Phenytoin (Epilepsy) updated on 04-22-2025

Severe cognitive developmental delay (Mental retardation) (> 6 years old)

R analysis
id Study   Lib. in paper Exposition period    Study type  Control type 
 
Tags OR 95%CI x1/n1 x0/n0 no cases no exposed ROB Ref.
S17394
R72927
Madley-Dowd_SE (Phenytoin) (Controls unexposed, sick), 2024 Intellectual disability (intelligence quotient below 70) - 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 0.73 [0.23;2.30] -/147   194/10,769 - 147
ref
S17253
R72211
Madley-Dowd_UK (Phenytoin) (Epilepsy), 2024 Intellectual disability - ICD10 codes - Median follow up 10.75 (7.82-13.62) years old during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: No 3.38 [0.20;57.75] C 0/45   13/4,075 13 45
ref
S7303
R21139
Meador (Phenytoin), 2013 IQ <70 (DAS) (at 6 years old) during pregnancy (anytime or not specified) prospective cohort exposed to other treatment, sick Adjustment: Yes 1.86 [0.04;95.58] C 0/40   0/74 0 40
ref
S6118
R15990
Titze (Phenytoin) (Controls unexposed, disease free), 2008 Learning disability (IQ<70) (German versions of the revised Wechsler Intelligence Scales for children and for adults) during pregnancy (anytime or not specified) prospective cohort unexposed, disease free excluded Adjustment: No Matched 4.22 [0.08;223.98] C
excluded (control group)
0/12   0/49 0 12
ref
S6119
R15991
Titze (Phenytoin) (Controls unexposed, sick), 2008 Learning disability (IQ<70) (German versions of the revised Wechsler Intelligence Scales for children and for adults) during pregnancy (anytime or not specified) prospective cohort unexposed, sick Adjustment: No 0.33 [0.01;9.07] C 0/12   1/13 1 12
ref
Total 4 studies 0.87 [0.32;2.32] 14 244
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

StudyTE95% CIn casesn exposedweightROBABCDEF Madley-Dowd_SE (Phenytoin) (Controls unexposed, sick), 2024Madley-Dowd_SE, 2024 1 0.73[0.23; 2.30]-14773%ROB confusion: criticalROB selection: lowROB classification: lowROB missing: lowROB mesure: criticalROB reporting: moderate Madley-Dowd_UK (Phenytoin) (Epilepsy), 2024Madley-Dowd_UK, 2024 2 3.38[0.20; 57.75]134512%ROB confusion: criticalROB selection: lowROB classification: criticalROB missing: unclearROB mesure: criticalROB reporting: moderate Meador (Phenytoin), 2013Meador, 2013 3 1.86[0.04; 95.58]0406%ROB confusion: moderateROB selection: lowROB classification: lowROB missing: moderateROB mesure: lowROB reporting: low Titze (Phenytoin) (Controls unexposed, sick), 2008Titze, 2008 4 0.33[0.01; 9.07]1129%ROB confusion: criticalROB selection: moderateROB classification: moderateROB missing: moderateROB mesure: moderateROB reporting: moderate Total (4 studies) I2 = 0% 0.87[0.32; 2.32]142440.210.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Phenytoin) (Controls unexposed, sick; 2: Phenytoin) (Epilepsy; 3: Phenytoin; 4: Phenytoin) (Controls unexposed, sick;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 0.87[0.32; 2.32]142440%NAMadley-Dowd_SE (Phenytoin) (Controls unexposed, sick), 2024 Madley-Dowd_UK (Phenytoin) (Epilepsy), 2024 Meador (Phenytoin), 2013 Titze (Phenytoin) (Controls unexposed, sick), 2008 4 case control studiescase control studies 0 Type of controls unexposed, sickunexposed, sick 0.82[0.30; 2.28]142040%NAMadley-Dowd_SE (Phenytoin) (Controls unexposed, sick), 2024 Madley-Dowd_UK (Phenytoin) (Epilepsy), 2024 Titze (Phenytoin) (Controls unexposed, sick), 2008 3 exposed to other treatment, sickexposed to other treatment, sick 1.86[0.04; 95.58]-40 -NAMeador (Phenytoin), 2013 1 Tags Adjustment   - No  - No 1.25[0.13; 11.81]14578%NAMadley-Dowd_UK (Phenytoin) (Epilepsy), 2024 Titze (Phenytoin) (Controls unexposed, sick), 2008 2   - Yes  - Yes 0.79[0.26; 2.37]-1870%NAMadley-Dowd_SE (Phenytoin) (Controls unexposed, sick), 2024 Meador (Phenytoin), 2013 2 All studiesAll studies 0.87[0.32; 2.32]142440%NAMadley-Dowd_SE (Phenytoin) (Controls unexposed, sick), 2024 Madley-Dowd_UK (Phenytoin) (Epilepsy), 2024 Meador (Phenytoin), 2013 Titze (Phenytoin) (Controls unexposed, sick), 2008 40.110.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-4.74.62.4120.000Madley-Dowd_SE (Phenytoin) (Controls unexposed, sick), 2024Madley-Dowd_UK (Phenytoin) (Epilepsy), 2024Meador (Phenytoin), 2013Titze (Phenytoin) (Controls unexposed, sick), 2008

Asymetry test p-value = NaN (by Egger's regression)

not enought points

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 6118

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 4.22[0.08; 223.98]-12 -NATitze (Phenytoin) (Controls unexposed, disease free), 2008 1 unexposed, sick controlsunexposed, sick controls 0.82[0.30; 2.28]1992040%NAMadley-Dowd_SE (Phenytoin) (Controls unexposed, sick), 2024 Madley-Dowd_UK (Phenytoin) (Epilepsy), 2024 Titze (Phenytoin) (Controls unexposed, sick), 2008 3 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.86[0.04; 95.58]-40 -NAMeador (Phenytoin), 2013 10.510.01.0