An international study across 73 countries finds that access to antiseizure medicines is improving, especially in low- and middle-income nations, but warns that valproate — a World Health Organization-listed essential medicine linked to serious birth defects when used in pregnancy — remains widely used. Researchers led by Aston University report uneven progress in safe prescribing between 2012 and 2022 and call for stronger safeguards for women of childbearing age.
Researchers Dr. Adrienne Chan and Professor Ian Wong from Aston University led a longitudinal study of antiseizure medication use in 73 countries and regions from 2012 to 2022. Conducted in collaboration with and supported by the World Health Organization (WHO), the study used national sales data to track trends and found that access to these essential neurological treatments is expanding, particularly in low- and middle-income countries. This increase in prescribing is presented by the authors as an encouraging sign that more patients now receive care for conditions such as epilepsy.
However, the research highlights a critical concern: valproate, which the WHO lists as an essential medicine, remains the most widely used antiseizure drug in many parts of the world. According to Aston University and related reports on the study, valproate exposure during pregnancy has been linked to serious harms, including birth defects such as spina bifida and cleft palate, as well as neurodevelopmental problems affecting intellectual ability, communication, behavior and memory.
WHO guidance advises against prescribing valproate to women and girls of childbearing potential because of these risks, and WHO has identified fetal disorders associated with prenatal valproate exposure as a major global health concern. While tighter regulations and pregnancy prevention programs in many high‑income countries have helped to reduce valproate use there, the study and accompanying briefings note that in countries where newer antiseizure medicines are less affordable or harder to obtain, valproate continues to be prescribed more frequently.
The authors warn that, without broader access to safer alternatives and better implementation of safety measures, ongoing reliance on valproate in such settings could put large numbers of pregnancies at risk. They call for global education campaigns so that healthcare providers clearly understand the dangers of valproate use in pregnancy and can consider appropriate alternative treatments where possible.
Dr. Chan said: "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."
The study, published in the journal eClinicalMedicine under the title "Antiseizure medications consumption in 73 countries and regions from 2012 to 2022: a longitudinal trend study," concludes that further work is needed to examine prescribing patterns in specific populations. The researchers say that understanding how safety guidelines are applied in practice — particularly for women of childbearing age — will be essential to reducing the risks to unborn children.
