Pharmacological outcomes in juvenile myoclonic epilepsy: Support for sodium valproate

Comparative effectiveness of antiepileptic drugs in juvenile myoclonic epilepsy

“…5 Despite its effectiveness, valproate use is limited by adverse drug reactions (ADRs), teratogenicity, and neurotoxicity, 6,7 with important recent restrictions on its use in women of childbearing potential. 3,[9][10][11][12] Key Points • We conducted a retrospective study of comparative effectiveness of five commonly used antiepileptic drugs in 305 individuals with JME • Valproate was associated with the highest response rate; levetiracetam ranked second • Topiramate and valproate were associated with highest rates of ADRs • Controlling for start year and sex, valproate was associated with the longest treatment duration • Valproate should remain available as a treatment option for people with refractory JME irrespective of sex 422 | SILVENNOINEN Et aL. 3,[9][10][11][12] Key Points • We conducted a retrospective study of comparative effectiveness of five commonly used antiepileptic drugs in 305 individuals with JME • Valproate was associated with the highest response rate; levetiracetam ranked second • Topiramate and valproate were associated with highest rates of ADRs • Controlling for start year and sex, valproate was associated with the longest treatment duration • Valproate should remain available as a treatment option for people with refractory JME irrespective of sex 422 | SILVENNOINEN Et aL.…”

“…13 In a retrospective study of 962 individuals with IGE, of whom 357 had JME, valproate monotherapy was associated with a higher response rate compared to lamotrigine or topiramate, but no statistical comparison was undertaken. These include a prospective study of 156 people 10 and a retrospective study of 186 individuals 11 ; statistical testing of differences between AED effectiveness was not reported in either study. These include a prospective study of 156 people 10 and a retrospective study of 186 individuals 11 ; statistical testing of differences between AED effectiveness was not reported in either study.…”

Juvenile Myoclonic Epilepsy: Focus on the Use of Topiramate (Literature Review and Own Data)

“…По мнению авторов, прежде чем констатировать медикаментозную резистентность при этих формах эпи-лепсии, необходимо провести курс терапии вальпроата-ми в терапевтической дозе [25]. По данным A. Chowdhury и M. J. Brodie (2016) на основании ретроспективного ана-лиза 186 пациентов с ЮМЭ, прогноз был лучше у мужчин (так как у них в стартовой терапии применялся вальпроат), чем у женщин (у них в стартовой терапии применялись менее эффективные при этой форме эпилепсии левети-рацетам и ламотриджин) [15].…”

“…Однако он констатирует, что эффективность ламо-триджина ниже эффективности вальпроата: ламотрид-жин способен контролировать ТА и ГСП у 50-60 % пациентов, однако может вызывать аггравацию МП (вальпроат контролирует ТА и МП у 75 % пациентов и ГСП -у 70 % пациентов); кроме того, ламотрид-жин часто вызывает кожную сыпь [43]. Леветирацетам и ламотриджин в целом менее эффективны в лечении ЮМЭ, чем вальпроаты (A. Chowdhury и M. J. Brodie, 2016) [15]. На основании ретроспективного анализа …”

Practice Current: When do you stop antiepileptic drugs in patients with genetic generalized epilepsies and in those with focal epilepsies?

“…9 In a study of 186 patients, of the 92% who achieved remission, only 6 remained seizure-free without medication at a median follow-up of 14 years. 10 Other studies indicate that not all patients with JME experience a seizure recurrence or disabling seizures once off AEDs. A study followed 23 patients with JME for more than 20 years.…”