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A high-risk antiepileptic for the child during pregnancy

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In France, 600,000 people live with epilepsy. Very debilitating neurological disease, some patients benefit from treatment antiepileptic which allows them to live properly. However, these treatments are not without side effects. The National Agency for the Safety of Medicines and Health Products (ANSM) points in particular to topiramate. It is, in fact, responsible for neurological disorders in children exposed during pregnancy. Explanations.

Topiramate, a high-risk antiepileptic in pregnancy

Worldwide, approximately 60 million people suffer from some form of epilepsy. They are 600,000 in France, half of whom are under 20 years old. To reduce the occurrence of epileptic seizures, patients may benefit from treatment antiepileptic. If they improve the quality of life of many patients, some present risks for the unborn child in the event of pregnancy.

This is the case of topiramate. Indeed, the ANSM recalls that this drug is teratogenic. This means that in the event of pregnancy, it exposes you to a major risk of malformations in the child such as cleft lips and palate, damage to the genitals or a reduction in the size of the brain. This antiepileptic drug increases the risk of malformations by 3.

Neurological disorders in children

The ANSM renews its recommendations concerning this treatment antiepileptic due to recent results published in the journal JAMA Neurology. Indeed, this study focuses on the neurodevelopmental risks in children exposed in utero antiepileptics in general. For this, the researchers analyzed data from several Nordic registers. In total, they retained 4.5 million mother-child pairs followed between 1996 and 2017. Among them, 24,825 children were exposed in utero at least one drug antiepilepticthen followed for 8 years.

Thus, this work reveals that the intake of topiramate during pregnancy increases:

  • The risk of occurrence of an autism spectrum disorder (multiplied by 2.77);
  • The risk of intellectual disability (multiplied by 3.47).

These risks are increased compared to women with epilepsy who did not take treatment during their pregnancy.

The ANSM has requested a European evaluation of these results. But, in the meantime, it encourages taking these data into account now when prescribing topiramate to a woman of childbearing age or who is pregnant.

ANSM recommendations for women taking topiramate

Also, the ANSM is taking advantage of these new data to reiterate its recommendations for women taking topiramate.

Indeed, if the woman is pregnant or suspects pregnancy and is taking topiramate as antiepileptic, it is essential to consult your doctor to assess the need to continue treatment. If taken as a treatment for migraines, it will most likely be discontinued in favor of another treatment.

Also, topiramate can reduce the effectiveness of birth control pills. Thus, the ANSM reminds that it is necessary to take a highly effective contraception, under the recommendation of his doctor.

If you plan to become pregnant or breast-feeding, the treatment will be adapted by the doctor. In any case, if topiramate is taken asantiepileptic, it should not be stopped without the advice of his doctor. Indeed, a sudden stop could lead to a major resurgence of epileptic seizures that could endanger the life of the woman and her child.

Alexia F., Doctor in Neurosciences

Sources

– Association of Prenatal Exposure to Antiseizure Medication With Risk of Autism and Intellectual Disability. jamanetwork.com. Accessed July 1, 2022.
– Topiramate: risk of neurodevelopmental disorders in children exposed in utero and reminder of the rules for use in women. ansm.sante.fr. Accessed July 1, 2022.

#highrisk #antiepileptic #child #pregnancy


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