A 22-year-old woman with generalised tonic-clonic seizures wants to start treatment. Why is sodium valproate not first choice?
Answer and explanation
Correct answer: D. It carries a high risk of fetal malformation and neurodevelopmental disorder in pregnancy
- Step 1: Antiepileptic drug choice for women of childbearing potential must consider teratogenicity. Step 2. MHRA rules and NICE advise that valproate is not started in women unless a pregnancy prevention programme is in place and no alternative works, with lamotrigine or levetiracetam preferred. Answer: It carries a high risk of fetal malformation and neurodevelopmental disorder in pregnancy. Why not the others: Valproate is effective in generalised epilepsy, which is why it is used in men. It is not particularly linked to hyperkalaemia. It remains available but is tightly restricted.
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