Abstracts

Valproate (VPA) is the typical treatment of juvenile myoclonic epilepsy (JME), but not all patients respond to it. VPA is also often associated with adverse effects that can cause medication discontinuation. Newer antiepilepsy drugs (AEDs) (ie, lamotrigine [LTG], topiramate [TPM], zonisamide [ZNS], and levetiracetam [LEV]) have been developed that are associated with fewer adverse effects; however no direct comparisons between these medications and VPA in JME treatment have been undertaken. A retrospective chart review was performed at the University of Alabama, Birmingham epilepsy clinic for JME patients [gt]15 years old who had initiation of 1 new AED at the clinic. Patients with poor documentation of seizure frequency, prior treatment with a new AED, or treatment with more than 1 new AED were excluded from the analysis. Treatment data before and after initiation of the new AED were compared. Frequency of myoclonic (MYO), absence (AB), and generalized tonic-clonic (GTC) seizures; adverse effects; VPA dosage; weight; and reasons for discontinuation of the new AED (if applicable) were evaluated. Initial data from 36 patients were evaluated (LTG, n=22; TPM, n=6; ZNS, n=4; LEV, n=4). MYO seizure frequency increased with use of LTG (by 13%) and LEV (by 20%); MYO seizure frequency decreased with use of TPM (by 34%) and ZNS (by 10%). AB seizure frequency increased with LEV treatment (by 100%), but decreased with LTG (by 24%), TPM (by 100%), and ZNS (by 80%) treatment. The frequency of GTC seizures increased with LTG (by 140%) and LEV (by 397%) treatment, but decreased by 94% and 78% in patients treated with TPM and ZNS, respectively. Dosages of VPA decreased in patients treated with ZNS (by 37%), TPM (by 53%), and LTG (by 56%), but increased by 14% with LEV treatment. VPA was discontinued in 50% of patients on TPM and ZNS, compared with 36% and 25% of patients treated with LTG and LEV, respectively. Mean patient body weight was unchanged in LTG-treated patients, decreased by 7% in TPM-treated patients, and increased by 6% and 4% in ZNS- and LEV-treated patients, respectively. Adverse effect reports were similar before and after new AED initiation. Additional data will be presented. Evaluation of patients receiving newer AEDs demonstrates that LTG and LEV may be less effective in this group of JME patients as these drugs are associated with an increase in MYO and GTC seizure frequency. On the other hand, TPM and ZNS were associated with a decrease in MYO, GTC, and AB seizure frequency, and often allowed for discontinuation of concurrent VPA use. (Supported by Eisai Inc.)