High-dose versus low-dose valproate for the treatment of juvenile myoclonic epilepsy: Going from low to high.
Juvenile myoclonic epilepsy (JME) is a genetic generalized epilepsy accounting for 3-12% of adult cases of epilepsy. Valproate has proven to be the first-choice drug in JME for controlling the most common seizure types: myoclonic, absence, and generalized tonic-clonic (GTC). In this retrospective study, we analyzed seizure outcome in patients with JME using valproate monotherapy for a minimum period of one year. Low valproate dose was considered to be 1000mg/day or lower, while serum levels were considered to be low if they were at or below 50mcg/dl. One hundred three patients met the inclusion criteria. Fifty-six patients (54.4%) were female. The current average age was 28.4±7.4years, while the age of epilepsy onset was 13.6±2.9years. Most patients corresponded to the subsyndrome of classic JME. Forty-six (44.7%) patients were free from all seizure types, and 76 (73.7%) patients were free from GTC seizures. No significant difference was found in seizure freedom among patients using a low dose of valproate versus a high dose (p=0.535) or among patients with low blood levels versus high blood levels (p=0.69). In patients with JME, it seems appropriate to use low doses of valproate (500mg to 1000mg) for initial treatment and then to determine if freedom from seizures was attained.
National Institute of Neurology and Neurosurgery of Mexico, Epilepsy Clinic, Mexico.
Laura E
LE
Hernández-Vanegas
National Institute of Neurology and Neurosurgery of Mexico, Neurogenetics and Molecular Biology Department, Mexico.
Aurelio
A
Jara-Prado
National Institute of Neurology and Neurosurgery of Mexico, Neurogenetics and Molecular Biology Department, Mexico.
Adriana
A
Ochoa
Benemérita Universidad Autónoma de Puebla, Mexico.
Nayelli
N
Rodríguez Y Rodríguez
Universidad Tecnológica Centroamericana (UNITEC), Tegucigalpa, Honduras.
Reyna M
RM
Durón
National Institute of Neurology and Neurosurgery of Mexico, Neuropsychiatry Unit, Mexico.
Daniel
D
Crail-Meléndez
National Institute of Neurology and Neurosurgery of Mexico, Neurogenetics and Molecular Biology Department, Mexico.
Ma Elisa
ME
Alonso
Epilepsy Genetics/Genomics Laboratories and Epilepsy Center of Excellence, Neurology and Research Services, VA GLAHS, Los Angeles, CA, United States; David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
Antonio V
AV
Delgado-Escueta
National Institute of Neurology and Neurosurgery of Mexico, Epilepsy Clinic, Mexico. Electronic address: imartinez@innn.edu.mx.
Iris E
IE
Martínez-Juárez
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use*; D002648:Child; D004305:Dose-Response Relationship, Drug; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020190:Myoclonic Epilepsy, Juvenile / Q000188:drug therapy*; D010349:Patient Compliance; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014635:Valproic Acid / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use*; D055815:Young Adult
D000927:Anticonvulsants; D014635:Valproic Acid
Antiepileptic drugs; Blood level; Dose; Epilepsy/seizures; Juvenile myoclonic epilepsy; Valproate