Outcomes of low-dose valproic acid treatment in patients with juvenile myoclonic epilepsy

Highlights

• VPA dose was ≤750 mg in 77.6% of patients who achieved remission.

• Low-dose VPA maintained seizure control for women with juvenile myoclonic epilepsy.

• VPA dose was significantly higher in the major malformation group than in the minor malformation group.

Abstract

Purpose

There are conflicting data regarding the drug dose that is sufficient to achieve seizure control as well as the parameters of seizure remission in juvenile myoclonic epilepsy (JME). The present study aimed to identify factors that contribute to seizure control in JME and to evaluate factors associated with JME remission and the efficacy of low-dose valproic acid (VPA) therapy.

Methods

This retrospective, cross-sectional study included a total of 215 patients (121 female and 94 male; mean age: 28.03 ± 8.43 [14–59] years) diagnosed with JME. The patients were divided into remission and refractory groups. Remission was defined as a seizure-free (myoclonic, absence, and/or generalized tonic–clonic) period of at least 2 years. Patients in whom remission was achieved with VPA monotherapy were further divided into two groups according to the use of low-dose VPA therapy (VPA ≤ 750 mg/day and >750 mg/day). Potential contributing factors were evaluated in terms of the relationship between the dose and the remission parameters.

Results

Remission was achieved with VPA monotherapy in 116 patients (87.9%) in the remission group; the VPA dose was ≤750 mg in 77.6% of the patients. The dose of VPA was higher in patients with absence seizure who achieved remission (p = 0.026). Remission was achieved with a lower dose of VPA in females than in males (p = 0.004).

Conclusions

Low-dose VPA can be used to achieve remission in JME. However, identification at follow-up visits of the factors that may affect remission may change the planned effective dose of VPA.