A 22-year-old woman has had two unprovoked generalised tonic-clonic seizures. EEG shows generalised spike-and-wave discharges at 3 Hz. She plans pregnancy within 2 years. Which antiseizure medication should be avoided due to highest teratogenic risk in this context?

• A Lamotrigine
• B Levetiracetam
• C Lacosamide
• D Valproate ✓

Explanation

Valproate carries the highest teratogenic risk among antiseizure medications — associated with neural tube defects (spina bifida), craniofacial abnormalities, and neurodevelopmental impairment (NEAD cohort, MONEAD study). Current EURAP and MHRA guidelines advise against valproate in women of childbearing potential unless no alternatives exist. Lamotrigine and levetiracetam have the most favourable safety profiles in pregnancy for generalised epilepsy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.