TY - JOUR
T1 - Withdrawal of valproic acid treatment during pregnancy and seizure outcome
T2 - Observations from EURAP
AU - Tomson, Torbjörn
AU - Battino, Dina
AU - Bonizzoni, Erminio
AU - Craig, John
AU - Lindhout, Dick
AU - Perucca, Emilio
AU - Sabers, Anne
AU - Thomas, Sanjeev V.
AU - Vajda, Frank
PY - 2016
Y1 - 2016
N2 - Based on data from the EURAP observational International registry of antiepileptic drugs (AEDs) and pregnancy, we assessed changes in seizure control and subsequent AED changes in women who underwent attempts to withdraw valproic acid (VPA) during the first trimester of pregnancy. Applying Bayesian statistics, we compared seizure control in pregnancies where VPA was withdrawn (withdrawal group, n = 93), switched to another AED (switch group, n = 38), or maintained (maintained-therapy group, n = 1,588) during the first trimester. The probability of primarily or secondarily generalized tonic–clonic seizures (GTCS) was lower in the maintained-therapy group compared with the other two groups, both in the first trimester and for the entire duration of pregnancy. GTCS were twice as common during pregnancy in the withdrawal (33%) and switch groups (29%) compared with the maintained-treatment group (16%). Limitations in the data and study design do not allow to establish a cause–effect relationship between treatment changes and seizure outcome, but these observations provide a signal that withdrawal of, or switch from, VPA during the first trimester could lead to loss of seizure control, and highlight the need for a specifically designed prospective observational study.
AB - Based on data from the EURAP observational International registry of antiepileptic drugs (AEDs) and pregnancy, we assessed changes in seizure control and subsequent AED changes in women who underwent attempts to withdraw valproic acid (VPA) during the first trimester of pregnancy. Applying Bayesian statistics, we compared seizure control in pregnancies where VPA was withdrawn (withdrawal group, n = 93), switched to another AED (switch group, n = 38), or maintained (maintained-therapy group, n = 1,588) during the first trimester. The probability of primarily or secondarily generalized tonic–clonic seizures (GTCS) was lower in the maintained-therapy group compared with the other two groups, both in the first trimester and for the entire duration of pregnancy. GTCS were twice as common during pregnancy in the withdrawal (33%) and switch groups (29%) compared with the maintained-treatment group (16%). Limitations in the data and study design do not allow to establish a cause–effect relationship between treatment changes and seizure outcome, but these observations provide a signal that withdrawal of, or switch from, VPA during the first trimester could lead to loss of seizure control, and highlight the need for a specifically designed prospective observational study.
KW - Epilepsy
KW - Pregnancy
KW - Seizures
KW - Valproic acid
UR - http://www.scopus.com/inward/record.url?scp=84985001166&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84985001166&partnerID=8YFLogxK
U2 - 10.1111/epi.13437
DO - 10.1111/epi.13437
M3 - Article
C2 - 27319360
AN - SCOPUS:84985001166
VL - 57
SP - e173-e177
JO - Epilepsia
JF - Epilepsia
SN - 0013-9580
IS - 8
ER -