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Low Vision & Learning DelayThis term is often used in education to separate those children with visual impairments who are more able learners, from those who need more support. A visually impaired child who is working towards exams to go to University and a child who may only speak a few words and is learning to hold a cup need different approaches and support – BUT both need approaches and support matched to their known difficulties. Low Vision & Learning Delay is an extremely broad term, and support needs to be tailored to the needs of the individual person. Moreover, we found significant correlations between DTI metrics and cognitive performances.

• PMLD indicates a severe level of need, but little more as the subject is so vast.
• Overall, these data are inconsistent and too limited to draw conclusions on a dose-dependent risk of congenital malformations following phenytoin exposure in utero.
• The available information also does not suggest an increased risk of the child having difficulties with learning or thinking ability but further data are needed to draw firm conclusions.

Psychology Memory PowerPoints / Google Slides / Video Links / Guided Notes

To date there are no non-clinical studies reporting a developmental neurotoxic effect. Overall, the data are supportive of a median prevalence of congenital malformations with topiramate of 4–5% and an increased risk compared with unexposed women with or without epilepsy. Overall, the data from clinical studies are suggestive of a possible adverse effect of pre-and postnatal phenobarbital exposure on neurodevelopment and IQ. Whilst some studies suggest the detrimental effects may weaken over time (Farwell 1990, Sulzbacher 1999, Thorp 1999 and 2003), in other instances they seemed to last into adulthood (Reinisch et al 1995). Clinical data on the risk of neurodevelopmental disorders with oxcarbazepine is primarily driven by data from retrospective studies using Danish national registries (Bech et al 2018, Christensen et al 2013 and 2019) and the meta-analysis by Veroniki et al 2017b. Similar to the findings for teratogenic effects, the limited picture caused by the dosing restrictions mean that caution is required with regards to the interpretation of these data.

Physical birth abnormality

At that time, similar reviews had not recently been done for the other epilepsy medicines. The Commission on Human Medicines recommended that the MHRA should review whether the available data raises any new safety concerns or changes current understanding about the safety of other epilepsy medicines during pregnancy. Epilepsy medicines (also known as antiepileptic drugs and antiseizure medicines) are medicines that treat epilepsy. For around 2 in 3 people with epilepsy, their seizures are controlled with one or more epilepsy medicines.

Sensory Processing DifficultiesThis is a general term meaning that the challenges a person may face, could be due to how the brain is processing information received from the senses. All the incoming information to the brain comes via the senses, so you really need a bit more information, as all it essentially means is that the difficulties are due to how the brain processes the incoming information from the senses, which is not specific enough to mean much. Challenging Behaviour / Distressed BehaviourThese terms are sometimes used when a person does not meet the criteria for another condition, typically autism, yet has some of the behaviours affecting both the person and possibly others around them. The behaviours can be very similar to autism, and either milder, or without the other behaviours.See also, Autism, above. Hubel and Wiesel carried out an experiment on kittens and adults cats in 1963 which proved that the visual cortex develops during a critical period early in life.

Congenital malformations were detected in 2 offspring (7.7%) exposed to zonisamide as part of polytherapy, so the role of zonisamide is unclear. In the study by Källén et al there were only 7 pregnancies exposed to zonisamide, of which 3 were exposed to zonisamide monotherapy; no congenital malformations were reported in any of these pregnancies. Data from non-clinical studies in rats published in the scientific literature reported some evidence of neurodegenerative changes in the brains of the offspring exposed during pregnancy (Glier et al 2004, Singh M, Mishra A., 2005, Hashish 2014). Limitations in the study designs, combined with conflicting findings in a Good Laboratory Practice compliant study in which there was no sign of degenerative changes in the brains of rat offspring means that there is no clear evidence of a potential for topiramate to adversely affect central nervous system development.

When we are born, our brains contain a load of neurones which begin to form connections (synapses) or are removed, making the brain more organised and allowing our visual system to develop. This all happens very early in life and relies on both of our eyes receiving cerebrumiq visual input. The period of early life when our brains are developing is called the critical period.

Overall, the available data do not allow for robust conclusions to be drawn on the safety of use during pregnancy of brivaracetam, clobazam, clonazepam, eslicarbazepine, ethosuximide, lacosamide, rufinamide, perampanel, primidone, tiagabine and vigabatrin. The risks of major congenital malformations, neurodevelopmental disorders and delay, and other reproductive toxic effects remain uncertain; the possibility of adverse effects can neither be confirmed nor ruled out. Overall, the available clinical data do not indicate a negative impact of lamotrigine on these outcomes. For the majority of these drugs the data relating to safety of use during pregnancy remains limited or very limited. For perampanel, primidone and vigabatrin there are data on less than 300 exposed pregnancies and for brivaracetam, eslicarbazepine, ethosuximide, lacosamide, rufinamide, and tiagabine there are data on less than 100 exposed pregnancies.

In clinical studies where the effect of dose is examined, the findings are inconsistent. The meta-analysis by Weston et al (2016) and data from the North American Antiepileptic Drug Pregnancy Registry and the Australian Pregnancy Registry failed to observe an increased risk of major congenital malformations with increasing doses of topiramate. The available clinical data examining the effect of topiramate on fetal loss are very limited and the findings are inconsistent (Ornoy et al 2008, Trivedi et al 2018, Vajda et al 2018, Veroniki et al 2017a).

• Fine motor skills refer to small movements in the hands, wrists, fingers, feet, toes, lips and tongue.
• This review was initiated in the context of the known harms of valproate in pregnancy.
• Knowledge of these learning rhythms can enable both teacher and pupil to optimise the learning and review process and prevent “learning decay”.
• Depending on a mix of genetic predisposition and early learning opportunity we may develop a preference for a particular learning style and people who feel that they only learn by “doing” are likely to have a preference for “kinesthetic” techniques, and would not learn easily with traditional school “chalk and talk” teaching methods.
• This further information can be collected by a number of means including through spontaneous reporting schemes such as the Yellow Card Scheme in the UK, population-based birth registries of children born with congenital malformations, pregnancy registries and observational studies.
• A birth defect in which a part of the aorta (the large blood vessel that carries blood from the heart to the rest of the body) is narrower than usual.

Neurobehavioural effects

In CVI we have seen repetitive body movements, including head turning from side to side, sometimes when a person is excited about something visual. In our experience it can also sometimes be a way of seeing more when the area of vision seen (field of vision) is very narrow. Also rocking, which we know can help stimulate vision by creating movement. Neurological Visual ImpairmentSome use this as an alternative to cerebral visual impairment, because the cerebrum is not the only part of the brain that is responsible for the visual difficulties that come under the current CVI umbrella. It is all part of the evolution of the labels around this condition that we explained in our introduction, and is a good sign that we are still learning and expanding our knowledge base and understanding. Intellectual DisabilityIntellectual Disability was previously called Mental Retardation.