Low-dose sodium valproate in the treatment of idiopathic generalized epilepsies.

Miro J, Aiguabella M, Veciana M, Juvany R, Santurino M, Leiva E,Salas-Puig J, Falip M. Low-dose sodium valproate in the treatment ofidiopathic generalized epilepsies.Acta Neurol Scand: DOI: 10.1111/ane.12216.© 2013 John Wiley & Sons A/S. Published by John Wiley & SonsLtd.Objective – Most patients with idiopathic generalized epilepsies (IGEs)have good seizure control when on antiepileptic drugs. To analyzeprospectively the response to low-dose sodium valproate (VPA)treatment (<1000 mg/day) together with plasma VPA levels in acohort of patients with IGE. Methods – Patients with IGE wereselected and followed for almost 2 years. In patients on VPA with noseizures in the last year, VPA dose was lowered to <1000 mg/day.Newly diagnosed patients with IGE started treatment on VPA directlyon this low dose. Results – Fifty-four patients were included, withjuvenile myoclonic epilepsy (JME) in 23 (42.6%), juvenile absenceepilepsy (JAE) in 17 (31.5%), and generalized tonic-clonic seizuresonly (GTCS only) in 14 (25.9%). VPA at low dose was administeredto 38 (70%) patients. Mean plasma VPA level was 44.21 mg/l (18–78;SD 15.18). Seizure relapse during the 2-year follow-up was observedin 8 (21%). A reduction in adverse events was observed (P < 0.048).The only factor related to efficacy of VPA at low dose was syndromicdiagnosis. Low-dose VPA controlled 92.9% (13) of patients withGTCS only, 78.3% (18) of those with JME, and 29.5% (5) of thosewith JAE. Conclusions – Low-dose VPA was a highly effectivetreatment for the majority of those with JME and GTCS only. Theseizures in JAE tended to be more resistant to treatment, usuallyrequiring higher doses of VPA or polytherapy.