AAN Issues Guideline for Use of Antiseizure Meds in People of Childbearing Potential

FRIDAY, May 17, 2024 (HealthDay News) -- In a practice guideline issued by the American Academy of Neurology, along with the American Epilepsy Society and the Society for Maternal-Fetal Medicine, recommendations are presented for the use of antiseizure medications (ASMs) among people with epilepsy of childbearing potential (PWECP). The guideline was published online May 15 in Neurology.

Alison M. Pack, M.D., M.P.H., from Columbia University in New York City, and colleagues developed evidence-based conclusions and recommendations relating to the effects of ASMs and folic acid supplementation on the prevalence of major congenital malformations (MCMs), adverse perinatal outcomes, and neurodevelopmental outcomes in children born to PWECP.

The authors note that at the earliest possible opportunity preconceptionally, clinicians should recommend ASMs and doses that optimize seizure control and fetal outcomes should pregnancy occur. The occurrence of convulsive seizures should be minimized in PWECP during pregnancy to reduce potential risks for the mother and fetus. Clinicians should exercise caution in attempting to remove or replace an ASM that is effective in controlling generalized tonic-clonic or focal-to-bilateral tonic-clonic seizures once a PWECP is already pregnant. To minimize the risk for MCMs, lamotrigine, levetiracetam, or oxcarbazepine should be considered when appropriate based on the patient's epilepsy syndrome, likelihood of achieving seizure control, and comorbidities. If clinically feasible, valproic acid should be avoided to minimize the risk for MCMs or neural tube defects; valproic acid should also be avoided to reduce the risk for poor neurodevelopmental outcomes, including autism spectrum disorder and lower IQ.

"Clinicians should prescribe at least 0.4 mg of folic acid supplementation daily preconceptionally and during pregnancy to any PWECP treated with an ASM to decrease the risk of neural tube defects and possibly improve neurodevelopmental outcomes in the offspring," the authors write.

Several authors disclosed ties to the biopharmaceutical industry.

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