Neurology. 2025 Oct 21;105(8):e214219. doi: 10.1212/WNL.0000000000214219. Epub 2025 Sep 30.
ABSTRACT
OBJECTIVES: To assess the recent prescribing practices for antiseizure medications (ASMs) to pregnant people with and without epilepsy and prescribers’ preferences beyond the first-line ASMs for patients with refractory generalized epilepsy.
METHODS: A retrospective survey extracted electronic medical data from 20 US tertiary centers (January 1, 2021-December 31, 2022) on ASM prescriptions in pregnant people with and without epilepsy. A second survey asked epileptologists for next-line ASM choices after lamotrigine and levetiracetam failure in women with generalized epilepsy.
RESULTS: The final analyses included 17 centers, 378,808 pregnant people who were prescribed ASMs-12,908 with and 365,900 without epilepsy. Key findings include the following: (1) benzodiazepines represented the most prescribed ASM group (12.13%); (2) gabapentin was the second most prescribed ASM (4.16%); (3) among pregnant people with epilepsy, levetiracetam (28.28%), lamotrigine (15.61%), and gabapentin (11.12%) were most frequent exposures; (4) other common ASMs in this group included topiramate (5.86%), oxcarbazepine (3.32%), lacosamide (2.93%), and zonisamide (2.90%); and (5) valproate use was high, with 492 (3.81%) epilepsy exposures and 1,419 overall. Thirty-two US epileptologists survey responders selected zonisamide and lacosamide as second-line ASM choices for female patients with generalized epilepsy.
DISCUSSION: Valproate use in pregnancy remains high despite its known teratogenicity. Many commonly used ASMs in pregnancy have inadequate safety information.
PMID:41026990 | DOI:10.1212/WNL.0000000000214219
