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Juvenile Myoclonic Epilepsy — SCE Neurology MCQ

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ModerateEpilepsy & Seizure DisordersJuvenile Myoclonic EpilepsySCE Neurology

A 24-year-old woman with juvenile myoclonic epilepsy (JME) controlled on sodium valproate wishes to plan a pregnancy. She is currently seizure-free. According to NICE NG217 (2025 update), what is the most appropriate next step?

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Correct answer: E — Refer for pre-conception counselling and discuss switching, as valproate must not be used in women of childbearing potential without a Pregnancy Prevention Programme

NICE NG217 and MHRA guidance state that valproate must not be started or continued in women of childbearing potential unless a Pregnancy Prevention Programme is in place, and ideally should be switched before conception. In JME, levetiracetam is a reasonable alternative, but the first step is specialist pre-conception counselling to discuss risks and alternative medications. A: Continuing valproate risks major congenital malformations (10%) and neurodevelopmental disorders (30-40%). B: Lamotrigine may exacerbate myoclonic seizures in JME. C: Levetiracetam is an option but the immediate priority is counselling. D: Stopping all medication risks seizure recurrence, especially in JME which has high relapse rates.

Reference: NICE NG217 (2025); MHRA Valproate Guidance (2024)