American Epilepsy Society

View all recommendations from this society

August 15, 2018

Do not treat females of childbearing potential with Valproate if other effective treatments are available.

The risks to an unborn child from valproate (VPA) are significant enough to warrant avoiding this medication if at all possible. If VPA is deemed necessary, aim for lowest effective dose. Females on VPA should receive risk counseling prior to conception including possibility of major malformations from first trimester exposure, and long-term cognitive and behavioral effects (lower IQ and increased risk of autism spectrum disorder and ADHD) throughout pregnancy.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Epilepsy Society (AES) and the AES Practice Management Committee (PMC) worked together to prepare the five statements from 2016–2018. The PMC met in person in December 2016 to use the ABIM Foundation’s Operating Principles for Clinician Organizations’ Participation in the Choosing Wisely Campaign to discuss and propose topics for further development. The PMC ultimately proposed seven potential topics for further discussion and tasked a subgroup of seven committee members to draft seven Choosing Wisely statements. Once drafted, each item was voted upon by the PMC subgroup for further inclusion.

Voters were provided additional instructions to select the item for further inclusion if it had (1) clinical relevance, (2) clinical validity, and (3) clarity of concept. Voting occurred electronically. Two items were eliminated, and five items were selected for further and final development. The final five items were completed by individual PMC subgroup members. The entire PMC subgroup then reviewed each statement for final editing and final vote for submission to Choosing Wisely, based on the same criteria mentioned above. Items receiving at least six “yes” votes (among seven voters) were advanced and reformatted and edited by the Practice Committee Chair, Dr. Gabriel Martz, to adhere to the ABIM Foundation’s Choosing Wisely submission specifications. The PMC subgroup then re-evaluated items to ensure consistency of message after re-formatting, and again voted on each item individually for or against advancement for review and consideration of approval by the AES Council on Clinical Activities, AES Executive Committee, AES Board of Directors. The AES Board of Directors provided feedback and final approval of the five statements for submission to the ABIM Foundation for consideration of inclusion in the Choosing Wisely Campaign. The PMC will review the statements on an annual basis to ensure adherence to the Foundation’s Operating Principles and that the statements continue to be supported by generally accepted evidence and are applicable to current clinical practice.


Campbell E1, Kennedy F2, Russell A3, Smithson WH4, Parsons L5, Morrison PJ6, Liggan B7, Irwin B1, Delanty N8, Hunt SJ1, Craig J1, Morrow J1. Malformation risks of antiepileptic drug monotherapies in pregnancy: updated results from the UK and Ireland Epilepsy and Pregnancy Registers. J Neurol Neurosurg Psychiatry. 2014 Sep;85(9):1029-34. doi: 10.1136/jnnp-2013-306318. Epub 2014 Jan 20.

Hernández-Díaz S1, Smith CR, Shen A, Mittendorf R, Hauser WA, Yerby M, Holmes LB; North American AED Pregnancy Registry; North American AED Pregnancy Registry.

Comparative safety of antiepileptic drugs during pregnancy. Neurology. 2012 May 22;78(21):1692-9. doi: 10.1212/WNL.0b013e3182574f39. Epub 2012 May 2.

Tomson T1, Battino D, Bonizzoni E, Craig J, Lindhout D, Sabers A, Perucca E, Vajda F; EURAP study group. Dose-dependent risk of malformations with antiepileptic drugs: an analysis of data from the EURAP epilepsy and pregnancy registry. Lancet Neurol. 2011 Jul;10(7):609-17. doi: 10.1016/S1474-4422(11)70107-7. Epub 2011 Jun 5.

Tomson T1, Marson A2,3, Boon P4, Canevini MP5, Covanis A6, Gaily E7, Kälviäinen R8,9, Trinka E10,11,12. Valproate in the treatment of epilepsy in girls and women of childbearing potential. Epilepsia. 2015 Jul;56(7):1006-19. doi: 10.1111/epi.13021. Epub 2015 May 16.