{"title":"Long-term outcomes of treatment with levetiracetam and valproate in idiopathic generalized epilepsy","authors":"Nasim Tabrizi , Hamed Cheraghmakani , Fahimeh Samadi , Reza Alizadeh-Navaei","doi":"10.1016/j.seizure.2025.03.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to compare the efficacy and tolerability of valproate and levetiracetam monotherapy in patients with juvenile myoclonic epilepsy and epilepsy with generalized tonic-clonic seizure alone.</div></div><div><h3>Methods</h3><div>This retrospective-prospective cohort study was conducted on 170 adult patients who commenced monotherapy with valproate or levetiracetam between March 2019 and March 2023. The study outcomes were seizure-free rate, time to first seizure, retention rate, time to withdrawal and adverse events, which were registered following a one-to-five-year follow-up period.</div></div><div><h3>Results</h3><div>The seizure-free rates of levetiracetam and valproate were comparable in the one-year follow-up (65.9 % vs. 62.4 %, p:0.74) and in favor of levetiracetam in the five-year follow-up (90.9 % vs. 44.4 %, p:0.05). The retention rate of levetiracetam was higher than valproate (97.6 % vs. 82.4 % in the first year and 55.2 % vs. 21.6 % in the fifth year). The time to first seizure was found to be similar between the two groups (<em>p</em> = 0.43), but the time to withdrawal was significantly longer in patients on levetiracetam (<em>p</em> < 0.001). The incidence of adverse events was comparable between the two groups. However, the withdrawal rate due to adverse events was significantly higher in the valproate group. Levetiracetam demonstrated a higher occurrence of psychiatric adverse events, which were addressed with dose adjustments and psychiatric intervention in 37.6 % of patients but resulted in drug discontinuation in 3.5 % of cases.</div></div><div><h3>Conclusion</h3><div>The findings of this study indicate that levetiracetam monotherapy may represent an efficacious alternative to valproate in patients with juvenile myoclonic epilepsy and epilepsy with generalized tonic-clonic seizure alone, particularly in women of reproductive age.</div></div>","PeriodicalId":49552,"journal":{"name":"Seizure-European Journal of Epilepsy","volume":"127 ","pages":"Pages 66-70"},"PeriodicalIF":2.7000,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Seizure-European Journal of Epilepsy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S105913112500069X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective
The aim of this study was to compare the efficacy and tolerability of valproate and levetiracetam monotherapy in patients with juvenile myoclonic epilepsy and epilepsy with generalized tonic-clonic seizure alone.
Methods
This retrospective-prospective cohort study was conducted on 170 adult patients who commenced monotherapy with valproate or levetiracetam between March 2019 and March 2023. The study outcomes were seizure-free rate, time to first seizure, retention rate, time to withdrawal and adverse events, which were registered following a one-to-five-year follow-up period.
Results
The seizure-free rates of levetiracetam and valproate were comparable in the one-year follow-up (65.9 % vs. 62.4 %, p:0.74) and in favor of levetiracetam in the five-year follow-up (90.9 % vs. 44.4 %, p:0.05). The retention rate of levetiracetam was higher than valproate (97.6 % vs. 82.4 % in the first year and 55.2 % vs. 21.6 % in the fifth year). The time to first seizure was found to be similar between the two groups (p = 0.43), but the time to withdrawal was significantly longer in patients on levetiracetam (p < 0.001). The incidence of adverse events was comparable between the two groups. However, the withdrawal rate due to adverse events was significantly higher in the valproate group. Levetiracetam demonstrated a higher occurrence of psychiatric adverse events, which were addressed with dose adjustments and psychiatric intervention in 37.6 % of patients but resulted in drug discontinuation in 3.5 % of cases.
Conclusion
The findings of this study indicate that levetiracetam monotherapy may represent an efficacious alternative to valproate in patients with juvenile myoclonic epilepsy and epilepsy with generalized tonic-clonic seizure alone, particularly in women of reproductive age.
期刊介绍:
Seizure - European Journal of Epilepsy is an international journal owned by Epilepsy Action (the largest member led epilepsy organisation in the UK). It provides a forum for papers on all topics related to epilepsy and seizure disorders.