EEC 2022 | How much folic acid should women with epilepsy take?

Marte-Helene Bjork, MD, PhD, Haukeland University Hospital, Bergen, Norway, explains that the International League Against Epilepsy (ILAE) has recommended that women with epilepsy who use anti-seizure medication should take 0.4mg of folic acid daily. This recommendation is suggested regardless of pregnancy plans, to keep folate status within a good range for their own health and in case of unplanned pregnancy. This is due to the known impact of anti-seizure medication on folate uptake and metabolism. Since experts agree that a low dose of folic acid is necessary, the controversy arises regarding higher doses of folic acid. Dr Bjork uses a high dose of 4mg after women stop contraception and during their first trimester, to then adjust it down to 0.4mg while measuring that the folate levels remain adequate. Although there is no evidence that the serum concentration of folate can be used to guide dosage, Dr Bjork believes it makes sense to use with general guidelines in place for safety. This interview took place at the 14th European Epilepsy Congress (EEC) 2022 in Geneva, Switzerland.