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NEUROSAE 2018 ANNUAL MEETING EDITION (VOLUME 10, ISSUE 3)
QUESTION 22 OF 100
A 21-year-old woman whose generalized epilepsy is well controlled with valproate 1,000 mg twice daily and reports she wants to start a family. The most appropriate course of action is to advise her with which of the following statements?
A. reliable contraception or surgical sterility is required in women with epilepsy.
B. antiepileptic drugs should be discontinued during pregnancy due to the risk of birth defects.
C. valproate therapy during pregnancy increases the risk of fetal death by 10%.
D. valproate therapy at the current dose is relatively safe and has no effect on fetal health.
E. valproate therapy is associated with decreased IQ of the child in a dose-dependent fashion. **
** = Your answer
Patients who require antiepileptic medications for seizure control should continue to take their medication throughout pregnancy. Although valproate is a suboptimal choice during pregnancy, it should be continued if the patient requires it for seizure control. Valproate does not increase the rate of fetal death by 10%, but it can increase the rate of birth defects and has been associated with decreased IQ and a wide range of neuropsychological markers. If a patient requires valproate during pregnancy, folate should be administered to decrease the risk of birth defects or long-term cognitive deficit.
* Meador, KJ, Baker GA, Browning N, et al. Fetal antiepileptic drug exposure and cognitive outcomes at age 6 years (NEAD study): a prospective observational study. Lancet Neurol. 2013 Mar;12(3):244-252.