Abstracts

RATIONALE: Advances in medication release systems have improved ease of medication administration, decreased side-effects and improved compliance with medication regimens. Since it has been available, an extended-release preparation of sodium divalproex (VPA ER) has been replacing delayed release sodium divalproex (VPA DR) in this office for the treatment of epilepsy. There are limited data on the use of this preparation in children with epilepsy.
At the end of this activity participants should be aware of the potential for improved compliance and tolerability with VPA ER for children with epilepsy.
METHODS: The charts of all children with primary-generalized epilepsies were reviewed to ascertain if the patient had received VPA ER for epilepsy treatment and the specifics of each case reviewed.
RESULTS: Nine children aged 10.2-20.1 years (mean 14.3 [plusminus] 3.4 yrs) received treatment with VPA ER. Epilepsy syndromes included Juvenile Myoclonic Epilepsy (4), Juvenile Absence Epilepsy (2), reflex epilepsies (2), and Childhood Absence Epilepsy with Generalized Tonic-Clonic seizures upon awakening (1). Prior to changing VPA preparations all children had complete seizure control except for the four with Juvenile Myoclonic Epilepsy (JME), two of whom only experienced seizures with medication noncompliance. Reasons for medication change were noncompliance (4), convenience of once-daily dosing (2), peak/trough effects of VPA DR (2) and nausea with VPA DR (1). The one child nauseated with VPA DR experienced no improvement with VPA ER, discontinued it after two weeks and continued to experience morning myoclonus. This was the only adverse event. Patients were on VPA DR for 25 [plusminus] 37 months (range 1-120 mo) and remained on VPA ER for 11.1 [plusminus] 5.5 months (range 0.5-17 mo). One child with JME experienced resolution of morning myoclonus and of EEG generalized spike-wave discharges upon changing medication formulations. The previously noncompliant subjects experienced complete seizure control on VPA ER. All other patients continued to experience complete clinical and electrographic control of their epilepsy. Two children continued to require concurrent treatment to maintain seizure control, one with VPA DR 125 mg qAM and one with levetiracetam. Dosage substitutions ranged between equivalent (375:500) and matching (500:500) depending on dose and availability.
CONCLUSIONS: In this preliminary, retrospective study, VPA ER was effective and well-tolerated by children and adolescents for the treatment of primary generalized epilepsies. The only patient unable to tolerate it has been unable to tolerate multiple medications. All of the patients who had been seizure-free before transition to VPA ER remained so, two JME patients with compliance-related seizures became seizure-free and the one JME patient with uncontrolled morning myoclonus improved clinically and electrographically. If controlled, prospective studies confirm these results, VPA ER may improve compliance, seizure control and tolerability.
[Supported by: This study was supported by a grant from Abbott Laboratories.]; (Disclosure: Grant - Research grant to support the review of records and abstraction of clinical data from the records, Consulting - Elan, Novartis, UCB-Pharma, Honoraria - Abbott, Astra-Zeneca, Elan, Glaxo-Smith-Kline, Merck, Pfizer)