Letter of support for reviewing treatment options for women and girls

Following publication of a review highlighting the risks linked to some epilepsy medications during pregnancy, our Medical Director, Professor Ley Sander, has written a letter to support women and girls requesting a review of their medication and an urgent referral to a neurologist if they are planning to become pregnant.

A new review has highlighted the risks associated with some of the most commonly prescribed epilepsy medications when taken during pregnancy.

The review was carried out by the Commission on Human Medicines (CHM) which is now urging all doctors to ensure that women and girls of childbearing age are called in to discuss their treatment options and ensure that they are on the safest treatment options both for themselves and for any future babies.

And it is stressing that any woman who is planning a pregnancy should be urgently referred to her neurologist.

It is important that no girl or woman should stop taking her medication without consulting her doctor but should be called in for a review to discuss her treatment options.

As Epilepsy Society launches its #SafeMumSafeBaby campaign, our Medical Director, Professor Ley Sander, has written the following letter to support all women in requesting a review with their doctor.

Download the pdf of the letter here. 

Evidence around epilepsy drugs

The review from the CHM was published by the regulatory agency for medication, the MHRA.

While it is well established that valproate carries a high risk of harm for an unborn baby exposed to the drug during pregnancy, evidence has now shown that other drugs including carbamazepine, topiramate, phenytoin and phenobarbital, also carry risks.

For many drugs there is still not enough evidence to draw conclusions around their safety. For instance, zonisamide increases the risk of a baby being born smaller than expected in comparison with the general population. But more evidence is still needed to understand whether the drug increases the risk of a baby being born with a physical abnormality or learning disability.

Comparative risks

In the general population, 2-3 out of every 100 babies is born with a physical abnormality. This risk increases to 4-5 babies for carbamazepine and topiramate; 6 for phenytoin; 6-7 for phenobarbital; and about 10 out of 100 babies for valproate.

You can read the full details here.

No woman or girl should be prescribed valproate without being signed up to the pregnancy prevention programme.

A review is important for all women and girls of childbearing age, even if they are not currently considering planning a baby.

It can take many months, sometimes years, to find the right medication or combination of medications to control each person’s seizures. Therefore it is better, where possible, for girls and women to first try those drugs with the highest safety profile during pregnancy. This could reduce the need to consider switching medications when it comes to planning a family.

Levetiracetam and lamotrigine are currently considered to be the safest epilepsy drugs during pregnancy.

All women who are planning to become pregnant should be offered 5mg of folic acid per day before any possibility of becoming pregnant.