BACKGROUND Idiopathic Generalized Epilepsy (IGE) management has become increasingly challenging due to the restricted use of Valproate (VPA) in females. The aim of the study was to assess possible differences in terms of seizure outcome between men and women suffering from IGE. METHODS A cohort of IGE patients (age range: 13-50 years) followed from 1980 to 2018 were included. Their medical history was retrospectively reviewed to investigate possible factors influencing seizure outcome. Seizure Remission (SR) was defined as the absence of any seizure type over 18 months prior to the last medical observation. The primary outcome was to evaluate sex differences in terms of SR at last observation. A multivariable logistic regression model was elaborated using SR as dependent variable. RESULTS Three-hundred and sixty patients were included, 204 (56.7%) of whom were women. The median age at the end of follow-up was 30. At last medical observation, fewer women were receiving VPA compared with men (females 39.7% vs males 79.5%, p < .001). Overall SR was 70.6%. SR was significantly different according to sex (females 62.3% vs males 81.4%, p < .001). Multivariable logistic regression model showed that female sex (Odds Ratios [OR] = 0.52, 95% Confidence Interval [CI] = 0.29-0.94; p = .03), VPA treatment at last observation (OR = 0.44, 95% CI = 0.25-0.76; p = .003) and epilepsy syndrome (p < .001) were the factors independently associated with SR. CONCLUSIONS Recent modifications in VPA prescribing patterns may have determined a worse seizure control among IGE female patients. Comparative clinical trials assessing the best therapeutic options for women with childbearing potential are urgently needed.

中文翻译：

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特发性全身性癫痫患者的丙戊酸盐作用和性别依赖性癫痫发作缓解

背景 由于丙戊酸 (VPA) 在女性中的使用受限，特发性全身性癫痫 (IGE) 的管理变得越来越具有挑战性。该研究的目的是评估患有 IGE 的男性和女性在癫痫发作结果方面可能存在的差异。方法 纳入了 1980 年至 2018 年随访的一组 IGE 患者（年龄范围：13-50 岁）。回顾性审查他们的病史以调查影响癫痫发作结果的可能因素。癫痫发作缓解 (SR) 定义为在最后一次医学观察前 18 个月内没有任何癫痫发作类型。主要结果是评估最后一次观察时 SR 方面的性别差异。使用SR作为因变量详细阐述了多变量逻辑回归模型。结果 共纳入 360 名患者，204 名 (56. 7%），其中女性。随访结束时的中位年龄为 30 岁。在最后一次医学观察时，接受 VPA 的女性比男性少（女性 39.7% 对男性 79.5%，p < .001）。总体SR为70.6%。SR 因性别而异（女性 62.3% 与男性 81.4%，p < .001）。多变量逻辑回归模型显示女性（优势比 [OR] = 0.52，95% 置信区间 [CI] = 0.29-0.94；p = .03），最后一次观察时 VPA 治疗（OR = 0.44，95% CI = 0.25 -0.76；p = .003) 和癫痫综合征 (p < .001) 是与 SR 独立相关的因素。结论 最近 VPA 处方模式的修改可能决定了 IGE 女性患者的癫痫控制更差。