Article

Postnatal concerns in children born to women with epilepsy

Thomas Jefferson University, Filadelfia, Pennsylvania, United States
Epilepsy & Behavior (Impact Factor: 2.06). 12/2007; 11(3):270-6. DOI: 10.1016/j.yebeh.2007.08.022
Source: PubMed

ABSTRACT 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. Phenobarbital, in particular, has been found to lead to adverse cognitive outcomes, whereas the newer AEDs have generally had more favorable outcomes. Although the pathophysiological mechanisms responsible for these deficits remain largely unknown, there is evidence that AEDs can adversely effect neuronal proliferation and migration, and increase apoptosis. While animal studies can provide valuable information regarding mechanism of AED-induced developmental pathology, they do not provide insight into cortical functions unique to humans, such as speech and language. Understanding the full spectrum of AED-induced effects on the developing brain will require both rigorous basic science and clinical studies.

2 Followers
 · 
48 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: In utero exposure to antiepileptic drugs (AEDs) may affect neurodevelopment causing postnatal cognitive and behavioral alterations. Phenytoin and phenobarbital may lead to motor and learning dysfunctions in the pre-exposed children. These disorders may reflect the interference of these AEDs with the development of hippocampal and cerebellar neurons, as suggested by animal studies. Exposure to valproic acid may result in inhibition of neural stem cell proliferation and/or immature neuron migration in the cerebral cortex with consequent increased risk of neurodevelopmental impairment, such as Autistic Spectrum Disorders. A central issue in the prevention of AED-mediated developmental effects is the identification of drugs that should be avoided in women of child-bearing potential and during pregnancy. The aim of this review is to explore the possible link between AEDs and neurodevelopmental dysfunctions both in human and in animal studies. The possible mechanisms underlying this association are also discussed.
    Reproductive Toxicology 05/2014; 48. DOI:10.1016/j.reprotox.2014.04.005 · 2.77 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Zahlreiche tierexperimentelle Untersuchungen zeigen, dass Anästhetika im unreifen Gehirn neurotoxisch wirken können, da sie Apoptose induzieren und die Neuro- sowie Synaptogenese beeinflussen. Im Tierexperiment hat dies erhebliche Auswirkungen auf die neurokognitiven Funktionen der Tiere im späteren Leben. Ob diese tierexperimentellen Ergebnisse auf den Menschen übertragen werden können, ist derzeit Gegenstand intensiver Forschung. In mehreren retrospektiven Untersuchungen konnte kein eindeutiger Zusammenhang zwischen einer Anästhesie im Früh-, Neugeborenen- oder Kleinkindalter und dem Auftreten von Lernstörungen oder Verhaltensauffälligkeiten gefunden werden. Zwei prospektive Studien (GAS und PANDA) sollen weiteren Einblick liefern und diese Frage möglichst klären. Wegen der großen Relevanz des Themas und um für die Problematik im Umgang mit den Eltern mehr Klarheit zu schaffen, haben der Wissenschaftliche Arbeitskreis für Kinderanästhesie und der Wissenschaftliche Arbeitskreis für Neuroanästhesie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) auf der Grundlage der derzeitigen Datenlage eine Stellungnahme verfasst ().
    Der Anaesthesist 02/2013; 62(2). DOI:10.1007/s00101-013-2139-0 · 0.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Various experimental studies in animals have shown that general anaesthetics are potentially toxic to the developing brain. By inducing apoptosis or interfering with neurogenesis, anaesthetic exposure during a critical period of neuronal development can have significant impact on neurocognitive function later in life. It remains controversial whether these experimental results can be transferred to human beings and this is under intensive scientific evaluation. To gain more insight into possible neurotoxic effects on the human brain of infants and small children, a number of retrospective studies have been performed. At present, there is no clear evidence that exposure to anaesthesia up to the age of 3–4 years is associated with neurocognitive or behavioural deficits. Currently, the PANDA, MASK and GAS studies are underway to explore this relationship. Anaesthesia is not an end in itself, but necessary to facilitate surgical procedures. There is evidence that maintaining physiological conditions is important for the overall outcome following anaesthesia and surgery. Until proven otherwise, it can be recommended to keep anaesthesia and surgery as short as possible, to use short-acting drugs and/or a combination of general anaesthesia and multimodal pain therapy including systemic analgesics, and local or regional anaesthesia, to reduce the overall drug dosage.
    Anaesthesia 05/2014; 69(9). DOI:10.1111/anae.12637 · 3.85 Impact Factor