Department of Pediatric Neurology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey.
Department of Pediatric Neurology, Gazi University Faculty of Medicine, Ankara, Turkey.
Seizure. 2022 Jul;99:48-53. doi: 10.1016/j.seizure.2022.05.005. Epub 2022 May 10.
Valproic acid (VPA) is frequently used and effective in juvenile myoclonic epilepsy (JME). Recently, levetiracetam (LEV) has been suggested as a monotherapy in JME. This study aimed to evaluate antiseizure medication (ASM) use in patients with JME.
Treatment choices in a total of 257 patients (age range 8-18 years, 152 girls, 105 boys) with JME diagnosed and treated between 2010 and 2020 were evaluated retrospectively. Seizure remission was defined as complete seizure control for at least 12 months.
Across the study period and entire patient group, VPA was most commonly chosen as the initial ASM (50.9%), followed by LEV (44.4%), and lamotrigine (4.7%). VPA was also the most frequent first choice in the subgroup of boys (73.3%), while LEV was the commonest first choice in girls (57.9%). The sex difference regarding the ASM of the first choice was statistically significant (p<0.001). While VPA was the most frequent initial ASM in the first 5 years of the study period (2010-2015,n = 66, 64%), LEV had taken over as the most popular first ASM in the last 5 years (n = 83, 53.9%, p = 0.005). The most frequent reasons for discontinuation were inefficacy for LEV and adverse effects for VPA (p = 0.001). During follow-up, 237 patients (92.2%) were seizure-free for at least 12 months, and 159 (61.9%) were also in electrographic remission. Seizure remission occurred earlier than electroencephalographic remission (p<0.001).
This study revealed that LEV has become the most frequently chosen initial ASM in the treatment of JME. Although LEV appears to have a better adverse effect profile, VPA seems more likely to be effective in achieving seizure control.
丙戊酸（VPA）在青少年肌阵挛癫痫（JME）中经常使用且有效。最近，左乙拉西坦（LEV）已被建议作为 JME 的单药治疗。本研究旨在评估 JME 患者的抗癫痫药物（ASM）使用情况。
回顾性评估了 2010 年至 2020 年间诊断和治疗的 257 例 JME 患者（年龄 8-18 岁，152 名女性，105 名男性）的治疗选择。癫痫发作缓解定义为至少 12 个月完全控制发作。
在整个研究期间和整个患者群体中，VPA 是最常被选为初始 ASM 的药物（50.9%），其次是 LEV（44.4%）和拉莫三嗪（4.7%）。VPA 也是男孩亚组中最常被选为初始 ASM 的药物（73.3%），而 LEV 是女孩中最常被选为初始 ASM 的药物（57.9%）。ASM 选择的性别差异具有统计学意义（p<0.001）。虽然 VPA 是研究前 5 年（2010-2015 年，n=66，64%）最常被选为初始 ASM 的药物，但在过去 5 年（n=83，53.9%，p=0.005）中，LEV 已成为最受欢迎的初始 ASM。停止使用的最常见原因是 LEV 无效和 VPA 不良反应（p=0.001）。在随访期间，237 名患者（92.2%）至少 12 个月无癫痫发作，159 名患者（61.9%）也无脑电图缓解。癫痫发作缓解早于脑电图缓解（p<0.001）。
本研究表明，LEV 已成为 JME 治疗中最常被选为初始 ASM 的药物。虽然 LEV 似乎具有更好的不良反应谱，但 VPA 似乎更有可能有效控制癫痫发作。
