OP-6 Switching from Valproate to Other ASMS in Women with Epilepsy: Is It Really Needed in All?

Background and Aim: Switching from valproate (VPA) to other ASMs during the reproductive ages in women with epilepsy (WWE) due to fear of teratogenicity is a common practice. Switching in well-controlled patients on low-dose VPA could lead to a poor seizure control in mother. We analyzed the difference in seizure control between VPA continued and switched to other ASMs groups in WWE.

Methods: We analyzed electronic medical records (EMR) of 290 WWE in the reproductive age group (18–45 years) with either focal or primary generalized epilepsy and compared the seizure frequency in those who were well controlled with VPA, with the seizure frequency after switching to alternative ASMs due to the fact that they are either in the reproductive age group or pregnant. We also analyzed the teratogenic effects of ASMs in both groups.

Results: Of the 290 WWE, 69 had their seizures well-controlled with VPA-based regimen and 20 were well-controlled on VPA monotherapy (mean dose of 660 mg/day). All the 20 patients well-controlled on VPA monotherapy had IGE. Of these 69 WWE, 17 (24%) had poor seizure control (>3/year) after switching to other ASM and 8 were on polypharmacy after switching (≥3 ASMs). Among the patients on VPA continued during pregnancy, 3 women had delivered babies with teratogenic effects and their VPA dose was more than 900 mg/day.

Conclusions: Switching to alternative ASMs in WWE who are already well controlled on low-dose VPA (<700 mg/d) leads to poor seizure control.