Tabrizi Nasim, Cheraghmakani Hamed, Samadi Fahimeh, Alizadeh-Navaei Reza
Neurology Department, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Seizure. 2025 Apr;127:66-70. doi: 10.1016/j.seizure.2025.03.004. Epub 2025 Mar 7.
The aim of this study was to compare the efficacy and tolerability of valproate and levetiracetam monotherapy in patients with juvenile myoclonic epilepsy and epilepsy with generalized tonic-clonic seizure alone.
This retrospective-prospective cohort study was conducted on 170 adult patients who commenced monotherapy with valproate or levetiracetam between March 2019 and March 2023. The study outcomes were seizure-free rate, time to first seizure, retention rate, time to withdrawal and adverse events, which were registered following a one-to-five-year follow-up period.
The seizure-free rates of levetiracetam and valproate were comparable in the one-year follow-up (65.9 % vs. 62.4 %, p:0.74) and in favor of levetiracetam in the five-year follow-up (90.9 % vs. 44.4 %, p:0.05). The retention rate of levetiracetam was higher than valproate (97.6 % vs. 82.4 % in the first year and 55.2 % vs. 21.6 % in the fifth year). The time to first seizure was found to be similar between the two groups (p = 0.43), but the time to withdrawal was significantly longer in patients on levetiracetam (p < 0.001). The incidence of adverse events was comparable between the two groups. However, the withdrawal rate due to adverse events was significantly higher in the valproate group. Levetiracetam demonstrated a higher occurrence of psychiatric adverse events, which were addressed with dose adjustments and psychiatric intervention in 37.6 % of patients but resulted in drug discontinuation in 3.5 % of cases.
The findings of this study indicate that levetiracetam monotherapy may represent an efficacious alternative to valproate in patients with juvenile myoclonic epilepsy and epilepsy with generalized tonic-clonic seizure alone, particularly in women of reproductive age.
本研究旨在比较丙戊酸盐和左乙拉西坦单药治疗对青少年肌阵挛性癫痫及仅伴有全身强直阵挛发作癫痫患者的疗效和耐受性。
本回顾性-前瞻性队列研究针对2019年3月至2023年3月期间开始使用丙戊酸盐或左乙拉西坦进行单药治疗的170例成年患者开展。研究结局包括无癫痫发作率、首次发作时间、保留率、停药时间及不良事件，这些数据在1至5年的随访期后进行记录。
在一年随访期内，左乙拉西坦和丙戊酸盐的无癫痫发作率相当（65.9%对62.4%，p：0.74），而在五年随访期内左乙拉西坦更具优势（90.9%对44.4%，p：0.05）。左乙拉西坦的保留率高于丙戊酸盐（第一年为97.6%对82.4%，第五年为55.2%对21.6%）。两组首次发作时间相似（p = 0.43），但左乙拉西坦治疗患者的停药时间显著更长（p < 0.001）。两组不良事件发生率相当。然而，丙戊酸盐组因不良事件导致的停药率显著更高。左乙拉西坦所致精神方面不良事件发生率更高，37.6%的患者通过调整剂量和精神科干预得以解决，但3.5%的病例导致停药。
本研究结果表明，对于青少年肌阵挛性癫痫及仅伴有全身强直阵挛发作癫痫患者，尤其是育龄期女性，左乙拉西坦单药治疗可能是丙戊酸盐的有效替代方案。
