Treatment decisions in women of childbearing age on valproate

• Published in: Acta neurologica Scandinavica Vol. 141; no. 4; pp. 287 - 293
• Main Authors: Harris, Lauren, Lowes, Olivia, Angus‐Leppan, Heather
• Format: Journal Article
• Language: English
• Published: Denmark John Wiley & Sons, Inc 01.04.2020
• Subjects: Age; Antiepileptic agents; antiepileptic drugs; Congenital defects; Contraception; Contraceptives; Convulsions & seizures; Decision making; Epilepsy; Etiracetam; Folic acid; Headache; informed choice; Lamotrigine; Migraine; Patients; Pregnancy; Seizures; teratogenicity; Valproic acid; antiepileptic drugs; seizures; informed choice; teratogenicity
• ISSN: 0001-6314; 1600-0404; 1600-0404
• DOI: 10.1111/ane.13211

Introduction There are little data on the understanding and participation of women of childbearing age in decisions about their choice of antiepileptic drugs (AEDs). Valproate carries a risk of major congenital malformations, developmental and behavioural delay. For some, valproate is the only medication to prevent potentially life‐threatening seizures. Materials & Methods This was a cross‐sectional study of two groups of women of childbearing age; 50 taking valproate and 50 controls. Each patient completed a patient questionnaire and structured telephone interview assessing understanding of the risks and benefits of AEDs in relation to pregnancy. Analysis used unpaired two‐tailed t test and chi‐squared test, with Bonferroni correction. Follow‐up at 12 months showed that 8% of the women taking valproate had switched to other medication. Results Hundred patients participated in the study, 89 on AEDs for epilepsy, 4 for migraine, and 7 for both. 55% of participants stated they were not involved in decision‐making. More patients in the valproate group were informed about (64% vs 42%, P < .005), and expressed understanding of (64%vs 32%, P < .001), the risks involved with treatment. 59% of all patients wanted more information. The minority of women surveyed took folic acid (37%) or used contraceptives (29%). Valproate was used following failure of other AEDs to control seizures in 80%. Discussion This in‐depth survey suggests more information is needed for women taking AEDs, using a range of formats. Women taking valproate are better informed than those on levetiracetam or lamotrigine. Information provision on the use of folic acid and contraception needs improvement.