Predictors of Seizure Recurrence in Women With Idiopathic Generalized Epilepsy Who Switch From Valproate to Another Medication

作者：Emanuele Cerulli Irelli, E. Cocchi, A. Morano, Joanna Gesche, Roberto H. Caraballo, Simona Lattanzi, Gionata Strigaro, Eleonora Rosati, Cecilia Catania, E. Ferlazzo, S. Casciato, G. Di Gennaro, C. Pizzanelli, L. Giuliano, Veronica Viola, B. Mostacci, Pietro Pignatta, F. Fortunato, Patrizia Pulitano, Chiara Panzini, A. Gambardella, A. C. Atalar, A. Labate, F. Operto, A. Giallonardo, B. Baykan, C. P. Beier, C. di Bonaventura · 发表于：Neurology · 年份：2024 · DOI：10.1212/wnl.0000000000209222 · 被引用次数：18 · 研究领域：Medicine

Background and Objectives To investigate the predictors of seizure recurrence in women of childbearing age with idiopathic generalized epilepsy (IGE) who switched from valproate (VPA) to alternative antiseizure medications (ASMs) and compare the effectiveness of levetiracetam (LEV) and lamotrigine (LTG) as VPA alternatives after switch. Methods This multicenter retrospective study included women of childbearing age diagnosed with IGE from 16 epilepsy centers. Study outcomes included worsening or recurrence of generalized tonic-clonic seizure (GTCS) at 12 months and 24 months after the switch from VPA to an alternative ASM. The comparative effectiveness of LEV and LTG as alternative ASM following VPA discontinuation was assessed through inverse probability treatment–weighted (IPTW) Cox regression analysis. Results We included 426 women with IGE, with a median (interquartile range) age at VPA switch of 24 (19–30) years and a median VPA dosage of 750 (500–1,000) mg/d. The most common reason for VPA switch was teratogenicity concern in 249 women (58.6%), and the most common ASM used in place of VPA was LEV in 197 (46.2%) cases, followed by LTG in 140 (32.9%). GTCS worsening/recurrence occurred in 105 (24.6%) and 139 (32.6%) women at 12 and 24 months, respectively. Catamenial worsening of seizures, higher VPA dosage during switch, multiple seizure types, and shorter duration of GTCS freedom before switch were independent predictors of GTCS recurrence or worsening at 12 months acco...