Neurology

Which seizure drugs are safest in pregnancy? AAN Guideline Update

May 29, 2024

Lamotrigine, levetiracetam, and oxcarbazepine are favored for patients with child-bearing potential, over valproic acid and topiramate, according to updated guidance from the American Academy of Neurology, the American Epilepsy Society, and the Society for Maternal-Fetal Medicine. Folic acid is also recommended pre-conception and during pregnancy for those on antiseizure medications.

Major clinical recommendations

• Once a patient becomes pregnant, exercise caution in removing/replacing medications that are effectively controlling generalized tonic-clonic or focal-to-bilateral tonic-clonic seizures.
• Consider lamotrigine, levetiracetam, or oxcarbazepine in epilepsy patients with childbearing potential—as appropriate based on epilepsy type, seizure control likelihood, and comorbidities—to minimize risks for major congenital malformations.
• Avoid valproic acid, when feasible, in epilepsy patients with childbearing potential, to minimize major congenital malformations or neural tube defects, as well as risk for poor neurodevelopmental outcomes (e.g., autism spectrum disorder, lower IQ) in children.
• Avoid valproic acid and topiramate, when feasible, in epilepsy patients with childbearing potential, to minimize the risks of offspring born small for their gestational age.
• Folic acid. Ensure that all epilepsy patients with childbearing potential on anti-seizure medications take 0.4 mg of folic acid daily pre-conception and during pregnancy, to reduce neural tube defect risks and to possibly improve offspring’s neurodevelopmental outcomes.

Source:

Pack AM, et al. (2024, June 1). Neurology. Practice Guideline. Teratogenesis, Perinatal, and Neurodevelopmental Outcomes After In Utero Exposure to Antiseizure Medication: Practice Guideline From AAN, AES, and SMFM. https://pubmed.ncbi.nlm.nih.gov/38748979/