The new trend for antiseizure medication selection in juvenile myoclonic epilepsy: A retrospective multi-center study from Turkey between 2010 and 2020

Objectives:Valproic acid (VPA) is a frequently used and effective drug in treating juvenile myoclonic epilepsy(JME).Recently, levetiracetam (LEV) has been suggested for monotherapy in patients with JME. This study aimed to evaluate the antiseizure medication therapy in patients with JME. Methods: 257 cases (152 girls, 105 boys) with the JME included in the study cohort between 2010 and 2020 were evaluated retrospectively.The seizure remission was defined in patients who were seizure-free for at least 12 months. Results:VPA was preferred in 131 (50.9%),LEV in 114 (44.4%), and lamotrigine (LTG) in 12 cases (4.7%) as the first choice of antiseizure drug.The first drug choice was VPA in 73.3% male cases and LEV in 57.8% female cases. A statistically significant difference was determined between both genders regarding the first drug choice (p<0.001). In the first five years (2010-2015),VPA (64%) was preferred the most, and in the last five years, LEV (57.1%) was the first choice (p=0.005). The most frequent reason for discontinuation was ineffective for LEV and adverse effects for VPA, which was statistically significant (p=0.001). During follow-up with treatment,237 cases (92.2%) were seizure-free for at least 12 months, while 61.9% of them were also in electrographic remission. Seizure remission occurred earlier than EEG remission (p<0.001). Conclusion:This study clearly reveals that LEV has been preferred more frequently as the first drug in the treatment of JME in recent years. Although LEV is more advantageous due to its low adverse-effect profile, it is still considered that VPA is more effective in terms of seizure control.
Keywords: Juvenile myoclonic epilepsy, valproic acid, levetiracetam