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Answer 7
  1. Obtain a repeat EEG and MRI to help guide decisions on continued use of valproate sodium prior to pregnancy. Over 90% of women with epilepsy can expect good pregnancy outcomes. All antiepileptic drugs carry some risk of teratogenicity. However, valproate sodium has the clearest and highest risk of teratogenicity, with a malformation rate of 2 to 3 times greater than the expected rate.6 Recurrent seizures also pose some risk to the developing fetus. Because this patient has been seizure-free for an extended period, consideration should be given to withdrawing the antiepileptic drug before she attempts to become pregnant. A repeat EEG and MRI will help to determine this patient’s risk of relapse if valproate sodium was discontinued. Antiepileptic drugs should only be discontinued before pregnancy when the risk for relapse is low. Beginning folic acid supplementation is an important step to prevent neural tube defects in all women taking antiepileptic drugs (usually 1–2 mg/day).

    6. Harden CL. Pregnancy and epilepsy. Semin Neurol 2007;27:453–9.

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