Shifting Valproic Acid to Levetiracetam in Women of Childbearing Age With Epilepsy: A Retrospective Investigation and Review of the Literature

Kuo, Cheng-Yen; Liu, Yi-Hsuan; Chou, I-Jun; Wang, Huei-Shyong; Hung, Po-Cheng; Chou, Min-Liang; Lin, Jainn-Jim; Lan, Shih-Yun; Hsieh, Meng‐Ying; Wang, Yishan; Lin, Kuang-Lin

doi:10.3389/fneur.2020.00330

Cited by 8 publications

(7 citation statements)

References 31 publications

(38 reference statements)

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“…The main limitation of our study is its relatively small sample size. Even so, our results are in line with those of other studies based on larger samples [18][19][20][21][22][23][24][25][26][27][28] and we believe that our sample is representative of day-to-day clinical practice in the epilepsy department of a secondary healthcare centre. Another possible limitation is the relatively short follow-up period: 6 months.…”

Section: Discussionsupporting

confidence: 92%

“…A recent study retrospectively analysed the experience of either discontinuing or reducing VPA by adding levetiracetam; this was done for various reasons including, planned pregnancy, poor seizure control and the occurrence of AEs. Successful switches to either monotherapy with levetiracetam or dual therapy with levetiracetam and VPA administered at 50% lower dosages were reported in 20 of the 24 women in the study [22].…”

Section: Discussionmentioning

confidence: 90%

See 1 more Smart Citation

Risk-benefit assessment of treatment of epileptic women of childbearing age with valproic acid

Quílez

Baraldés-Rovira

Gallego

et al. 2020

Seizure

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 90%

Risk-benefit assessment of treatment of epileptic women of childbearing age with valproic acid

Quílez

Baraldés-Rovira

Gallego

et al. 2020

Seizure

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“…Patients may present with sudden or recurrent neurological disorders, twitching of the limbs, temporary sensory failure, unconscious behavior, and other symptoms [ 2 , 3 ]. According to statistics from the World Health Organization, among all epilepsy cases, women of childbearing age account for a larger proportion of epilepsy, about 40%, and in these data, most patients with well-controlled seizures are eager to get pregnant and raise offspring [ 4 ]. However, existing data show that compared with women of normal childbearing age, women of childbearing age with epilepsy have lower marriage and fertility rates and have a higher risk of complications during pregnancy and childbirth [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Analysis of the Clinical Effects of Sodium Valproate and Levetiracetam in the Treatment of Women with Epilepsy during Pregnancy

Zhao

2021

Evidence-Based Complementary and Alternative Medicine

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Objective. To explore the clinical effects of sodium valproate and levetiracetam in the treatment of women with epilepsy during pregnancy. Methods. The clinical data of 124 women with epilepsy during pregnancy who received monotherapy with antiepileptic drugs (AEDs) in our hospital from September 2017 to January 2020 were retrospectively analyzed. According to the type of medication taken by the patients, they were recorded as the sodium valproate group (the VPA group, n = 56) and the levetiracetam group (the LEV group, n = 68 cases). The effects and the maternal and infant outcomes after treatment were compared between the two groups. The neuron-specific enolase (NSE), cognitive function-related parameters (brain-derived neurotrophic factor (BDNF) and myelin basic protein (MBP)), and related inflammatory factors (tumor necrosis factor- (TNF-) α and interleukin- (IL-) 6) levels were compared between the two groups before and after treatment. Results. After treatment, the total clinical effective rate of the LEV group was 91.18% higher than that of the VPA group 73.21%, and the frequency and duration of seizures were lower than those of the VPA group ( P < 0.05 ). After treatment, the probability of gestational hypertension, depression during pregnancy, low-weight infants, and neonatal deformities in the LEV group was lower than that in the VPA group ( P < 0.05 ). After treatment, the levels of NSE, MBP, TNF-α, and IL-6 in the two groups decreased, and the levels of BDNF increased, and the LEV group changed significantly compared with the VPA group ( P < 0.05 ). Conclusion. Compared with sodium valproate monotherapy, levetiracetam is more effective in controlling seizures and improving maternal and infant outcomes in women with epilepsy during pregnancy and can effectively regulate their neurological and cognitive functions and reduce the serum inflammation factor level.

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“…A robust literature that has developed over the last 50 years succinctly documents the apparent teratogenicity of all the frontline ASMs commonly used to manage seizure disorders ( Dansky and Finnell, 1991 ). These ASMs include phenytoin ( Hanson and Smith, 1975 ; Hanson et al, 1976 ; Buehler et al, 1990 ) trimethadione ( Zackai et al, 1975 ), carbamazepine ( Ornoy and Cohen, 1996 ; Hill et al, 2010 ; Kohl et al, 2019 ), lamotrigine ( Hernandez-Diaz et al, 2012 ; Tomson et al, 2019 ; Trifu et al, 2020 ), levetiracetam ( Tomson et al, 2015 ; Kuo et al, 2020 ), VPA ( Wyszynski et al, 2005 ; Koren et al, 2006 ; Kluger and Meador, 2008 ; Gerard and Meador, 2015 ), and topiramate ( Veroniki et al, 2017 ; Vajda et al, 2020 ). More alarming is the fact that many of these compounds are now widely prescribed to women of reproductive age for the management of more common afflictions, including neuropathic pain, migraine headaches, mood disorders, obesity, and psychiatric disorders, adding significantly to the number of women of reproductive age who are exposed to these important medications.…”

Section: Discussionmentioning

confidence: 99%

Gene Environment Interactions in the Etiology of Neural Tube Defects

et al. 2021

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Human structural congenital malformations are the leading cause of infant mortality in the United States. Estimates from the United States Center for Disease Control and Prevention (CDC) determine that close to 3% of all United States newborns present with birth defects; the worldwide estimate approaches 6% of infants presenting with congenital anomalies. The scientific community has recognized for decades that the majority of birth defects have undetermined etiologies, although we propose that environmental agents interacting with inherited susceptibility genes are the major contributing factors. Neural tube defects (NTDs) are among the most prevalent human birth defects and as such, these malformations will be the primary focus of this review. NTDs result from failures in embryonic central nervous system development and are classified by their anatomical locations. Defects in the posterior portion of the neural tube are referred to as meningomyeloceles (spina bifida), while the more anterior defects are differentiated as anencephaly, encephalocele, or iniencephaly. Craniorachischisis involves a failure of the neural folds to elevate and thus disrupt the entire length of the neural tube. Worldwide NTDs have a prevalence of approximately 18.6 per 10,000 live births. It is widely believed that genetic factors are responsible for some 70% of NTDs, while the intrauterine environment tips the balance toward neurulation failure in at risk individuals. Despite aggressive educational campaigns to inform the public about folic acid supplementation and the benefits of providing mandatory folic acid food fortification in the United States, NTDs still affect up to 2,300 United States births annually and some 166,000 spina bifida patients currently live in the United States, more than half of whom are now adults. Within the context of this review, we will consider the role of maternal nutritional status (deficiency states involving B vitamins and one carbon analytes) and the potential modifiers of NTD risk beyond folic acid. There are several well-established human teratogens that contribute to the population burden of NTDs, including: industrial waste and pollutants [e.g., arsenic, pesticides, and polycyclic aromatic hydrocarbons (PAHs)], pharmaceuticals (e.g., anti-epileptic medications), and maternal hyperthermia during the first trimester. Animal models for these teratogens are described with attention focused on valproic acid (VPA; Depakote). Genetic interrogation of model systems involving VPA will be used as a model approach to discerning susceptibility factors that define the gene-environment interactions contributing to the etiology of NTDs.

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Shifting Valproic Acid to Levetiracetam in Women of Childbearing Age With Epilepsy: A Retrospective Investigation and Review of the Literature

Cited by 8 publications

References 31 publications

Risk-benefit assessment of treatment of epileptic women of childbearing age with valproic acid

Risk-benefit assessment of treatment of epileptic women of childbearing age with valproic acid

Analysis of the Clinical Effects of Sodium Valproate and Levetiracetam in the Treatment of Women with Epilepsy during Pregnancy

Gene Environment Interactions in the Etiology of Neural Tube Defects

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