title: Levetiracetam and Valproate Retention Rate in Juvenile Myoclonic Epilepsy.
abstract: BACKGROUND
  Valproic acid (VPA) is an effective treatment in juvenile myoclonic epilepsy (JME), but concerns on its use during pregnancy are remarkable. Levetiracetam (LEV) is approved as second-line therapy, and used as monotherapy in clinical practice. Our objective was to analyze the outcome of LEV and VPA in JME.
  
  
  METHODS
  We analyzed patients with JME attending our epilepsy unit between 2010 and 2014, including all patients treated with LEV and/or VPA at some point of the disease course. The primary end point was drug retention rate in monotherapy after the final analysis.
  
  
  RESULTS
  We identified 58 patients (62% women). All had myoclonic seizures, 86% had generalized tonic-clonic seizures (GTCS) before the diagnosis, and 9% also had absences. All had generalized spike and wave on the interictal electroencephalogram, and 86% of them also had generalized polyspike and wave discharges. In total, LEV monotherapy was maintained in 15 (65%) of 23 patients, and VPA was maintained in 37 (74%) of 50 patients (P = 0.062). In women younger than 35 years, LEV had a similar retention rate with VPA (P = 0.939). More VPA patients achieved seizure freedom during follow-up (P < 0.01), whereas LEV patients showed a trend toward higher myoclonic freedom (0.085).
  
  
  CONCLUSIONS
  Levetiracetam showed lower retention rate than VPA, primarily due to poorer seizure control during long-term follow-up. More LEV patients achieved myoclonic seizure freedom than VPA patients. In women younger than 35 years, LEV and VPA had comparable retention rate; therefore, LEV could be a good option for women with JME with prominent myoclonic seizures.
authors.affiliation: *Epilepsy Unit, †Neuropediatric Unit, and ‡Neurophysiology Unit, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Jacint
authors.initials: J
authors.lastname: Sala-Padró
authors.forename: Manuel
authors.initials: M
authors.lastname: Toledo
authors.forename: Estevo
authors.initials: E
authors.lastname: Santamarina
authors.forename: Montserrat
authors.initials: M
authors.lastname: González-Cuevas
authors.forename: Miquel
authors.initials: M
authors.lastname: Raspall-Chaure
authors.forename: Maria
authors.initials: M
authors.lastname: Sueiras-Gil
authors.forename: Manolo
authors.initials: M
authors.lastname: Quintana
authors.forename: Xavier
authors.initials: X
authors.lastname: Salas-Puig
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D008875:Middle Aged; D020190:Myoclonic Epilepsy, Juvenile / Q000188:drug therapy*; D010889:Piracetam / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D014635:Valproic Acid; D010889:Piracetam