Levetiracetam in Pregnancy: Results from the UK and Ireland Epilepsy and Pregnancy Registers

In the January 9, 2013 articles ahead of press Neurology, Doctors Mawhinney and colleagues from various centers across Ireland and the United Kingdom present results from the United Kingdom Epilepsy and Pregnancy Register. Specifically, the United Kingdom and Ireland Epilepsy and Pregnancy Registries are prospective, observational databases in which individuals who are pregnant and have epilepsy are followed to determine the safety of all seizure drugs taken during pregnancy. In this particular analysis the researchers reported results from first trimester exposure to levetiracetam from October 2000 to August of 2011.

Outcome data was available for 671 pregnancies. Of those 304 had been exposed to levetiracetam in monotherapy and 367 had been exposed to the drug in combination with at least another seizure drug. There were two major congenital malformations in the monotherapy group, and 19 in the group in which levetiracetam was combined with other drugs. The major congenital malformation rate in the group of patients who were taking more than one seizure drug varied by the seizure drug combinations but had lower rates when levetiracetam was given in combination with lamotrigine than when given with valproate or carbamazepine. The authors concluded that there is a low risk for major congenital malformation with levetiracetam used in isolation during pregnancy. However, the risk increases when levetiracetam is taken as part of a combination therapy.

This study presents some reassuring news about the use of levetiracetam. Because it may take up to two decades in order to make conclusions about safety of various medications when it comes to the issue of malformations in children exposed to those agents while the mother is pregnant, any interim conclusions are important to note. Clearly more work is needed to determine the risk of particular combinations of levetiracetam and other drugs that may create problems. However, levetiracetam taken alone can be considered a safer alternative to valproate for women with epilepsy of childbearing years. However, it is always important to keep in mind that we need to reassess these conclusions when larger numbers of patients are included to see if these results remain valid.