A workshop was held in Göteborg in June 2005 to discuss the place of
valproate in treating adult
epilepsies. Consensus positions were developed on the
epilepsy types for which the drug is most suitable and the use of
valproate in women of child-bearing age, in men and in patients with psychiatric comorbidity.
Valproate was considered to be effective across a broad variety of
epilepsy syndromes and seizure types and should be considered a suitable choice for first-line monotherapy of
juvenile myoclonic epilepsy and other idiopathic
generalized epilepsies. The use of
valproate by women of child-bearing age is associated with potential harm to the foetus. A conservative approach to treatment is recommended in these patients whereby alternative
antiepileptic drugs should be proposed to women planning pregnancies wherever satisfactory seizure control can be thereby maintained. In cases where
valproate is used during pregnancy, either because the pregnancy was unplanned or because alternative treatment options of equivalent efficacy are unavailable, appropriate counselling, precautionary measures and monitoring should be provided. The evidence for an impact of
valproate on male reproductive health is equivocal and considerations of male fertility should not be taken into account in deciding whether to prescribe
valproate to men.
Valproate can be proposed safely to patients with comorbid
psychiatric disease or underlying psychiatric vulnerability.