Avoiding the use of valproate

Abstract

Over the course of some 50 years, valproate first became established as a major antiseizure medication and also found a significant therapeutic role in psychiatry and in the prevention of migraine. In addition to having some unusual and serious unwanted effects, exposure to the drug during pregnancy became recognised as a major cause of foetal structural malformation and was also found to be associated with an increased incidence of various manifestations of abnormal childhood neurodevelopment. Because of these malformations and neurodevelopmental issues, use of valproate began to decrease some 25 years ago, initially because of prescriber action but later reinforced by the added influence of drug regulatory authority advice and, in some instances, virtual prohibition. Following the reduced use of valproate, evidence has begun to appear showing that the actual antiseizure medication related foetal structural malformation rate in the community has fallen, though possibly at the cost of some lessening in overall epileptic seizure control. However, till data concerning possible consequences for childhood neurodevelopment also become available it may be premature to attempt a final assessment of the balance between advantages and disadvantages that are attributable to limiting the availability of an effective antiseizure medication.