Management of Valproat Monotherapy in Adolescent Girls with Epilepsy; Evaluation of Predictive Factors of Seizure Recurrens

Introduction:Valproate remains an important antiepileptic drug for the treatment of childhood epilepsy including adolescence.ILAE and the EAN recently increased restrictions and warnings on the use of VPA in adolescent girls and women. Methods:We evaluated the adolescent girls patients with epilepsy and treatment with valproate monotherapy, between March2019 and March2020 in the division of pediatric neurology in our university.Considering the diagnosis of patients without clinical seizures and pathological EEG findings for at least 24 months, valproate treatment withdrew.Other patients treatment switch to an alternative AEDs.The electroclinical prognosis of the patients after at least one year of follow-up was evaluated. Results:Fifty-seven female patients(mean age:15.8 ±0.7years) whose seizures were controlled with VPA monotherapy were included in the study.Thirty-one patients had generalized epilepsy, 24 focal epilepsy.The mean duration of VPA use was 65.2months, the mean time between the last clinical seizure and VPA switch/withdraval was 38.4months, and the follow-up period was 22.2±8.8months.The valproate treatment withdrew in 30 of patients.The seizures relapsed on withdrawal of VPA in 3patients, and epileptiform discharges were observed on the EEG without clinical seizure in 4patients.The valproate treatment switched in 27 of our patients, the seizures didn’t reccur in only 10 of them.The potential risk factor for seizure recurrence was epileptiform EEG before withdrawal/switch of valproat(p<0.0001).The age at onset of epilepsy, seizure-free interval before withdrawal of VPA, history of febrile seizures, didn’t detected for seizure recurrence. Conclusions:Before a switch/withdrawal attempt of VPA monotheraphy, the epileptic activity at the EEG at the time of VPA switch/withdrawal must be taken into account.
Keywords: Adolescent Girls; Epilepsy; Valproat