Study warns of unsafe antiseizure drug use despite rising access

In a study carried out in collaboration with the World Health Organization, two Aston University academics have found that while access to antiseizure medication in low- and middle-income countries is growing, it is not necessarily always prescribed safely.

Dr. Adrienne Chan and Professor Ian Wong led the study to analyze antiseizure medication use across 73 countries between 2012 and 2022 and say that the rise in prescribing is an encouraging sign that access to essential neurological medicines is improving. However, the most widely prescribed is valproate, which can cause birth defects and neurodevelopmental problems in babies if taken by mothers during pregnancy. These can include spina bifida, cleft palate, and intellectual, communication, behaviour and memory disorders.

The World Health Organization (WHO) lists valproate as an "essential medicine" but has issued guidance against prescribing it to women and girls of childbearing age because of the risks of birth defects. It has identified valproate-related foetal disorders as a major global concern.

The researchers say that education is urgently required globally to ensure that the risks are known and alternative medicines are prescribed where necessary. In many high-income countries, tighter regulations and pregnancy prevention programmes have reduced valproate use. In contrast, in countries where newer antiseizure drugs are less affordable or available, valproate continues to be prescribed more frequently.

The WHO commissioned the study led by Dr Chan and Professor Wong as part of ongoing efforts to understand and promote the safe and equitable use of essential neurological medicines worldwide.

The study used sales data from the affected countries, but the researchers say the next step is to understand patterns within specific populations and to evaluate how safety measures are being implemented in different regions. This will give a better understanding of whether such drugs are being prescribed to women of childbearing age and the risks to unborn children.

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."

Dr. Adrienne Chan, Aston University