Epilepsy in pregnancy — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

HardSpecial GroupsEpilepsy in pregnancySCE Neurology

A woman with epilepsy controlled on lamotrigine is 22 weeks pregnant. She reports full adherence, but focal seizures have recurred and her lamotrigine concentration has fallen to 45% of her documented pre-pregnancy baseline. What is the best management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Baseline-guided lamotrigine adjustment with repeat concentration monitoring

The best answer is “Baseline-guided lamotrigine adjustment with repeat concentration monitoring”. Pregnancy can markedly increase lamotrigine clearance; an individual pre-conception concentration provides a useful target, and specialist dose adjustment with repeat levels balances maternal seizure control against toxicity as physiology later normalises. “Abrupt lamotrigine withdrawal to minimise ongoing fetal exposure” is less appropriate because abrupt withdrawal risks maternal and fetal harm from breakthrough seizures “Continuation of the baseline dose assuming unchanged pregnancy clearance” is less appropriate because enhanced glucuronidation commonly lowers lamotrigine exposure during pregnancy “Addition of sodium valproate as the second antiseizure medicine” is less appropriate because valproate has major reproductive risks and is not a reflex add-on “Deferred dose adjustment until after delivery with recurrent seizures” is less appropriate because ongoing seizures warrant prompt optimisation rather than deferred care

Reference: NICE NG217: Epilepsies in children, young people and adults. https://www.nice.org.uk/guidance/ng217/chapter/Recommendations NICE NG217: rationale and impact for antiseizure medicines in pregnancy. https://www.nice.org.uk/guidance/ng217/chapter/Recommendations