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Epilepsy in Pregnancy — SCE Neurology MCQ

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ModerateEpilepsy & Seizure DisordersEpilepsy in PregnancySCE Neurology

A 40-year-old woman with epilepsy well controlled on lamotrigine discovers she is 6 weeks pregnant. She is seizure-free on lamotrigine 200 mg daily. What is the most appropriate advice?

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Correct answer: B — Continue lamotrigine and monitor serum levels; dose adjustments may be needed as pregnancy progresses

Lamotrigine is one of the safer antiseizure medications in pregnancy. However, lamotrigine clearance increases significantly during pregnancy (particularly in the 2nd and 3rd trimesters) due to increased glucuronidation, requiring monitoring of serum levels and potential dose increases to maintain seizure control. NICE NG217 advises continuing the most effective medication at the lowest effective dose. A: Stopping medication risks seizure recurrence. C: Valproate is contraindicated in pregnancy. D: Reducing dose risks breakthrough seizures. E: Carbamazepine has higher teratogenic risk than lamotrigine.

Reference: NICE NG217 (2025); MHRA Safety Advice on AEDs in Pregnancy