Wężyk Kamil, Słowik Agnieszka, Bosak Magdalena
Faculty of Health Sciences, Jagiellonian University, Krakow, Poland.
University Hospital, Krakow, Poland.
Neurol Neurochir Pol. 2025;59(3):240-244. doi: 10.5603/pjnns.103380. Epub 2025 Feb 14.
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.
本研究旨在评估育龄期女性特发性全身性癫痫（IGE）治疗处方的变化情况，并评估从丙戊酸盐（VPA）转换用药对癫痫发作结果的影响。IGE占所有癫痫病例的15%-20%。虽然VPA是最有效的治疗方法，但其致畸风险限制了其在育龄期女性中的使用，因此推荐使用更安全的替代药物，如拉莫三嗪（LTG）和左乙拉西坦（LEV）。
我们回顾性分析了2000年至2022年期间130名年龄在18-49岁之间被诊断为IGE的女性的数据。
在107名使用VPA的患者中，44名在最后一次随访时仍继续使用。74%的参与者在某个时间点实现了无癫痫发作，62%在最后一次随访时仍无癫痫发作。由于不良反应或癫痫控制不佳，23名（107名中的21.5%）患者从VPA转换为其他药物的尝试未成功。VPA与LEV和LTG等替代抗癫痫药物（ASM）在12个月后的无癫痫发作率相似。
我们的研究表明，对于许多IGE女性患者，LEV和LTG是VPA的有效替代药物。然而，一些患者仍需要VPA来实现最佳的癫痫控制。需要进一步开展大规模随机研究来证实这些发现。
