Epilepsy Drugs and Pregnancy: A Doctor’s Dilemma?

Words by Joe Crutwell, Edited by Calum Kirk

Our November SciBar was presented by Dr Rhys Thomas. An epilepsy researcher and honorary consultant. Dr Rhys put the SciBar patrons in the position of a clinician, allowing us to see the difficult balance that must be struck while making decisions for a patient.

Classifying epilepsy, which affects approximately 1% of people in the UK, is not easy. It is a chronic condition, but it’s symptoms are intermittent and can be severe. It is a brain disorder, but can manifest at any age. It has underlying genetic triggers but an environmental correlation has been shown with factors such as economic deprivation.

Despite this knowledge, the exact causes of epilepsy are not known, but this has not stopped many treatments being discovered that help alleviate the seizures that are the main symptom associated with the disease.

Nov SciBar 2 cropped

 

One of these treatments, which has been used in epilepsy treatment since the 1960s , is sodium valproate . It is unclear how the treatment works as it was discovered, like many early drugs, by accident. It has a documented history of being able to halt the occurrence of seizures whilst having a relatively low rate of side effects, with one very important and very worrying exception.

After researching records of valproate use in pregnant women, it was discovered that there seemed to be a significantly higher risk of birth  defects, including intellectual defects, if a woman is on valproate during her pregnancy.

Despite these findings being quickly incorporated into advice given by medical professionals, as of 2017 almost one-fifth (18%) of women taking sodium valproate didn’t know the risks this medicine can pose during  .

These worrying side-effects coupled with the lack of patient awareness led to sodium valproate being prominently and negatively featured in the media, with some publications referring to the drug as “worse than thalidomide .”

There is another side to the story of Valproate however. Being the most effective epilepsy drug, any deviation from this treatment increases the risk of seizures. Epilepsy causes a high number of deaths in pregnancy. So despite valproate being worse in pregnancy, in men and non-pregnant women it is by far the drug of choice .

After describing all of the up to date information outlined above, Dr Rhys then left it up to the audience of the SciBar as to what they would prescribe for an epileptic patient who has become pregnant and is already on valproate. Was the right decision to keep the person on the drug, risking potential abnormalities, or change them to another, increasing the risk of a seizure?

After much discussion, the audience agreed there was not always a ‘right’ answer in these situations, especially as you cannot know the outcome until after the decision has been made. This is why current methods in medical practice involve patient-shared decision making. The patient is given all the resources possible to understand the potential benefits and risks of the treatment, and able to take a part of that important life decision into their own hands.

This was the British Science Association’s last SciBar of 2017, thanks for everyone who attended and made the events as popular as they are. If you missed us, keep an eye out on our Facebook and Twitter for what events we have coming up in the New Year!

For current UK advice about epilepsy and pregnancy follow this link: www.nhs.uk/Conditions/pregnancy-and-baby/pages/epilepsy-pregnant.aspx

 

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