Study: Taking epilepsy drug during pregnancy can impair child's cognitive development

ATLANTA Exposure to the epilepsy drug Depakote (valproate) during pregnancy can impair a child’s cognitive development, according to a study published in the April 16 edition of the New England Journal of Medicine.

Three-year-olds whose mothers took the antiepileptic drug valproate during pregnancy had average IQs six to nine points lower than children exposed to three other antiepileptic drugs, according to the research.

The study’s authors say that women of childbearing age should avoid valproate as a first choice drug for the treatment of epilepsy.

The Neurodevelopmental Effects of Antiepileptic Drugs study is following more than 300 children born to women with epilepsy between 1999 and 2004. Investigators at 25 epilepsy centers in the United States and the United Kingdom are participating. At enrollment, the women were taking a single antiepileptic agent: carbamazepine, lamotrigine, phenytoin or valproate.

The NEAD study previously found that valproate exposure also increases the risk of anatomical birth defects, even though it was not designed to look for them.

“There are clear risks associated with valproate, and physicians have an obligation to inform women about them,” stated lead study author Kimford Meador, professor of neurology at the Emory University School of Medicine. “Valproate still has an important role in treating epilepsy, because some patients’ seizures can only be controlled with valproate. However, we are recommending that women with epilepsy try another drug first.”

Around 15% of patients with primary generalized epilepsy respond only to valproate, but this selectivity does not apply to other forms of epilepsy, Meador said.

A child’s IQ is usually strongly influenced by the mother’s IQ. Out of the four antiepileptic drugs studied, only valproate disrupted this relationship.

Valproate is also prescribed for bipolar disorder and migraine headaches. It is sold under the brand name Depakote. Last year the FDA approved a generic version.