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The Swiss League Against Epilepsy has revised its recommended daily intake of folic acid. The recommendation applies to women of child-bearing age who are on anti-seizure medication.

August 2023 – Taking folic acid prior to conception and during pregnancy can help protect the unborn baby from developing abnormalities. Supplements are particularly important for women who have epilepsy, as anti-seizure medication (previously known as anti-convulsants or anti-epileptic drugs) can lead to a deficiency in folic acid. Until recently, high doses of 4-5 mg per day were recommended.

A Scandinavian cohort study has recently discovered an increased risk of cancer in children born to mothers with epilepsy who had taken high doses of folic acid before or during their pregnancies. The average daily dose was 4.3 mg of folic acid per day.

In the light of this new information, the Swiss League Against Epilepsy is revising its recommendation: women of child-bearing age who are on anti-seizure medication should continue to take folic acid regularly in consultation with their doctor – at the latest when they start trying for a baby, and definitely prior to conception. The Epilepsy League now recommends a dose of 1-3 mg per day.

Higher doses can be considered on an individual basis, depending on the mother’s folate blood level or ethrocyte test results. This could be the case for expectant mothers who are on powerful enzyme-inducing medicines.

The daily dose recommended above is based on the knowledge available in August 2023. It may be subject to revision in the future if necessary.

Literature: Vegrim HM, Dreier JW, Alvestad S, et al. Cancer Risk in Children of Mothers With Epilepsy and High-Dose Folic Acid Use During Pregnancy. JAMA Neurol 2022;79(11):1130–1138.

Bjørk MH, Vegrim H, Alvestad S et al. Pregnancy, folic acid, and antiseizure medication. Clin Epileptol 36, 203–211 (2023).

Renzel R, Sellitto E. Die Rolle der Folsäuretherapie in der Epilepsiebehandlung. Schweizer Zeitschrift für Psychiatrie & Neurologie 2023/3: 41-45.

von Wrede R, Witt JA, Auvin S et al. Unjustified allegation on cancer risks in children of mothers with epilepsy taking high-dose folic acid during pregnancy − No proof of a causal relationship. Epilepsia 2023;00:1–5.

Bjørk M-H, Tomson T, Dreier JW, Alvestad S, Gilhus NE, Gissler M, et al. High-dose folic acid and cancer risk; unjustified concerns by von Wrede and colleagues regarding our paper. Epilepsia. 2023;00:1–5.