Title : Seizure outcome in women of reproductive age after switching from valproate
Abstract:
Objective: We analysed seizure control in reproductive age group women on Valproic acid (VPA) and studied the difference in seizure control between VPA maintenance and after changing to other Anti-seizure medications (ASMs), because of reproductive age group or impending pregnancy.
Methods: All women with epilepsy (WWE) from prospectively maintained electronic medical records (EMR) from 2013 to 2022 were analysed. We included WWE in age group 18- 45 years, both primary generalised and focal epilepsy well controlled on VPA. We studied their clinical profile, ASMs use, seizure control while on VPA and after changing to other ASMs and adverse effect and pregnancy related complications.
Results: Totally 290 WWE were analysed. After excluding 221 due to various reasons, there were 69 WWE who were well controlled on VPA, enrolled in this study. Among 69 WWE well controlled on VPA, 28 (40.58%) had diagnosis of JME, 30 (43.47%) were having other subtypes of GGE, whereas 11 (15.9%) patient had focal onset epilepsy. Among these patients, 26 (37.68%) only needed VPA dose more than 800mg/d for their control of seizures, remaining majority of patients required less than 800mg/d of VPA. Also, VPA mono-therapy needed for about 21 (30.43%) with the mean dose of 660mg/d. Out of the 69 patients who were well controlled on VPA, 18 patients were switched to other ASMs. Among these Switch group (n= 18), 10 (55.55%) had lost their seizure control after switching from VPA. Among the patients who continued on VPA, teratogenicity occurred in 3 patients with the mean dose of 966mg/d.
Conclusion: Switching to alternative ASMs in WWE who are already well controlled on low dose VPA (<800mg/d) leads to poor seizure control which could be detrimental for both mother and fetus
Audience Take Away Notes:
- Importance of maintaining seizure control, whenever possible with low dose VPA, which is the drug of choice, especially in IGE subtypes
- IGE subtypes, requires mostly low dose VPA monotherapy for seizure control which can be safely continued during pregnancy
- Further studies to look into the aspect of losing seizure control and risk to growing fetus including IUGR, decreased placental flow affecting developing organs like brain, is needed
