develops autism.
The British findings, appearing in the Dec. 2 issue of
Neurology, add to previous research showing that valproate
and other anti-epilepsy drugs can contribute to birth defects
(particularly neural tube defects).
"There's a fair amount of early data that indicates, for
instance, that valproate may cause neural tube closure problems.
That's an indication that valproate affects brain development,"
said Dr. Michel Berg, medical director of the Strong Epilepsy
Center at the University of Rochester Medical Center. "That's an
indication that valproate affects brain development. It's not
surprising that it might affect other aspects of brain
development."
Physicians are already cautious about prescribing valproate and
other drugs to pregnant women or women planning to become pregnant,
however.
"I don't think this will change practice dramatically," said Dr.
Jeffrey P. Brosco, an associate professor of clinical pediatrics at
the University of Miami Miller School of Medicine and director of
clinical services at the Mailman Center for Child Development in
Miami. "This reaffirms that there is a lot of reason to try to
avoid this drug if there is another available."
Reassuringly, added Berg, the study did not seem to find a
substantial increase in the development of autism spectrum
disorders among the children of women who had taken another
anti-seizure drug, lamotrigine (brand name Lamictal), while
pregnant.
Drugs for this condition have encountered other problems.
Previous studies have also found that pregnant women who use the
epilepsy drug topiramate (brand name Topamax) alone or in
combination with other epilepsy drugs may be increasing their risk
of birth defects. And the U.S. Food and Drug Administration
recently considered, but eventually rejected, adding a black-box
warning that anti-seizure drugs can increase suicidal tendencies in
patients.
The current paper is part of an ongoing study by the Liverpool
and Manchester Neurodevelopment Group in Britain looking at the
effects of anti-epileptic drugs in pregnant women.
The study involved 632 live births from 620 women, 296 of those
births to women with epilepsy and 249 of whom took anti-epilepsy
drugs at the beginning of the pregnancy.
Controls were 336 live births to women without epilepsy and
therefore not taking these medications.
The children were assessed for autism or related conditions at
1, 3 and 6 years of age.
Out of the group of 632 children, nine were diagnosed with
autism spectrum disorders and another with features of these
disorders, amounting to a total incidence of 1.6 percent.
Seven of the 10 children were born to mothers taking
anti-epileptic drugs. Four of the children were exposed to
valproate, one to valproate plus lamotrigine, one to phenytoid
(Dilantin among other brand names) and one to lamotrigine
alone.
Just over 6.3 percent of children exposed to valproate alone
have autism spectrum disorders or features of these disorders, a
number that's seven times higher than that in the control
group.
There is a possibility that more children in the study could be
diagnosed with autism or related disorders as time progresses,
given that most are still young.
Still, the absolute risk is relatively low. "Ninety-four percent
of children exposed to valproate did not go on to have an autism
spectrum disorder," Brosco said. "This adds to the evidence that we
need to be cautious with every drug we use, especially during
pregnancy, when the fetus is sensitive to external influences."
"This is not a strong study and doesn't really definitely make a
causal relationship, but obviously it's a good start towards trying
to figure out if there are any particular drugs that lead to
autism," added Dr. Jane Ripperger-Suhler, an assistant professor of
psychiatry and behavioral science and an assistant professor of
pediatrics at Texas A&M Health Science Center College of
Medicine and a psychiatrist with Scott & White Mental Health
Center in Temple.
More information
There's more on autism spectrum disorders at the
U.S. National Institute of Mental Health.
HealthDay News
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