Seizure outcome in adult patients with valproic acid treated epilepsy: gender-related differences

Seizure control following Valproic Acid (VPA) withdrawal and the effects of VPA avoidance were mainly studied in women of childbearing age. Currently, there are limited and conflicting data regarding gender outcomes following VPA withdrawal or switch to another Antiseizure Medication (ASM).

To evaluate gender outcomes in a cohort of patients with VPA-treated epilepsy and to assess their relation to VPA treatment patterns.

A retrospective review of the computerized database and the medical records of patients who presented to their first visit in our adult epilepsy outpatient clinic during a 10-year period (2012-2021). Of the 142 patients identified, 79 continued their follow-up in the clinic and were included in the study.

The study group included 50 (63.3 %) men and 29 (36.7 %) women, aged 18-83 years (median - 24 y). VPA was discontinued in 17 (21.5 %) patients, more commonly in women compared to men (41.4 % vs 10 %) (p = 0.004). Seizure outcome at last observation was worse in women (p = 0.023) and did not significantly differ according to VPA treatment patterns during follow-up. The prescribed daily dose/defined daily dose ratios for VPA and concomitant ASMs did not significantly differ between men and women at last observation.

Women are more likely to have a worse seizure outcome, regardless of VPA treatment pattern. Further studies are needed to assess the best treatment options in women with epilepsy.