Cognitive Function at 3 Years of Age after Fetal Exposure to Antiepileptic Drugs

Meador, Kimford J.; Baker, Gus A.; Browning, N. Andrew; Clayton‐Smith, Jill; Combs-Cantrell, Deborah T.; Cohen, Morris J.; Kalayjian, Laura A.; Kanner, Andrés M.; Liporace, Joyce; Pennell, Page B.; Privitera, Michael; Loring, David W.

doi:10.1056/nejmoa0803531

Cited by 704 publications

(559 citation statements)

References 29 publications

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“…Divalproex should be avoided during pregnancy due to elevated risk of neural tube defects (up to 5%), even higher incidences of other congenital abnormalities, and evidence of striking degrees of neurodevelopmental delay in children at 3 years of age and loss of an average of nine IQ points 529, 530, 531. Because of changes in physiology in the second and early third trimesters, such as increased plasma volume, hepatic activity, and renal clearance, patients may require higher doses of medications towards the later part of the pregnancy.…”

Section: Specific Populationsmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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Section: Specific Populationsmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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“…Valproic acid exposure during pregnancy has been associated with a lower IQ in the child 37 . No evidence exists for a comparable cognitive effect for carbamazepine or lamotrigine.…”

Section: Discussionmentioning

confidence: 99%

Economic evaluation of anti-epileptic drug therapies with specific focus on teratogenic outcomes

Jentink

Boersma

Berg

et al. 2012

Journal of Medical Economics

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“…It is also known that fetal exposure to valproic acid can cause autism features in animal models, and can also affect mental development in offspring of pregnant epileptic women on this medication. 86 This may be related to the timing of cytokine effects in utero because the postnatal effects that are known to be different in the human brain show this medication to be beneficial in autism after the perinatal period of development is complete.…”

Section: Treatment Of Cytokine Abnormalitiesmentioning

confidence: 99%

Immune Therapy in Autism: Historical Experience and Future Directions with Immunomodulatory Therapy

Chez

Guido-Estrada

2010

Neurotherapeutics

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Summary: Autism affects 1 in 110 new births, and it has no single etiology with uniform agreement. This has a significant impact on the quality of life for individuals who have been diagnosed with autism. Although autism has a spectrum quality with a shared diagnosis, it presents a uniquely different clinical appearance in each individual. Recent research of suspected immunological factors have provided more support for a probable immunological process or for processes that may play a role in the acquisition of an autistic condition. These factors include prenatal, genetic, and postnatal findings, as well as the discovery of a dysfunctional chronic pro-inflammatory state in brain tissue and cerebrospinal fluid in subsets of autistic patients. These findings offer new theories that may lead to the development of disease modification or preventative therapeutic options in the near future. This article reviews prenatal, genetic, and observed immune aspects of the autism condition that may be risk factors in the presentation of the autistic clinical phenotype. Historical immune interventions in autism are reviewed and potential new therapies and interventions are discussed.

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Cognitive Function at 3 Years of Age after Fetal Exposure to Antiepileptic Drugs

Abstract: BACKGROUND-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.

Cited by 704 publications

References 29 publications

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Economic evaluation of anti-epileptic drug therapies with specific focus on teratogenic outcomes

Immune Therapy in Autism: Historical Experience and Future Directions with Immunomodulatory Therapy

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