Sodium valproate monotherapy in childhood epilepsy
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Valproate monotherapy effectively controlled various epilepsies in children, with absence and benign myoclonic types showing best responses. Discontinuation led to relapse in some generalized tonic-clonic epilepsy cases but not others.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Valproate is a common antiepileptic drug used in children.
- Understanding its efficacy and safety in monotherapy is crucial for treatment optimization.
Purpose of the Study:
- To evaluate the efficacy and tolerability of valproate monotherapy in pediatric epilepsy.
- To assess seizure recurrence after valproate discontinuation in different epilepsy types.
Main Methods:
- Prospective follow-up of 154 pediatric patients on valproate monotherapy for 5-27 months.
- Analysis of seizure control, adverse effects, and relapse rates after treatment cessation.
Main Results:
- Valproate monotherapy showed good control for absence epilepsies, benign myoclonic epilepsies, and epilepsies with tonic-clonic seizures on awakening.
- Improvement was noted in 13/14 patients with primary generalized epilepsy on monotherapy.
- Mild to moderate adverse effects occurred in 16% of patients.
- No relapse was observed in absence, benign myoclonic, infantile spasms, or benign partial epilepsy after discontinuation.
- Two-thirds of patients with generalized tonic-clonic seizures on awakening relapsed post-cessation.
Conclusions:
- Valproate monotherapy is effective for several pediatric epilepsy syndromes, particularly absence and benign myoclonic types.
- While generally well-tolerated, careful consideration of discontinuation is needed for generalized tonic-clonic seizures on awakening due to relapse risk.
Abstract:
154 patients with a mean age of 6 years 1 month were followed on valproate monotherapy for a period ranging from 5 to 27 months (mean 22 months). Absence epilepsies, benign myoclonic epilepsies and epilepsies with tonic-clonic seizures on awakening were the best controlled, followed by benign partial epilepsies and infantile spasms. Reduction to monotherapy resulted in improvement in 13 of 14 patients with primary generalized epilepsy. Sixteen per cent of the 154 patients suffered mild to moderate adverse effects. After cessation of treatment in 28 seizure-free patients, no recurrence was observed in absence epilepsy, benign myoclonic epilepsy, infantile spasms or benign partial epilepsy, whereas two thirds of the patients with generalized tonic-clonic seizures on awakening relapsed in the year following the cessation of the treatment.