title: Withholding the choice of sodium valproate to young women with generalised epilepsy: Are we causing more harm than good?
abstract: OBJECTIVE
  Although sodium valproate (VPA) remains the most effective antiepileptic for generalised and unclassified epilepsies, clinicians may be failing to discuss this treatment option because of guideline misinterpretation. Current guidelines recommend caution regarding teratogenic risks but do not advocate absolute avoidance.
  
  
  METHODS
  We assessed VPA prescribing in young people attending a transition epilepsy clinic. We present six patients with idiopathic generalised epilepsy (IGE) in whom VPA had been initially avoided.
  
  
  RESULTS
  Overall, the results were consistent with VPA's superior antiepileptic efficacy and ability to reduce harmful seizure-related complications. Young people denied of VPA showed prolonged periods of poor seizure control with medical, social and psychological complications. Following contraceptive counselling and VPA introduction, all six patients showed improved seizure control including seizure-freedom during follow-up of up to twenty-four months. There was also evidence of reduced seizure-related morbidity and improved educational and occupational functioning. Prior to referral, documentation revealed no discussion of VPA treatment options.
  
  
  CONCLUSIONS
  Failure to prescribe valproate for IGE, particularly when another first-line treatment has failed, may not be in a young woman's best interests-particularly when they are most vulnerable to sequelae from uncontrolled seizures. Indiscriminate avoidance of valproate needs to be recognised as a misinterpretation of current epilepsy guidelines as it may harm young people. Although the use of valproate demands careful consideration, there remains a strong case to always discuss this medication because of its efficacy and potential to reduce seizure-related harm. Patients must be allowed to make their own informed decisions about effective epilepsy treatments.
authors.affiliation: Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK. Electronic address: tm507@cam.ac.uk.
authors.forename: Tom B
authors.initials: TB
authors.lastname: Mole
authors.affiliation: The Roald Dahl EEG Unit, Paediatric Neurosciences Foundation, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Appleton
authors.affiliation: Division of Neurological Science, University of Liverpool, Clinical Sciences Building, Lower Lane, Fazakerley, Liverpool L9 7LJ, UK. Electronic address: A.G.Marson@liverpool.ac.uk.
authors.forename: Anthony
authors.initials: A
authors.lastname: Marson
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use*; D004829:Epilepsy, Generalized / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid
keywords: Anticonvulsants; Epilepsy; Health policy & practice