Long-term outcomes of treatment with levetiracetam and valproate in idiopathic generalized epilepsy

Abstract

Objective: The aim of this study was to compare the efficacy and tolerability of valproate and levetiracetam monotherapy in patients with juvenile myoclonic epilepsy and epilepsy with generalized tonic-clonic seizure alone.

Methods: This retrospective-prospective cohort study was conducted on 170 adult patients who commenced monotherapy with valproate or levetiracetam between March 2019 and March 2023. The study outcomes were seizure-free rate, time to first seizure, retention rate, time to withdrawal and adverse events, which were registered following a one-to-five-year follow-up period.

Results: The seizure-free rates of levetiracetam and valproate were comparable in the one-year follow-up (65.9 % vs. 62.4 %, p:0.74) and in favor of levetiracetam in the five-year follow-up (90.9 % vs. 44.4 %, p:0.05). The retention rate of levetiracetam was higher than valproate (97.6 % vs. 82.4 % in the first year and 55.2 % vs. 21.6 % in the fifth year). The time to first seizure was found to be similar between the two groups (p = 0.43), but the time to withdrawal was significantly longer in patients on levetiracetam (p < 0.001). The incidence of adverse events was comparable between the two groups. However, the withdrawal rate due to adverse events was significantly higher in the valproate group. Levetiracetam demonstrated a higher occurrence of psychiatric adverse events, which were addressed with dose adjustments and psychiatric intervention in 37.6 % of patients but resulted in drug discontinuation in 3.5 % of cases.

Conclusion: The findings of this study indicate that levetiracetam monotherapy may represent an efficacious alternative to valproate in patients with juvenile myoclonic epilepsy and epilepsy with generalized tonic-clonic seizure alone, particularly in women of reproductive age.

Keywords: Generalized tonic-clonic seizure; Juvenile myoclonic epilepsy; Levetiracetam; Monotherapy; Valproate.