Valproic acid and pregnancy: Failed other medications

Abstract

A 25-year-old woman was diagnosed with Juvenile Myoclonic Epilepsy (JME) since age 13. She was tried on lamotrigine which resulted in full body rash. She has failed other medications including topiramate, zonisamide, and levetiracetam due to lack of efficacy for controlling her seizures. She has been managed with valproic acid in the past 5 years with no reported seizure recurrence. She would like to get pregnant in the next year or two. How would you counsel her and what treatment changes would you make, if any?.