Neurodevelopmental Outcomes in Children Exposed to Newer Anti-Seizure Medications in the Womb

Abstract

This thesis comprises three papers investigating neurodevelopmental outcomes of children exposed to newer anti-seizure medications (ASMs) in the womb: a systematic review, an empirical study and a critical appraisal. Within the review, systematic searching techniques were used to identify all available literature pertaining to child neurodevelopmental outcomes following in-utero exposure to newer ASMs. Thirty-five publications were identified for inclusion in the review. All studies underwent quality assessment and results were brought together using narrative synthesis, with ongoing recommendations for clinical practice and research discussed thereafter. Overall, it was highlighted that the effect of in-utero exposure to many newer ASMs remains unclear, with concerning implications for mothers with epilepsy and their children. The empirical research project explored adaptive behaviour outcomes in children exposed to a newer ASM, topiramate, in the womb. Mothers with epilepsy completed parental report assessments about their children’s adaptive behaviour skills (n = 25), with prospective pregnancy and ASM information available via the research registry from which they were recruited. When compared to normative data, topiramate-exposed children had significantly poorer adaptive behaviour skills. There were also high rates of Autism Spectrum Disorder and low birthweights within the topiramate-exposed sample. Potential explanations for these findings and suggestions for future research and clinical implications are presented. Finally, the critical appraisal included a discussion of the strengths and limitations of the systematic review and empirical study. Reflections on process and contributions to research are discussed, in addition to the clinical implications of the findings.

Date of Award	31 Dec 2020
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Anja Wittkowski (Supervisor) & Rebecca Bromley (Supervisor)