Is remission in women with idiopathic generalized epilepsy possible without valproate?

This study aimed to evaluate changes in prescription practices for treating idiopathic generalized epilepsy (IGE) in women of childbearing age, and to assess how switching from valproate (VPA) affects seizure outcomes. IGE accounts for 15-20% of all epilepsy cases. While VPA is the most effective treatment, its teratogenic risk limits its use in women of reproductive age, leading to recommendations for safer alternatives such as lamotrigine (LTG) and levetiracetam (LEV).

We retrospectively analysed the data from 130 women aged 18-49 diagnosed with IGE from 2000 to 2022.

Of the 107 who used VPA, 44 remained on it until the last follow-up. 74% of participants achieved seizure freedom at some point, and 62% remained seizure-free at the last follow-up. The attempt to switch from VPA to other medications was unsuccessful in 23 (21.5% out of 107) patients due to adverse effects or loss of seizure control. Seizure freedom rates after 12 months were similar between VPA and alternative ASMs like LEV and LTG.

Our study indicates that LEV and LTG are effective alternatives to VPA for many women with IGE. However, some patients still require VPA for optimal seizure control. Further large-scale, randomised studies are needed to confirm these findings.