Growing Access to Seizure Medicines and New Safety Concerns
A recent study highlights a concerning trend: while more individuals in low- and middle-income countries are gaining access to essential antiseizure medications, the continued widespread use of valproate poses significant risks to unborn children. The research, conducted by Dr. Adrienne Chan and Professor Ian Wong of Aston University with support from the World Health Organization (WHO), examined antiseizure medication trends across 73 countries between 2012 and 2022.
The increasing availability of these medications signifies progress in neurological care. However, the study revealed that valproate, despite its known risks, remains a commonly prescribed option. Valproate use during pregnancy is linked to severe birth defects and neurodevelopmental issues, including spina bifida, cleft palate, and a range of intellectual, communication, behavioral, and memory disorders.
WHO Flags Valproate as a Major Global Risk
The WHO includes valproate on its list of "essential medicines," acknowledging its importance in treating certain conditions. However, the agency strongly advises against its use for women and girls who could become pregnant, citing the potential for severe birth defects. The WHO recognizes disorders linked to prenatal valproate exposure as a major global public health concern.
Uneven Global Progress in Safe Prescribing
The study underscores an urgent need for comprehensive education programs targeting healthcare providers. These programs should emphasize the risks associated with valproate and promote the use of safer alternatives when appropriate. High-income countries have seen a decline in valproate use due to stricter regulations and the implementation of pregnancy prevention programs. Conversely, in regions where newer antiseizure therapies are either too expensive or inaccessible, valproate continues to be prescribed more frequently.
This disparity highlights a critical gap in equitable access to safe and effective neurological treatments. The WHO commissioned the research to inform its efforts to promote safe, fair, and consistent access to essential neurological medicines worldwide.
Next Steps to Protect Patients and Future Children
The current study relied on sales data from participating countries. The researchers emphasize the need for further investigation into how these medications are being used within specific populations and whether existing safety guidelines are being adhered to. This includes assessing how often valproate is prescribed to women of childbearing age and the potential risks to their unborn children.
Dr. Chan and Professor Wong conclude, "Our findings show that access to antiseizure medicines is expanding globally, which is good news for patients who previously had little or no treatment options. But the continued widespread use of valproate in some parts of the world is concerning, given its known risks during pregnancy. Greater global alignment on safe prescribing and education is urgently needed to protect future generations."
