Levetiracetam reduces epilepsy seizure risk at 24 months in women of childbearing age

Key takeaways:

• The study included 426 women with IGE or tonic-clonic seizures who switched from valproate to other medications.
• 58.6% of study participants noted teratogenicity as a reason to switch medications.

For childbearing aged women with idiopathic generalized epilepsy, switching medication from valproate to levetiracetam compared with lamotrigine decreased seizure recurrence at 24 months, according to research from Neurology.

“Idiopathic generalized epilepsy is a common form of epilepsy, accounting for approximately 15%-20% of cases, with a slight female predominance,” Emanuele Cerulli Irelli, MD, PhD, doctoral researcher in the department of human neurosciences at Sapienza University in Rome, and colleagues wrote. “Valproic acid has traditionally been considered the preferred treatment for IGE syndromes due to its efficacy in managing all types of generalized seizures.”

Irelli and colleagues sought to investigate the predictors of seizure recurrence in women of childbearing age with idiopathic generalized epilepsy (IGE) who switched from valproate (VPA) to alternative antiseizure medications (ASMs) and to compare the effectiveness of levetiracetam (LEV) and lamotrigine (LTG) as alternatives after switching.

Their multicenter, retrospective study included 426 women (median age 24 years) diagnosed with IGE or generalized tonic-clonic seizures (GTCS) who switched from VPA to an alternative medication or used an ASM (such as topiramate, zonisamide, phenobarbital, clonazepamas a VPA substitute who attended 16 epilepsy centers between January 1980 and January 2022. All participants had at least 1 year of follow-up unless GTCS recurred at an earlier time, with GTCS worsening defined as an increase of at least 50% in frequency compared to baseline. The median age for epilepsy onset for the study group was 13 years and the median duration of epilepsy during VPA switch was 11 years.

Study outcomes included worsening or recurrence of GTCS at 12 months and 24 months after the switch from VPA to an alternative ASM, while comparative effectiveness of LEV and LTG as alternative following VPA discontinuation was assessed through inverse probability treatment weighted (IPTW) Cox regression analysis.

The most common reason for a switch from VPA was teratogenicity in 249 women (58.6%) while the most common ASM used in place of VPA was LEV in 197 (46.2%) cases, followed by LTG in 140 (32.9%), Irelli and colleagues wrote.

They also reported that GTCS worsening or recurrence occurred in 105 (24.6%) and 139 (32.6%) women at 12 and 24 months, respectively.

Using IPTW Cox regression, Irelli and colleagues found that in the subgroup of 337 women who switched from VPA to LEV or LTG, LEV was associated with a reduced risk of GTCS worsening or recurrence compared with LTG (adjusted HR = 0.59; 95% CI, 0.4–0.87) during the 24-month follow-up.

“We observed that a substantial proportion of women with [idiopathic generalized epilepsy] who discontinued valproate remained free from [generalized tonic-clonic seizures] during the follow-up period,” they wrote.