Comparative Efficacy of Valproate and Levetiracetam Monotherapy in Women of Childbearing Age with Juvenile Myoclonic Epilepsy: A Retrospective Cohort from Latin America
Juan Carlos Vera-López1, Stefan Narvaez-Labuhn1, Maximiliano Salgado-Deza1, Fernando Vazquez Lopez1, Irving Fuentes Calvo1, Betsy C. Vázquez Cruz1, Jimena Gonzalez-Salido1, Jimena Colado-Martinez1, Katherin Milagros Plasencia Correa1, Mariana Peschard-Franco1, Andres Felipe Morcillo Muñoz1, Alberto Cervantes-Hernandez1, Mario A. Sebastian-Diaz1, Iris E. Martínez Juárez1
1Epilepsy Clinic and Clinical Epileptology Fellowship National Institute of Neurology and Neurosurgery and UNAM, Mexico City, Mexico
Objective:
To compare seizure freedom between valproate (VPA) and levetiracetam (LEV) monotherapy in women of childbearing age with Juvenile Myoclonic Epilepsy (JME).
Background:
In the SANAD II study VPA was found to be the most effective antiseizure medication (ASMs) for JME. However, its teratogenic potential limits its use in women of childbearing age. Identifying alternative ASMs with comparable efficacy is crucial to balance seizure control and reproductive safety. LEV has emerged as a promising option.
Design/Methods:
A retrospective observational study of 60 females aged 15 to 49 years (the recognized reproductive-age range per WHO) who were on monotherapy with either valproate (n=25) or levetiracetam (n=35) from a single tertiary epilepsy center was conducted. Groups were comparable in age and epilepsy duration. Primary outcome: Seizure freedom ≥12 months for any seizure type and for generalized Tonic Clonic Seizure (GTCS). Statistical comparisons were performed using Chi-square and binary logistic regression adjusting for age at diagnosis and duration of treatment.
Results:
Seizure freedom was achieved in VPA 17/25 (68%) vs LEV 19/35 (54.3%), Freedom from GTCS was VPA 19/25 (76%) vs LEV 25/35 (71.4%). In the logistic regression model oriented as VPA vs LEV, the odds ratios (OR) for overall seizure and GTCS freedom were OR 1.79 (95% CI: 0.61–5.26) and OR 1.27 (95% CI: 0.39–4.17), respectively; after adjustment, the OR was 1.01 (95% CI: 0.27–3.70; p=0.98)
Conclusions:
We found no statistically significant differences between LEV and VPA in achieving seizure freedom. Point estimates and their 95% CIs were consistent with similar efficacy within the available precision. Given the teratogenic profile of VPA and reproductive safety considerations, LEV emerges as a reasonable alternative when minimizing fetal risk is prioritized; however, larger samples or non-inferiority studies are required to confirm comparability.
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