Topiramate (Epilepsy) updated on 04-22-2025

ASD (Autism spectrum disorder): Diagnosis/Risk

id	Study   Auto Straub (Controls exposed to LTG) (Topiramate) (Epilepsy), 2026Straub (Controls unexposed, sick) (Topiramate) (Epilepsy), 2026Madley-Dowd_SE (Topiramate) (Controls exposed to LTG), 2024Madley-Dowd_SE (Topiramate) (Controls unexposed, sick), 2024Madley-Dowd_UK (Topiramate) (Controls unexposed, sick) (Epilepsy), 2024Dreier (Topiramate) (Epilepsy) (Controls exposed to LTG), 2023Dreier (Topiramate) (Epilepsy) (Controls unexposed, sick), 2023Bjørk (Topiramate) (Controls exposed to Lamotrigine, sick), 2018Bjørk (Topiramate) (Controls unexposed, disease free), 2018Bjørk (Topiramate) (Controls unexposed, sick), 2018Wood (Topiramate), 2015	Lib. in paper	Exposition period  Auto during pregnancy (anytime or not specified)1st trimester2nd trimester3rd trimester2nd and/or 3rd trimesterthroughout pregnancyearly pregnancydays before deliverylate pregnancypreconception-onlypericonceptionalpreconceptional for kinetic reasonat least 1st trimester3 months (or more) before pregnancy or during pregnancy1st and 2nd trimester3 months or more before pregnancy or1st trimesterPaternal exp. genotoxic window only (0–3 months preconception)Paternal exposure: epigenetic window only (3–xxx months preconception)Paternal exposure: genotoxic/epigenetic window (0–xxx months preconception)Paternal exposure: other window	Study type  All studies Case control excluded Only case control	Control type    Auto unexposed (general population or NOS)unexposed, sickunexposed, disease freeexposed to other treatment, sicknot specifiedsiblingwhatever (meta-analysis)	Tags	OR 95%CI	x1/n1 x0/n0	no cases	no exposed	ROB	Ref.
S19464 R82992	Straub (Controls exposed to LTG) (Topiramate) (Epilepsy), 2026	Autism spectrum disorder - ICD-10 codes: F84.x (except F84.2, F84.3) - Mean follow up (full cohort): 3.4 years	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	exposed to other treatment, sick excluded	Adjustment: No	1.51 [0.82;2.79] C excluded (control group)	15/961   34/3,273	49	961		ref
S19474 R83128	Straub (Controls unexposed, sick) (Topiramate) (Epilepsy), 2026	Autism spectrum disorder - ICD-10 codes: F84.x (except F84.2, F84.3) - Mean follow up (full cohort): 3.4 years	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	unexposed, sick	Adjustment: Yes	0.83 [0.46;1.48]	15/961   106/8,887	121	961		ref
S17437 R73276	Madley-Dowd_SE (Topiramate) (Controls exposed to LTG), 2024	Autism - ICD-8/9/10 codes - Mean 5-20 years old (according groups)	during pregnancy (anytime or not specified)	population based cohort retrospective	exposed to other treatment, sick excluded	Adjustment: No Partial overlapping	4.06 [1.68;9.78] C excluded (control group)	6/71   53/2,383	59	71		ref
S17438 R73271	Madley-Dowd_SE (Topiramate) (Controls unexposed, sick), 2024	Autism - ICD-8/9/10 codes - Mean 5-20 years old (according groups)	during pregnancy (anytime or not specified)	population based cohort retrospective	unexposed, sick	Adjustment: Yes Partial overlapping	2.79 [1.23;6.30]	6/71   425/10,769	431	71		ref
S17255 R72254	Madley-Dowd_UK (Topiramate) (Controls unexposed, sick) (Epilepsy), 2024	Autism - ICD10 codes - Median follow up 5.41 (3.59-8.40) years old	during pregnancy (anytime or not specified)	retrospective cohort (claims database)	unexposed, sick	Adjustment: Yes	0.68 [0.08;5.36]	-/43   78/4,075	-	43		ref
S15875 R65448	Dreier (Topiramate) (Epilepsy) (Controls exposed to LTG), 2023	Autism spectrum disorder - Corresponding ICD-10 F-chapter - Up to 22 years of age	during pregnancy (anytime or not specified)	population based cohort propective	exposed to other treatment, sick excluded	Adjustment: No	2.32 [1.10;4.88] C excluded (control group)	8/290   64/5,288	72	290		ref
S15876 R65457	Dreier (Topiramate) (Epilepsy) (Controls unexposed, sick), 2023	Autism spectrum disorder - Corresponding ICD-10 F-chapter - Up to 22 years of age	during pregnancy (anytime or not specified)	population based cohort propective	unexposed, sick	Adjustment: Yes	1.93 [0.95;3.94]	8/290   323/22,203	331	290		ref
S9960 R48036	Bjørk (Topiramate) (Controls exposed to Lamotrigine, sick), 2018	Autistic traits at 18 months and/or at 36 months (M-CHAT <2/6 critical or <3/23 or SCQ >13)	during pregnancy (anytime or not specified)	population based cohort propective	exposed to other treatment, sick excluded	Adjustment: No	0.97 [0.10;9.00] C excluded (control group)	1/6   13/76	14	6		ref
S9955 R48037	Bjørk (Topiramate) (Controls unexposed, disease free), 2018	Autistic traits at 18 months and/or at 36 months (M-CHAT <2/6 critical or <3/23 or SCQ >13)	during pregnancy (anytime or not specified)	population based cohort propective	unexposed, disease free excluded	Adjustment: No	1.99 [0.23;17.00] C excluded (control group)	1/6   6,907/75,497	6,908	6		ref
S9957 R48038	Bjørk (Topiramate) (Controls unexposed, sick), 2018	Autistic traits at 18 months and/or at 36 months (M-CHAT <2/6 critical or <3/23 or SCQ >13)	during pregnancy (anytime or not specified)	population based cohort propective	unexposed, sick	Adjustment: No	1.81 [0.20;16.11] C	1/6   27/272	28	6		ref
S6183 R48028	Wood (Topiramate), 2015	Score >30 (CARS)	during pregnancy (anytime or not specified)	prospective cohort	exposed to other treatment, sick	Adjustment: No	17.00 [0.13;2166.90] C	0/1   0/9	0	1		ref
					Total	6 studies	1.54 [0.87;2.73]		911	1,372
x1: number of endpoints among exposed, n1: number of exposed; x0: number of endpoints among non exposed, n0: number of non exposed; C: calculated odds ratio from numbers of events and effectives

Forest plot

Sensitivity analysis

Publication bias and p-hacking diagnosis

Sub-groups analysis using all included studies

excluded 9960, 9955, 15875, 17437, 19464