Neurology: antiseizure drugs and pregnancy: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology: antiseizure drugs and pregnancy

Sample item

A 24-year-old woman with juvenile myoclonic epilepsy is planning a pregnancy. Her neurologist wants to reduce the risk of major malformations and impaired neurodevelopment in her child. Which drug carries the highest risk and should be avoided if possible?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Sodium valproate

Valproate has the highest risk among antiseizure drugs of major congenital malformations, including neural tube defects, and of lower IQ and autism spectrum disorder after in utero exposure. Lamotrigine and levetiracetam have the lowest risks. Folic acid supplementation, commonly at a higher dose, is advised before conception.

Option by option

  • A. Carbamazepine

    Carbamazepine carries a modest risk, clearly lower than valproate, and is not the highest.

  • B. Lamotrigine

    Lamotrigine has among the lowest malformation rates, although levels fall in pregnancy.

  • C. Sodium valproate (correct)

    Correct. Valproate has the greatest teratogenic and neurodevelopmental risk.

  • D. Levetiracetam

    Levetiracetam has a low malformation risk and is a preferred option.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Sodium valproate. Valproate has the highest risk among antiseizure drugs of major congenital malformations, including neural tube defects, and of lower IQ and autism spectrum disorder after in utero exposure.

Why is "Carbamazepine" not the answer?

Carbamazepine carries a modest risk, clearly lower than valproate, and is not the highest.

Why is "Lamotrigine" not the answer?

Lamotrigine has among the lowest malformation rates, although levels fall in pregnancy.

Why is "Levetiracetam" not the answer?

Levetiracetam has a low malformation risk and is a preferred option.

What concept does this question test?

It tests Neurology: antiseizure drugs and pregnancy in General Medicine. Lamotrigine and levetiracetam have the lowest risks. Folic acid supplementation, commonly at a higher dose, is advised before conception.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: antiseizure drugs and pregnancy?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.