Epilepsy in Pregnancy — RACP Adult Medicine MCQ

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EasyNeurologyEpilepsy in PregnancyRACP Adult Medicine

A 30-year-old woman with epilepsy controlled on sodium valproate is planning pregnancy. She takes valproate 1500 mg daily. What is the most important medication change?

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Correct answer: A — IV levetiracetam

Sodium valproate is contraindicated in women of childbearing potential due to high teratogenicity risk (neural tube defects in 6–10%) and neurodevelopmental effects. It must be switched to a safer alternative before conception. Levetiracetam and lamotrigine are the preferred anti-seizure medications in pregnancy due to lower teratogenic risk.

Reference: eTG Neurology – 2024 – Epilepsy in Pregnancy; TGA/MHRA Valproate Pregnancy Prevention