Valproate Teratogenicity — SCE Neurology MCQ

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EasyEpilepsy & Seizure DisordersValproate TeratogenicitySCE Neurology

A 30-year-old woman with epilepsy asks about the UK Epilepsy and Pregnancy Register. Her neurologist explains that certain antiseizure medications carry higher teratogenic risks. According to the register and MHRA data, which medication carries the highest risk of major congenital malformations?

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Correct answer: A — Sodium valproate

Sodium valproate carries the highest teratogenic risk of all commonly used antiseizure medications: approximately 10% risk of major congenital malformations (neural tube defects, cardiac defects, cleft palate) and 30–40% risk of neurodevelopmental disorders (reduced IQ, autism spectrum disorder). The UK Epilepsy and Pregnancy Register has confirmed these risks. Lamotrigine and levetiracetam have the lowest reported risks (~2–3%). A: Lamotrigine has one of the lowest risks. B: Levetiracetam has a low risk profile. D: Carbamazepine carries intermediate risk (~5%). E: Zonisamide has limited data.

Reference: UK Epilepsy and Pregnancy Register; MHRA Valproate Guidance (2024); NICE NG217 (2025)