Withholding the choice of sodium valproate to young women with generalised epilepsy: Are we causing more harm than good?

Although sodium valproate (VPA) remains the most effective antiepileptic for generalised and unclassified epilepsies, clinicians may be failing to discuss this treatment option because of guideline misinterpretation. Current guidelines recommend caution regarding teratogenic risks but do not advocate absolute avoidance. In this study, the authors assessed VPA prescribing in young people attending a transition epilepsy clinic. Six patients with idiopathic generalised epilepsy (IGE) in whom VPA had been initially avoided were examined. Overall, the results were consistent with VPA’s superior antiepileptic efficacy and ability to reduce harmful seizure-related complications. Young people denied of VPA showed prolonged periods of poor seizure control with medical, social and psychological complications. Following contraceptive counselling and VPA introduction, all six patients showed improved seizure control including seizure-freedom during follow-up of up to twenty-four months. There was also evidence of reduced seizure-related morbidity and improved educational and occupational functioning. Prior to referral, documentation revealed no discussion of VPA treatment options. The authors concluded that failure to prescribe valproate for IGE, particularly when another first-line treatment has failed, may not be in a young woman’s best interests-particularly when they are most vulnerable to sequelae from uncontrolled seizures. Indiscriminate avoidance of valproate needs to be recognised as a misinterpretation of current epilepsy guidelines as it may harm young people. Although the use of valproate demands careful consideration, there remains a strong case to always discuss this medication because of its efficacy and potential to reduce seizure-related harm. Patients must be allowed to make their own informed decisions about effective epilepsy treatments.

Authors: Mole TB, Appleton R, Marson A. ;Full Source: Seizure. 2014 Aug 26. pii: S1059-1311(14)00234-9. doi: 10.1016/j.seizure.2014.08.006. [Epub ahead of print] ;