High-Risk Anti-Seizure Medication Use in Childbearing-Age People with Epilepsy in a Taenia solium Endemic Region
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Background/Objectives
People of childbearing potential with epilepsy who live in regions endemic for Taenia solium represent a particularly vulnerable population due to the high burden of epilepsy related to neurocysticercosis (NCC) combined with limited access to safer anti-seizure medications (ASMs). However, the extent of these resource limitations and current prescribing practices remains poorly characterized, limiting the development of appropriate clinical guidelines. This study aimed to characterize ASM prescribing patterns, including pregnancy-associated risk profiles and polytherapy, and to evaluate how these patterns vary by demographic and clinical characteristics among people of childbearing potential in an epilepsy cohort in Peru, a region highly endemic for T. solium .
Methods
Participants were drawn from a prospective, population-based epilepsy cohort established in Tumbes, Peru (2006–2020). The analytic population included individuals with epilepsy of childbearing potential, defined as females aged 15–49 years. The primary outcome was ASM risk, categorized by pregnancy-associated risk of congenital malformations and adverse neurodevelopmental outcomes. ASMs were classified as “Established Low Risk” (lamotrigine, levetiracetam), “Possible Risk/Inadequate Data” (carbamazepine, phenobarbital, phenytoin), and “Established High Risk” (valproic acid). Prescription patterns were analyzed in relation to demographic and clinical characteristics.
Results
Among 1,975 individuals with epilepsy in the cohort, 685 were people of childbearing potential. Approximately one-third met criteria for probable or definite NCC (34.9%). Most ASM prescriptions fell into the “Possible Risk/Inadequate Data” category (87.0%), while 12.8% of participants received medications in the “Established High Risk” category. In multivariable analysis, factors associated with high-risk prescriptions included ASM use prior to enrollment and polytherapy.
Discussion
People of childbearing potential with epilepsy in this cohort were predominantly treated with carbamazepine, phenytoin, phenobarbital, and valproate, the ASMs most consistently available in this region during the study period. Despite strong evidence supporting the use of newer-generation agents such as lamotrigine and levetiracetam for individuals who may become pregnant, prescribing patterns in this cohort reflect significant formulary and resource constraints. Current recommendations for the management of people of childbearing potential with epilepsy do not adequately address the realities of care in resource-limited, NCC-endemic settings.
