There are extremely limited clinical data available to inform on the effect of topiramate exposure during pregnancy and the risk of neurodevelopmental disorders in the offspring. Data from a very small study by Rihtman et al (2012), that involved only 9 children whose mothers had taken topiramate during pregnancy suggested that, compared with control children, topiramate had an adverse effect on cognitive, motor, and behavioural outcomes, as well as on IQ score, and motor and visual spatial skills. In contrast, a retrospective observational study in the UK Epilepsy and Pregnancy Registry (Bromley et al 2016b) reported on data for 27 children who had prenatal exposure to topiramate and the findings did not suggest reductions in the cognitive abilities of the children.
Antiepileptic drug or AED
The conclusions of this assessment are based on an evaluation of the available non-clinical and clinical data. The assessment takes into account the methodology, including the quality of data, how it was collected, the existence of a non-exposed group or control group, the type of controls, and if possible, the inclusion of foetuses aborted due to malformation, and so on. To allow a proper evaluation of the reliability of the data, the available studies must cerebrumiq be of adequate scientific quality. This public assessment report summarises the main evidence and key findings for the antiepileptic drugs considered in this review. It also presents the conclusions of the Commission on Human Medicines and its Neurology, Pain and Psychiatry Expert Advisory Group (NPPEAG). The epilepsy medicine, valproate or valproic acid (▼; brand names Epilim, Depakote, Convulex, Episenta, Epival, Kentlim, Syonell, Orlept, Valpal) can seriously harm an unborn baby if taken by the mother during pregnancy.
- These are broadly reflected in the current product information (the Summary of Product Characteristics for healthcare professionals and the Patient Information Leaflet).
- The Human Genome Project (HGP) was an ambitious target, set in 1990, to sequence the entire DNA found in humans.
- NICE guidance recommends that pregabalin may be considered by the tertiary epilepsy specialist in the treatment of focal seizures if adjunctive treatment is not effective or not tolerated.
- Evidence for a ‘critical period’ comes from some ethically-dubious experiments on kittens (see below).
- Myoclonic seizures are brief but can happen in clusters (many happening close together in time), and often happen shortly after waking.
- Learning faster than change fosters a pro-active rather than a re-active lifestyle.
Adjunctive treatment/therapy
The left side of the brain specialises in logical, linear, analytical processes and the right side specialises in intuitive, holistic, imaginative processes (gross simplification). The real power of the brain to tackle a task is unleashed when left and right brains work together simultaneously and synergistically. Today we have several generations of adults with low ability in these important skills which is a major problem. If parents, teachers and politicians worked on these intelligences within themselves, then these skills would diffuse to our children. Fortunately those of us interested in positive health (and consequently reading this magazine) are learning the wisdom of the ancient ones and the ancient traditions of the East and North America.
- StimmingStimming is short for self-stimulating behaviour, and is commonly seen in autistic people who may repeatedly make the same movement, like waving a hand or tapping something over and over.
- They have CVI leading to ADHD like reactive behaviours.Further reading UKs NHS Pages on ADHD.
- The assessment takes into account the methodology, including the quality of data, how it was collected, the existence of a non-exposed group or control group, the type of controls, and if possible, the inclusion of foetuses aborted due to malformation, and so on.
- It is an observation of repetitive body movements, that is all we really know at present, although there are many theories.
NICE guidance recommends that phenytoin can be used as adjunctive treatment for convulsive status epilepticus in hospital and may be considered on referral to tertiary care for the treatment of focal seizures. Phenytoin (brand name Epanutin) is indicated for the control of tonic-clonic seizures (grand mal epilepsy), partial seizures (focal including temporal lobe) or a combination of these, and for the prevention and treatment of seizures occurring during or following neurosurgery and/or severe head injury. NICE guidance recommends that it can be used as adjunctive treatment in convulsive status epilepticus and may be considered for use by a tertiary epilepsy specialist in focal seizures when adjunctive treatment is not effective or not tolerated.
Where there are either a limited number of studies, the available studies are too small or only poor quality studies are available then the data is considered insufficient to allow a conclusion to be reached on the likelihood of a causal association. Clinical data on reproductive toxic effects are limited and the findings are mixed. Individual pregnancy registry and population-based cohort studies have reported increased risks of fetal loss with carbamazepine compared with unexposed women with epilepsy (Artama et al 2013, Trivedi et al 2018). However, the meta-analysis by Veroniki et al (2017a) that included data on 3,911 carbamazepine monotherapy exposed pregnancies did not support an increased risk of fetal loss compared with unexposed women with epilepsy (OR 1.25, 95% credible intervals 0.73 to 2.36). Randomised controlled clinical trials are usually considered the best evidence to support a causal association. However, because pregnant women are rarely included in randomised controlled clinical trials, once a product is marketed the aim is to collect information on safety in pregnancy in order that better information can be provided to patients and healthcare professionals.
The assessment of the reproductive and developmental effects of lamotrigine in non-clinical studies is limited by the induction of maternal toxicity at human therapeutic doses and consequently its effects at higher exposures has not been performed. However, acknowledging such limitations, the non-clinical evidence reports that lamotrigine at doses relevant to human therapeutic doses is not teratogenic in rodents and rabbits. The absence of teratogenicity provides some reassurance over the use of lamotrigine in pregnancy but caution is required due to the limitations caused by the dosing restrictions.
It’s what happens if you live close to a hospital and start to blank out the sound of sirens, for example. It’s important because it means that organisms don’t waste time and energy by responding to stimuli that do not pose a danger to them. The cerebellum is a leaf-shaped structure found towards the back of the brain. Things like learning to ride a bike or the movement involved in writing will involve a large input from the cerebellum. Below the cerebrum is a structure called the hypothalamus, which is involved in homeostatic responses such as maintaining body temperature (thermoregulation). It also produces hormones that control the pituitary gland, which is found just beneath the hypothalamus.
Similar findings were not seen in the meta-analyses (Banach et al 2010 (83 children in the carbamazepine group) and Bromley et al 2014 (150 children in the carbamazepine group)) that included other prospective observational studies. These differences may reflect the different methodologies and designs in the individual studies and limitations such as the potential for residual confounding and lack of a comparison to women with epilepsy in some studies. During its clinical development a drug is tested on a range of people in clinical trials in order to generate information on safety and efficacy. However pregnant women are generally excluded from participation in these trials for ethical reasons. Studies in pregnant animal models (non-clinical studies) are used as a surrogate to investigate the effects of a drug in pregnancy.