Dados do Trabalho

Título

Evolution of patientes with Genetic Generalized Epilepsies undergoing switch from valproate to another anti-seizure medication

Resumo

Valproate (VPA) is widely used as the first-line treatment in Genetic Generalized Epilepsy (GGE). Compared to new anti-seizure medications (ASM), which have better tolerability, VPA is superior in controlling myoclonic and generalized tonic-clonic (GTC) and has a good response in the absence seizures. However, there is a lack of literature about the evolution of patients who switched from VPA to another ASM.

Compare the evolution of patients with GGE in regular use of VPA to those who switched it to another ASM.

This study was retrospective and observational in a cohort of GGE patients in outpatient follow-up, with data collected from medical records. We compared the evolution of patients using VPA in monotherapy or in associations ('VPA group') vs. those who switched it ('switch group').
Results were presented as mean ± standard deviation or proportion. ANOVA with Tukey's post hoc or Student's t-test was used for parametric variables. Mann-Whitney test was used to compare non-parametric numerical data in the switch group. χ2 or Fisher tests were used to compare the VPA and switch groups before and after the substitution. Comparing the switch group before and after the substitution, McNemar's tests were used. The level of statistical significance was determined by p<0.05 in all analyses. R program was used.

The study sample comprised 40 patients in the switch group and 225 in the VPA group. The percentage of women was much higher in the first group: 31(78%) vs. 127(56%) (Fisher, p=0.02). As for the types of seizure, in the switch group, 29 (73%) had myoclonus, 26 (65%) absences, and 39 (98%) GTC. In another one, 176 (78%) had myoclonus, 145 (64%) absences and 220 (98%) GTC.
Among patients in the switch group, the single leading cause of the substitution was lack of efficacy, reported by 23/40 cases (58%). The most common adverse effects as a cause of switching were in order: weight gain, hair loss, and gastrointestinal intolerability.
As for the dose of VPA used, the switch group used higher doses of VPA (Switch: 1244±405 mg/day vs. VPA: 992±505 mg/day, T-Test, p<0.001). The most used ASM after the switch and in association with VPA was lamotrigine.

In this series, the switch group presented more unfavorable clinical evolution having the greater frequency of control got worse after VPA switch. Addictionally, the higher prevalence of the female gender is probably related to concerns about potential fetal hazards.