Rethinking Seizure Care Blog

Study Proves Teratogenic Drugs Are Still Given to Young Women Despite Risks

Posted by RSC Diagnostics on Sep 5, 2019

Doctor holding some pills in her hand-1

A recent study revealed something quite disturbing in the world of epilepsy treatment. It showed that in spite of the known teratogenic risks of commonly prescribed drugs like “valproate, phenytoin, and topiramate,” they are still being prescribed to women with epilepsy during their childbearing years.

What Are Teratogenic Drugs and What are Their Risks?

Teratogenic drugs or agents will disturb the development of a fetus or embryo and even halt a pregnancy or run the risks of congenital malformation (birth defect). According to experts, they include “radiation, maternal infections, chemicals, and drugs,” and include ACE inhibitors, acne medications, alcohol, certain hormones, some antibiotics, blood thinners, anticonvulsants, and many others.

The study noted their use as a “prescribing pattern,” among younger women newly diagnosed with epileptic conditions. And according to the report in Neurology Today, “These prescribing patterns may be influenced by the presence of comorbidities in these women. Valproate and topiramate were often prescribed for women with certain comorbid conditions—valproate, for comorbid mood or anxiety and dissociative disorder, and topiramate for women with comorbid headache or migraine.”

According to one children’s health expert, “Some anti-epileptic drugs are associated with a wide array of birth defects, such as cardiovascular abnormalities, cleft palate, and microcephaly, which is a condition where the brain is too small. These drugs include phenytoin, valproic acid, and trimethadione. Women with epilepsy need special monitoring and care during pregnancy, which may include a change in medication.”

Unfortunately, the study found that young women are still receiving some AEDs with noted teratogenic effects.

Almost 50,000 Patients' Data Evaluated

The team looked at data relating to more than 46,000 women with epilepsy. Ranging in age from 15 to 44, and spread all over the U.S., they ranged in the types of epilepsy they suffered. It was focal, generalized or undefined, and the “researchers reported that most newly diagnosed young women received monotherapy as first-line treatment for epilepsy, which is consistent with the 2018 guideline of the AAN and the American Epilepsy Society.”

They noted that the most commonly prescribed anti-epilepsy drugs are:

·         Levetiracetam

·         Lamotrigine

·         Topiramate

This was true of prevalent and incident cases. However, in evaluating all of the data, it was determined that topiramate had associations with a greater risk for cleft palate as well as smaller newborns. Valproate is “associated with behavioral and anatomic teratogenicity,” and the two are the most frequently prescribed in newly diagnosed patients treated with mono- or poly-therapies.

The study’s in-depth analysis also found that “valproate use has decreased in women of childbearing age following recommendations against its use during pregnancy. Yet, they noted valproate was prescribed in a considerable proportion of women in this study.”

Changes to Prescribing Patterns

Knowledge of teratogenicity of commonly used AEDs alongside dissemination of this data to both patients and health care professionals is something the research team feels should arise from their findings. In fact, they recommended that patients in a population-based cohort receive a medical information program that is both monitored and implemented for AED prescribing patterns.

This was true whether a patient was given a monotherapy (a single type of treatment for their epilepsy) or polytherapy (a combination of therapeutic treatments that relies on more than a single modality).

A report from PubMed indicated that “monotherapy has been promoted as the ideal in epilepsy treatment because of reduced side effects, absence of drug interactions, better compliance, lower cost and, in many cases, improved seizure control compared to polytherapy. The question of monotherapy vs. polytherapy has assumed increasing importance with the availability of multiple new antiepileptic drugs (AEDs),” and among them are both topiramate and lamotrigine.

Described as first-line agents, they are also touted as offering “theoretical advantages,” when called upon as a part of monotherapy.

Naturally, high risks for teratogenic results means that a new approach may be needed in women of childbearing age, and is something all patients should know about.

 

Sources:

https://journals.lww.com/neurotodayonline/blog/breakingnews/pages/post.aspx?PostID=821

https://www.rxlist.com/script/main/art.asp?articlekey=9334

https://www.aboutkidshealth.ca/Article?contentid=341&language=English

 

 

Topics: Anti-Epileptic Drugs (AEDs)