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Pregnant women ‘more likely to discontinue epilepsy drugs’

Women with epilepsy need to be counselled on the risks of stopping anti-epilepsy drugs in pregnancy because many are still discontinuing treatment, a UK study has found.

The study

Only limited evidence is available about the discontinuation rates of anti-epilepsy drugs during pregnancy. UK researchers analysed prescribing trends for anti-epilepsy drugs from 1994 to 2009, based on primary care data for 174,055 pregnancies and anti-epilepsy drug use by 745 women with epilepsy and 54 with bipolar disorder.

The findings

Prescribing of newer anti-epilepsy drugs in pregnancy has steadily increased and lamotrigine has been the most popular anti-epilepsy drug prescribed in pregnancy since 2004, whereas use of carbamazepine and sodium valproate has declined. Pregnancy was linked to discontinuation of anti-epilepsy drugs, with discontinuation rates twice as high in women with epilepsy and three times higher for women with bipolar disorder compared with non-pregnant women using anti-epilepsy medications. 

What does it mean for GPs?

The authors recommend the risks and benefits of anti-epilepsy medications are explained to women - ideally prior to pregnancy - to allow them to make an informed decision on whether to continue treatment in pregnancy. They concluded: ‘Pregnancy is a strong determinant for the discontinuation of anti-epilepsy drug prescribing particularly for women with bipolar disorder.’

Expert comment

Dr Henry Smithson, a GP in Sheffield and the founding chair of the GP Society for Epilepsy, said: ‘There is good evidence from work in the UK and Ireland about the relative safety of anti-epileptic drugs in pregnancy. So the advice is to not change anything until you have received a specialist opinion when a women [with epilepsy] become pregnant, although that’s easier said than done. Pre-conception advice is also important. ‘

PLOS Medicine 2012; 157: 865-877

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