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Withdrawal of valproic acid treatment during pregnancy and seizure outcome: Observations from EURAP
Author(s) -
Tomson Torbjörn,
Battino Dina,
Bonizzoni Erminio,
Craig John,
Lindhout Dick,
Perucca Emilio,
Sabers Anne,
Thomas Sanjeev V,
Vajda Frank
Publication year - 2016
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13437
Subject(s) - valproic acid , pregnancy , observational study , epilepsy , medicine , gestation , first trimester , anesthesia , pediatrics , psychiatry , genetics , biology
Summary Based on data from the EURAP observational International registry of antiepileptic drugs (AEDs) and pregnancy, we assessed changes in seizure control and subsequent AED changes in women who underwent attempts to withdraw valproic acid ( VPA ) during the first trimester of pregnancy. Applying Bayesian statistics, we compared seizure control in pregnancies where VPA was withdrawn (withdrawal group, n = 93), switched to another AED (switch group, n = 38), or maintained (maintained‐therapy group, n = 1,588) during the first trimester. The probability of primarily or secondarily generalized tonic–clonic seizures ( GTCS ) was lower in the maintained‐therapy group compared with the other two groups, both in the first trimester and for the entire duration of pregnancy. GTCS were twice as common during pregnancy in the withdrawal (33%) and switch groups (29%) compared with the maintained‐treatment group (16%). Limitations in the data and study design do not allow to establish a cause–effect relationship between treatment changes and seizure outcome, but these observations provide a signal that withdrawal of, or switch from, VPA during the first trimester could lead to loss of seizure control, and highlight the need for a specifically designed prospective observational study.