Following recent European Medication Agency restrictions on
valproate (VPA) use in girls and women of childbearing potential (WOCP), the Commission on
Epilepsy and Gender of the Italian League against
Epilepsy integrated current literature and legislative data in order to provide clinicians with guidance on antiseizure medication (ASM) prescription for Idiopathic
Generalized Epilepsies (IGEs) in this population, avoiding VPA. We reviewed the updated literature on ASMs and examined the teratogenicity of those showing efficacy in IGEs. For all relevant ASMs, we considered the indications for use and the pregnancy and
contraception-related recommendations given in the Italian Summary of Product Characteristics (SmPC) and on the websites of the European Medicines Agency (EMA) and other European Union (EU) countries' regulatory agencies. With the exception of absence
seizures, the literature lacks high quality studies on ASMs in IGEs. In girls and WOCP,
levetiracetam and
lamotrigine should be considered the first-choice drugs in
Generalized Tonic-Clonic Seizures Alone and in
Juvenile Myoclonic Epilepsy,
lamotrigine in
Juvenile Absence Epilepsy, and
ethosuximide in
Childhood Absence Epilepsy. Although supported by the literature, several ASMs are off label, contraindicated or burdened by special warnings in pregnancy. Some discrepancies emerged between the various SmPC warnings for different brands of the same active principle. We provided a therapeutic algorithm for each
IGE syndrome and highlighted the need for revised prescription rules, consistent with the latest literature data, uniformity of SmPC warnings for the same active principle, and more data on the efficacy of new ASMs in IGEs and their safety in pregnancy.