29-year old, pregnant primigravida in 4th month, has a history of Juvenile myoclonic epilepsy. She has been regularly taking sodium valproate and is now seeking an opinion for her anti-epileptic regimen. What would you suggest her?
Patient is in the second trimester of pregnancy. Organogenesis occurs in early pregnancy and the damage may have already occurred. Fetus may already be having an NTD and hence there is no point in changing her treatment plan. If patient had presented when she was planning her pregnancy, we should gradually reduce Valproate dosage and initiate Lamotrigine.
Immediately taper Valproate and sta Lamotrigine
Continue Valproate with monitoring of drug level
Switch to Carbamazepine
Add Lamotrigine
Epilepsy and EEG