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Predictors of Seizure Recurrence in Women With Idiopathic Generalized Epilepsy Who Switch From Valproate to Another
Emanuele Cerulli Irelli1, Enrico Cocchi1, Alessandra Morano1
1From the Department of Human Neurosciences (E.C.I., A.M., C.C., P. Pulitano, C. Panzini, A.T.G., C.D.B.), Sapienza University, Rome, Italy; Department of Precision Medicine and Genomics (E.C.), Department of Medicine, Columbia University, New York, NY; Department of Neurology (J.G., C.P.B.), Odense University Hospital; Department of Clinical Research (J.G., C.P.B.), University of Southern Denmark, Odense, Denmark; Department of Neurology (R.H.C.), Hospital de Pediatría "Prof. Dr. Juan P Garrahan," Buenos Aires, Argentina; Neurological Clinic (S.L.), Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona; Neurology Unit (G.S.), Department of Translational Medicine, University of Piemonte Orientale, and Azienda Ospedaliero-Universitaria "Maggiore della Carità," Novara; Neuromuscular and Sense Organs Department (E.R.), Careggi University Hospital, Florence; Regional Epilepsy Centre (E.F.), "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria; Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro; IRCCS NEUROMED (S.C., G.D.G.), Pozzilli, Isernia; Neurology Unit (C. Pizzanelli), Department of Clinical and Experimental Medicine, University of Pisa; Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia (L.G.)," Section of Neurosciences, University of Catania; IRCCS Istituto delle Scienze Neurologiche di Bologna (V.V., B.M.); Full member of the ERN EpiCARE; DIBINEM (V.V.), University of Bologna; Humanitas Gradenigo Hospital (P. Pignatta), Turin; Institute of Neurology (F.F., A.G.), University Magna Graecia, Catanzaro, Italy; Istanbul University Istanbul Faculty of Medicine (A.Ç.A., B.B.B.), Department of Neurology, Turkey; Neurophysiopatology and Movement Disorders Clinic (A.L.), University of Messina; Department of Science of Health School of Medicine (F.F.O.), University of Catanzaro, Italy; and EMAR Medical Center (B.B.B.), Istanbul, Turkey.
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 according to mixed multivariable logistic regression analysis. After internal-external validation through 16 independent cohorts, the model showed an area under the curve of 0.71 (95% CI 0.64-0.77). In the subgroup of 337 women who switched to LEV or LTG, IPTW Cox regression analysis showed that LEV was associated with a reduced risk of GTCS worsening or recurrence compared with LTG (adjusted hazard ratio 0.59, 95% CI 0.40-0.87, p = 0.008) during the 24-month follow-up.
Discussion:
Our findings can have practical implications for optimizing counselling and treatment choices in women of childbearing age with IGE and may help clinicians in making informed treatment decisions in this special population of patients.
Classification Of Evidence:
This study provides Class III evidence that for women with IGE switching from VPA, LEV was associated with a reduced risk of GTCS worsening or recurrence compared with LTG.
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