Antiseizure medications as migraine preventatives: a call for action for a teratogenic and neurodevelopmental risk removal

Introduction: A recent study has demonstrated an increased risk of neurodevelopmental disorders, including autism spectrum disorder, in individuals exposed to either valproate or topiramate mono-therapy. Regulatory bodies have initiated a review to reassess the safety of topiramate exposure during pregnancy. These novel findings raise concerns regarding the recommendation of antiseizure medica-tions in women of childbearing potential. This manuscript highlights current research defining concerns specific to the use of valproate and topiramate in women of childbearing potential.Areas covered: This manuscript summarizes recent findings regarding the safety of valproate and topiramate when compared to alternative therapies for the preventative treatment of migraine in women of childbearing potential. The studies included in this review were selected following a comprehensive literature review of multiple relevant databases. All studies that were published within the past 15 years were considered for inclusion.Expert opinion: The use of valproate and topiramate in women of childbearing potential should be highly discouraged. Our recommendations include a review of current prescribing guidelines, further public education regarding the neurodevelopmental and congenital risks associated with the use of valproate and topiramate, and an appeal for further research defining the safety of alternative medica-tions for migraine prevention when intrauterine exposure is possible.

Automated summary

A recent study has found an increased risk of neurodevelopmental disorders in individuals exposed to valproate or topiramate. Regulatory bodies are reviewing the safety of topiramate during pregnancy. This review highlights the concerns regarding the use of valproate and topiramate in women of childbearing potential.