Women younger than 50 on valproate are advised to seek specialist review.
Epilepsy is a neurological condition in which seizures result from abnormal brain activity. Treating epilepsy largely centres on controlling and preventing these seizures. This is very commonly achieved by using anti-epileptic medication, which for many patients works to make them seizure-free. One such medication commonly used is sodium valproate. Whilst this can be very effective as a treatment, complications arise when a woman either chooses to or becomes pregnant.
Dr Dora Lozsadi is a leading neurologist and specialist in treating epilepsy. Here she explains how anti-epileptic medications work, taking a focus on sodium valproate, and the steps that must be taken when an epilepsy patient chooses to become pregnant.
What is valproate and how is it used in treating epilepsy?
Sodium valproate (also known as Epilim, Depakote, Episenta) is a well-known and effective anti-epileptic drug. It is beneficial for more epilepsy syndromes than most other medications. Valproate is also used in psychiatry as a mood stabiliser to treat bipolar disorder. When used to treat epilepsy, tablets are prescribed once or twice daily. They should be taken as directed, as missing doses may lead to rebound seizures. This also applies to women who have just discovered they are pregnant.
Why can't patients take valproate to treat their epilepsy if they are pregnant?
We have known for some years that valproate, if taken during pregnancy, can cause birth defects (such as spina bifida, cleft lip and palate, kidney and heart problems, to name a few) as well as learning difficulties which manifest only months or years after birth. This may be as high as 40% in total. Some months ago the Medicines and Healthcare Products Regulatory Agency (MHRA) issued new guidelines to prompt a specialist review of all women in childbearing age taking sodium valproate. Everyone on this medication who may become pregnant should discuss this with their GP and/or specialist.
What should epilepsy patients do who have valproate prescribed but wish to become pregnant?
Anyone being treated by a specialist should already have discussed possible pregnancy and alternative medication as part of the ongoing treatment process. Check your past clinic letters as a reminder. If you are not under a specialist (neurology, psychiatry, paediatric etc.) approach your GP to refer you. Guidelines set out by the MHRA also answer questions about valproate and pregnancy. Seeking specialist advice about becoming pregnant and your medication for treating epilepsy should be done more than six months before planning to conceive. If someone has just confirmed a pregnancy, valproate should be continued, and they should start taking folic acid, 5mg daily, and seek an urgent medical review with a GP or specialist.
What alternative treatments are there for epilepsy?
There are several dozen alternative antiepileptic drugs available in the UK. Most women will be able to change their medication to an equally effective and well-tolerated alternative. In rare cases after careful consideration and risk assessment women may stay on a low dose of valproate during pregnancy if suitable alternatives have failed and drug withdrawal is unsafe. Rarely, women may be recommended and decide to receive a pacemaker-like stimulator, called a vagal nerve stimulator. This device sends mild pulses to the vagus nerve at regular intervals throughout the day, which should stop seizures before they start. They can also work to reduce the severity and length of a seizure, shortening your recovery time.
If you suffer from epilepsy and are considering having children, make an appointment with an expert to discuss your treatment options.