Valproate use in women aged 15–44 years: an observational study in general practice

Dear authors,

I was very interested to read your article regarding the prescription of valproate in women of child-bearing age. As a clinician who is currently taking sodium valproate, I thought I would offer an additional perspective.

I was diagnosed with juvenile myoclonic epilepsy (JME) in my third year of medical school and commenced on levetiracetam by my neurologist. Thus followed the extensive process of surrendering my driving licence, occupational health assessments and evidencing extenuating circumstances. Uptitration of levetiracetam was unsuccessful in helping me regain total control over my seizures, so my neurologist suggested commencing me on sodium valproate. At the age of 22 and in the middle of a medical degree, having a family was not on my radar for several years. I commenced valproate on the pregnancy prevention programme in November 2021 and was instantly totally seizure-free.

I am so glad I have been able to take valproate and experience a “normal” life for the past few years. In this time, I have successfully completed the UK Foundation Programme and regained my driving licence. I am doubtful levetiracetam monotherapy would have been sufficient to achieve this.

I hope to have a family one day, but I recognise that I may not be lucky enough to become pregnant straight away. I may not have a partner, or I may change my mind. I made a decision based on my life and priorities at the time, not what may or may not occur in the future.

I support the argument by the authors that patient education regarding foetal abnormalities and higher rates of learning disabilities in babies born to mothers taking sodium valproate is paramount to informed consent. From a patient perspective, an understanding of what the patient’s priorities are (for me, being able to drive and complete my degree!) and a collaborative approach to care are fundamental to safeguarding the health and wellbeing of the affected mother and any future pregnancies.