Is valproate contraindicated in young women with epilepsy? No

Although a wide variety of antiepileptic drugs (AEDs) are available, counseling women of childbearing age with epilepsy is still a challenge.

Are there treatment alternatives available for these women? Are there data in the studies and registries allowing women to use VPA under certain circumstances? Is there enough knowledge available to council women and how can this be done?

For generalized and unclassified epilepsies, valproate (VPA) should still be considered the gold standard. In many cases, VPA cannot be replaced in patients suffering from idiopathic generalized epilepsy (IGE). There are many reasons for contraindicating the use of VPA in female patients, e.g. increasing risk for Major congenital malformations (MCM) and influence on cognition. These risks are dose dependent and there is evidence that low dose therapy reduces the risks considerable. If VPA proves to be indispensable, then administering the lowest dose possible is mandatory.