Treating women with juvenile myoclonic epilepsy

Epilepsy has special implications for women, especially during their childbearing years, and particularly when pregnancy is contemplated. Being aware of the relevant issues is therefore essential. For anyone with juvenile myoclonic epilepsy and other idiopathic generalised epilepsies, valproate is generally regarded as the gold standard treatment against which other antiepileptic drugs are compared. However, information from pregnancy registers consistently show valproate to be associated with the highest risk for major congenital malformations, and studies exploring cognitive and behavioural development of offspring also show that valproate has an adverse impact. This creates a significant headache when trying to choose the "right" drug for most women with a generalised epilepsy syndrome.