New Data on Antiepileptic Drugs and Birth Defects

Hans-Christoph Diener, MD, PhD

September 25, 2019

This transcript has been edited for clarity.

Dear colleagues, I am Christoph Diener from the faculty of medicine at the University of Duisburg-Essen in Germany, here to discuss some highlights from the recent literature. I have five papers to share with you today: one in epilepsy, two in stroke, and two in headache.

Antiepileptic Drugs to Avoid in Pregnancy

We all know that some antiepileptic drugs have teratogenic properties. In a recent study published in Neurology,^[1] researchers accessed the French healthcare database to identify women who were pregnant between 2011 and 2015. They analyzed approximately 1.8 million pregnancies, out of which 800,794 patients took an antiepileptic drug as monotherapy in the first 2 months of the pregnancy. Then the authors looked at 23 specific malformations associated with prenatal exposure to 10 different antiepileptic drugs.

As you would expect, the one drug that really stuck out was valproic acid. It had an increased risk for eight different malformations, in particular spina bifida, ventricular or septal heart defects, and cleft palate. Topiramate had an increased risk for cleft lip or cleft palate. The other antiepileptic drugs had a very low risk of being associated with malformations.

These results very clearly show that valproic acid should only be used in women where everything else has failed.

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