ReviewCognitive outcomes of prenatal antiepileptic drug exposure

- Studies show the developing brain is vulnerable to antiepileptic drugs (AEDs).
- Valproate has the worst impact on cognition of prenatally exposed children.
- More studies are needed to evaluate the cognitive consequences of all AEDs in utero.
- New therapies are needed to prevent cognitive impairment by prenatal AED exposure.

SummaryAntiepileptic drugs (AEDs) have been known to have teratogenic effects for a little over 50 years. While early reports focused on fetal malformations, there has been an increasing amount of data over the last few decades exploring the cognitive outcomes of offspring exposed to AEDs in utero. Although the challenges of confounding factors and varied methodologies have led to inconsistent results, the negative impact of some of the agents, such as valproate, have become clear. Further studies are needed to evaluate the cognitive effects of prenatal exposure to many AEDs which have not been tested, to clarify the effects of existing AEDs which have yielded mixed results, and to better understand the effects of polytherapy. Research in animal models is warranted to screen AEDs for their effects on cognition in exposed offspring and to further our understanding of the underlying mechanisms by which AEDs exert their harmful effects on the developing brain. And finally, new AEDs without these harmful effects and agents which can prevent or reverse the negative consequences imparted by AED therapy on cognition should be sought.