The Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) Study was a prospective observational multicenter study in the USA and UK, which enrolled pregnant women with epilepsy on antiepileptic drug (AED) monotherapy from 1999 to 2004. The study aimed to determine if differential long-term neurodevelopmental effects exist across four commonly used AEDs (carbamazepine, lamotrigine, phenytoin, and valproate). In this report, we examine fetal AED exposure effects on learning and memory functions in 221 six-year-old children (including four sets of twins) whose mothers took one of these AEDs during pregnancy.
View Article and Find Full Text PDFImportance: Breastfeeding is known to have beneficial effects, but concern exists that breastfeeding during maternal antiepileptic drug (AED) therapy may be harmful. We previously noted no adverse effects of breastfeeding associated with AED use on IQ at age 3 years, but IQ at age 6 years is more predictive of school performance and adult abilities.
Objectives: To examine the effects of AED exposure via breastfeeding on cognitive functions at age 6 years.
Background: Many women of childbearing potential take antiepileptic drugs, but the cognitive effects of fetal exposure are uncertain. We aimed to assess effects of commonly used antiepileptic drugs on cognitive outcomes in children up to 6 years of age.
Methods: In this prospective, observational, assessor-masked, multicentre study, we enrolled pregnant women with epilepsy on antiepileptic drug monotherapy (carbamazepine, lamotrigine, phenytoin, or valproate) between October, 1999, and February, 2004, at 25 epilepsy centres in the UK and the USA.
The Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) Study is an ongoing prospective observational multicenter study in the United States and United Kingdom that enrolled pregnant women with epilepsy on antiepileptic drug (AED) monotherapy from 1999 to 2004. The study seeks to determine if differential long-term neurodevelopmental effects exist across four commonly used AEDs (carbamazepine, lamotrigine, phenytoin, valproate). In this article, we examine fetal AED exposure effects on motor, adaptive, and emotional/behavioral functioning in 229 children who completed at least one of these tests at 3 years of age.
View Article and Find Full Text PDFPurpose: To determine if seizure frequency differs between anovulatory and ovulatory cycles.
Methods: The data came from the 3-month baseline phase of an investigation of progesterone therapy for intractable focal onset seizures. Of 462 women who enrolled, 281 completed the 3-month baseline phase and 92 had both anovulatory and ovulatory cycles during the baseline phase.
Clinical trial designs need to control for genetic and environmental influences when examining cognitive outcomes in children for whom clinical considerations preclude randomization. However, the contributions of maternal and paternal IQ and education to pediatric cognitive outcomes are uncertain in disease populations. The Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) Study is an ongoing prospective observational multicenter study in the United States and United Kingdom, which enrolled pregnant women with epilepsy to determine if differential long-term neurodevelopmental effects exist across four commonly used antiepileptic drugs.
View Article and Find Full Text PDFWe previously reported that foetal valproate exposure impairs intelligence quotient. In this follow-up investigation, we examined dose-related effects of foetal antiepileptic drug exposure on verbal and non-verbal cognitive measures. This investigation is an ongoing prospective observational multi-centre study in the USA and UK, which has enrolled pregnant females with epilepsy on monotherapy from 1999 to 2004.
View Article and Find Full Text PDFResearch on antiepileptic drug (AED) teratogenesis has demonstrated an increased risk for valproate. The impact of these findings on current AED prescribing patterns for women of childbearing age with epilepsy is uncertain. The Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) Study is an ongoing prospective multicenter observational investigation that enrolled pregnant women with epilepsy on the most common AED monotherapies from October 1999 to February 2004 (carbamazepine, lamotrigine, valproate, and phenytoin).
View Article and Find Full Text PDFBackground: Fetal exposure of animals to antiepileptic drugs at doses lower than those required to produce congenital malformations can produce cognitive and behavioral abnormalities, but cognitive effects of fetal exposure of humans to antiepileptic drugs are uncertain.
Methods: Between 1999 and 2004, we enrolled pregnant women with epilepsy who were taking a single antiepileptic agent (carbamazepine, lamotrigine, phenytoin, or valproate) in a prospective, observational, multicenter study in the United States and the United Kingdom. The primary analysis is a comparison of neurodevelopmental outcomes at the age of 6 years after exposure to different antiepileptic drugs in utero.
Objective: Although lamotrigine use during pregnancy has substantially increased over the past decade secondary to accumulated reproductive safety data, systematic data on lamotrigine during breastfeeding remains sparse. We sought to characterize the determinants of lamotrigine concentrations in breast milk and nursing-infant plasma.
Patients And Methods: Women who enrolled in a prospective investigation of perinatal medication pharmacokinetics, were treated with lamotrigine, and chose to continue lamotrigine while breastfeeding were included in the analysis.
Purpose: To define characteristics of subclinical seizures (SCS) and their prognostic significance after epilepsy surgery.
Methods: Reports from intracranial video-EEG monitoring were reviewed for patients who had epilepsy surgery between 1989 and 2003. Relationships between SCS and clinical seizures were categorized as either: complete colocalization (Group A), when both SCS and clinical seizures originated from the same single focus, or incomplete and no colocalization (Group B), when some or all SCS and clinical seizures originated from different foci in different lobes or hemispheres.
Infants born to mothers with epilepsy are at substantial risk for neurocognitive and behavioral disorders. Although exposure of the child to antiepileptic drugs (AEDs) during pregnancy and postnatally through breast milk has been implicated in disorders of higher cortical function, there have been relatively few clinical or animal studies examining the long-term effects of AEDs on cognition in the developing brain. In the limited animal studies done thus far, drug-specific effects on cognitive function have been identified.
View Article and Find Full Text PDFSeizure severity is an important aspect of epilepsy. The relationship between seizure severity and quality of life in epilepsy, however, has been incompletely explored. With a data set of 118 women from the baseline phase of a clinical treatment trial, the relationship between seizure severity and aspects of quality of life was evaluated.
View Article and Find Full Text PDFPurpose: The vagal nerve stimulator (VNS) and corpus callosotomy can reduce seizure frequency when seizures are refractory to medications. However, the efficacy and safety of these two procedures have not been compared. This study evaluates the two procedures for generalized seizures.
View Article and Find Full Text PDFMortality rates are higher in people with refractory epilepsy than in the general population. We assessed mortality rates in a prospectively followed cohort who had epilepsy surgery, to examine the factors related to mortality and to assess the relationship between seizure control and mortality. Five hundred eighty-three patients were evaluated.
View Article and Find Full Text PDFWe investigated the value of non-invasive data for predicting the outcome of intracranial EEG and anterior temporal lobectomy (ATL) (follow-up>1 year) in patients who have bitemporal independent seizures in the scalp EEG. No previous report has dealt with this patient group. Independent variables were duration of epilepsy, febrile seizures, interictal and ictal scalp EEG, ictal behavior, MRI, [18F]-fluorodeoxyglucose-PET (PET) and Wada test and dependent variables were surgical outcome (seizure free or not) and localized on intracranial EEG (finding all symptomatic seizures from one temporal lobe).
View Article and Find Full Text PDFStudies have demonstrated that "seizure-alert dog" owners with epilepsy exhibit improvement in seizure rates. One of the most difficult aspects for patients with epilepsy is the unpredictability of seizures. We evaluated the detection abilities of seizure-alert dogs in an inpatient epilepsy care unit where patients were undergoing continuous computer-assisted EEG.
View Article and Find Full Text PDFThis investigation assessed the frequency of catamenial epilepsy in 87 women who charted seizures and menses during three cycles. Catamenial epilepsy designation was made if two of three cycles showed at least one of three previously defined catamenial patterns. Among ovulatory cycles, average daily seizure frequency was significantly greater during the perimenstrual and preovulatory phases.
View Article and Find Full Text PDFPurpose: Temporal lobe epilepsy patients are well known to present deficits on explicit verbal memory procedures (e.g., recall, recognition).
View Article and Find Full Text PDFPurpose: Sudden unexpected death in epilepsy (SUDEP) is a major cause of mortality for patients with epilepsy. Cardiac factors may be involved and were evaluated in this study.
Methods: EEG and ECG data for 21 patients with definite (n = 6) or probable (n = 15) SUDEP were compared with data from a group of 43 patients with refractory partial epilepsy.
Purpose: Many women with epilepsy who are planning a pregnancy are treated with lamotrigine (LTG), resulting in greater fetal exposure to the drug. Current care guidelines suggest that mothers with epilepsy breast-feed their children. These recommendations are made without regard to how nursing newborns metabolize medication.
View Article and Find Full Text PDFEpilepsy is a condition of the central nervous system that is characterized by recurrent seizures. The goal of management is to make patients seizure free without intolerable adverse effects from treatment. Men and women differ in their physiologic makeup and therefore have different needs that must be considered when attempting to attain this goal.
View Article and Find Full Text PDFEpilepsy uniquely affects more than 1 million American women and girls. Health care providers must be aware of the specific concerns and issues regarding the different effects epilepsy has on male and female patients. Epilepsy and antiepileptic drugs substantially affect women's health in the areas of menstruation, contraception, sexual function, pregnancy, menopause, and bone health.
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