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Clayton-Smith J, Bromley R, Dean J, Journel H, Odent S, Wood A, Williams J, Cuthbert V, Hackett L, Aslam N, Malm H, James G, Westbom L, Day R, Ladusans E, Jackson A, Bruce I, Walker R, Sidhu S, Dyer C, Ashworth J, Hindley D, Diaz GA, Rawson M, Turnpenny P. Diagnosis and management of individuals with Fetal Valproate Spectrum Disorder; a consensus statement from the European Reference Network for Congenital Malformations and Intellectual Disability. Orphanet J Rare Dis 2019; 14:180. [PMID: 31324220 PMCID: PMC6642533 DOI: 10.1186/s13023-019-1064-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/12/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A pattern of major and minor congenital anomalies, facial dysmorphic features, and neurodevelopmental difficulties, including cognitive and social impairments has been reported in some children exposed to sodium valproate (VPA) during pregnancy. Recognition of the increased risks of in utero exposure to VPA for congenital malformations, and for the neurodevelopmental effects in particular, has taken many years but these are now acknowledged following the publication of the outcomes of several prospective studies and registries. As with other teratogens, exposure to VPA can have variable effects, ranging from a characteristic pattern of major malformations and significant intellectual disability to the other end of the continuum, characterised by facial dysmorphism which is often difficult to discern and a more moderate effect on neurodevelopment and general health. It has become clear that some individuals with FVSD have complex needs requiring multidisciplinary care but information regarding management is currently lacking in the medical literature. METHODS An expert group was convened by ERN-ITHACA, the European Reference Network for Congenital Malformations and Intellectual Disability comprised of professionals involved in the care of individuals with FVSD and with patient representation. Review of published and unpublished literature concerning management of FVSD was undertaken and the level of evidence from these sources graded. Management recommendations were made based on strength of evidence and consensus expert opinion, in the setting of an expert consensus meeting. These were then refined using an iterative process and wider consultation. RESULTS Whilst there was strong evidence regarding the increase in risk for major congenital malformations and neurodevelopmental difficulties there was a lack of high level evidence in other areas and in particular in terms of optimal clinical management.. The expert consensus approach facilitated the formulation of management recommendations, based on literature evidence and best practice. The outcome of the review and group discussions leads us to propose the term Fetal Valproate Spectrum Disorder (FVSD) as we feel this better encompasses the broad range of effects seen following VPA exposure in utero. CONCLUSION The expert consensus approach can be used to define the best available clinical guidance for the diagnosis and management of rare disorders such as FVSD. FVSD can have medical, developmental and neuropsychological impacts with life-long consequences and affected individuals benefit from the input of a number of different health professionals.
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Affiliation(s)
- Jill Clayton-Smith
- Division of Evolution and Genomic Sciences School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Rebecca Bromley
- Division of Evolution and Genomic Sciences School of Biological Sciences, University of Manchester, Manchester, UK
- Paediatric Psychosocial Department, Royal Manchester Children’s Hospital, Manchester Academic Health Sciences Centre, Manchester, UK
| | - John Dean
- Clinical Genetics, Clinical Genetics Service, Ashgrove House, Foresterhill, Aberdeen, UK
| | - Hubert Journel
- Génétique Médicale – Consultation, CHBA Centre Hospitalier Bretagne Atlantique - CH Chubert, 20 boulevard du Général Maurice Guillaudot, BP 70555, 56017 Vannes Cedex, France
| | - Sylvie Odent
- Service de Génétique Clinique, CNRS UMR 6290, Université de Rennes, CHU de Rennes - Hôpital Sud, 16 Boulevard de Bulgarie, 35203 Rennes Cedex 2, France
| | - Amanda Wood
- Aston Brain Centre, School of Life and Health Sciences, Aston Triangle, Birmingham, UK
- Brain and Mind, Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Melbourne, Australia
| | - Janet Williams
- INFACT/FACSA, Independent Fetal Anti-Convulsant Trust & FACS Syndrome Association, Preston, UK
| | - Verna Cuthbert
- Department of Paediatric Rheumatology, Royal Manchester Children’s Hospital, Oxford Road, Manchester, M13 9WL UK
| | - Latha Hackett
- Child and Adolescent Mental Health Services (CAMHS), Royal Manchester Children’s Hospital, Oxford Road, Manchester, M13 9WL UK
| | - Neelo Aslam
- Child and Adolescent Mental Health Services (CAMHS), Royal Manchester Children’s Hospital, Oxford Road, Manchester, M13 9WL UK
| | - Heli Malm
- Teratology Information Service, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Tukholmankatu 17, 00029 HUS, Helsinki, Finland
| | - Gregory James
- Department of Neurosurgery, Great Ormond Street Hospital, Great Ormond Street, London, UK
- Craniofacial Unit, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH UK
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG UK
| | - Lena Westbom
- Lund University, Barnmed klin, SUS, Lund, Sweden
| | - Ruth Day
- Guardian Medical Centre, Guardian Street, Warrington, UK
| | - Edmund Ladusans
- Department of Paediatric Cardiology, Royal Manchester Children’s Hospital, Oxford Road, Manchester, UK
| | - Adam Jackson
- Department of Neurology, Salford Royal Hospital NHS Trust, Stott Lane, Salford, UK
| | - Iain Bruce
- Paediatric ENT Department, Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Robert Walker
- Department of Paediatric Anaesthesia, Royal Manchester Children’s Hospital, Oxford Road, Manchester, M13 9WL UK
| | - Sangeet Sidhu
- Department of Paediatric Nephrology, Royal Manchester Children’s Hospital, Oxford Road, Manchester, UK
| | - Catrina Dyer
- Cleft Lip and Palate Team, Royal Manchester Children’s Hospital, Oxford Road, Manchester, UK
| | - Jane Ashworth
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Daniel Hindley
- Community Paediatrics, Bolton NHS Foundation Trust, Breightmet Health Centre, Bolton, UK
| | - Gemma Arca Diaz
- Department of Neonatology, Hospital Clinic (Maternitat), Sabino Arana 1, 08028 Barcelona, Spain
| | - Myfanwy Rawson
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Peter Turnpenny
- Clinical Genetics, Royal Devon and Exeter NHS Foundation Trust, Gladstone Rd, Exeter, UK
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