Neurologists Don’t Know the Dangers of Anti-Seizure Migraine Preventives

Results discussed at a recent American Academy of Neurology (AAN) conference has critics blaming the FDA for not effectively disseminating important information to neurologists who use anti-seizure medications with their patients.  This is important because anti-seizure medications are some of the most popular preventive medications used by primary care doctors, neurologists and Migraine and headache specialists for the prevention of Migraine, as well as other pain related disorders such as facial neuralgias etc.

4,627 AAN neurologists were emailed and asked to participate in an online survey.  The survey asked the participating doctors multiple choice questions about four recent FDA warnings on anti-epileptic drugs (AED’s).  505 physicians responded from all 50 states.  96% of respondents were board certified, and their average number of years in practice was 22.4. The results of the survey were quite interesting.

Although 80% of the respondents were aware of the warnings, their knowledge about the specifics was varied.

Curious about those questions?

  • Question one was about screening patients of Asian descent for a particular genetic marker called HLA-B*1502 (1) before prescribing a drug called Carbamazepine.  If this drug is given to someone with the mutation, there is an increased risk of a serious or even potentially fatal side effects called Steven-Johnson’s syndrome and toxic epidermal necrolysis.  About 29% used the drug in Asian patients, but less than 25% of respondents had tested their Asian patients considering Carbamazepine for the gene.
  • Question two was about the reported relationship between suicidality and the use of 11 anti-seizure medicines.
  • Questions three addressed the labeling change and need for counseling for women considering or using valproate because of the increased risk of malformations if they took the drug while they were pregnant.  This was the least known detail among those surveyed (31%), although most did counsel their female patients about pregnancy while on the drug.
  • Topic four questioned the doctors about the FDA’s communication regarding the safety of the use of valproate during pregnancy and the increased risk of lowered IQ in the children after birth.  Less than half those surveyed knew the degree of lowered IQ with valproate.  Fully one third of respondents did not know there was any association found with valproate and cognitive ability.

Those questioned who did the best in the survey said their information came not from the FDA notifications, but notifications from specialty organizations.  The more knowledgeable respondents took care of a higher number of epileptic patients each year. Less than 5% of those surveyed wanted to continue with the current unchanged system of notification.  Most of the doctors said they preferred the prospect of creating a formal notification process through their professional organizations, or through emails that detailed product insert information, and the research leader Susan Shaw, MD  said, “We suggest that the AAN or another similar organization consider a formal electronic safety update system.”

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