BACKGROUND Valproic acid (VPA) is the most effective medication in juvenile myoclonic epilepsy (JME) but, due to its teratogenic potential, levetiracetam (LEV) and lamotrigine (LTG) are preferred in women of childbearing age. The aim of this study was to compare the effectiveness and tolerability of LEV and LTG monotherapy in patients with a previous good seizure control in VPA monotherapy, in which VPA was withdrawn because of teratogenic potential or adverse drug effects. METHODS We retrospectively analyzed 65 patients with JME which had been followedup at the Epilepsy Center of Pisa University Hospital, identifying 28 subjects who had been successfully treated with VPA monotherapy and who were shifted to another monotherapy. The second monotherapy was LEV for 14 subjects and LTG for the remaining 14 ones. Drug efficacy was measured in terms of seizure freedom for more than twelve months after reaching the minimum effective or the highest tolerated dose. RESULTS In terms of seizure control, our analysis showed a significantly better outcome for LEV compared to LTG (14.3% and 71.4% of seizure relapse, respectively, p = 0.006) monotherapy. Such a higher efficacy was confirmed in those subjects with seizure relapse on LTG, who achieved good seizure control after switching to LEV monotherapy (89% of cases). Concerning tolerability, none of the patients reported severe side effects. CONCLUSION Although obtained in a small case series, our analysis showed a significant better efficacy of LEV compared to LTG in monotherapy, in patients with JME with a good response to VPA, concerning both myoclonic and generalized tonic-clonic seizures.

中文翻译：

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先前接受丙戊酸治疗的青少年肌阵挛性癫痫患者对左乙拉西坦或拉莫三嗪的反应：一项单中心回顾性研究

背景 丙戊酸 (VPA) 是治疗青少年肌阵挛性癫痫 (JME) 最有效的药物，但由于其潜在的致畸性，左乙拉西坦 (LEV) 和拉莫三嗪 (LTG) 更适合育龄妇女。本研究的目的是比较 LEV 和 LTG 单药治疗对先前在 VPA 单药治疗中癫痫控制良好的患者的有效性和耐受性，其中 VPA 因潜在致畸性或药物不良反应而停用。方法 我们回顾性分析了在比萨大学医院癫痫中心随访的 65 名 JME 患者，确定了 28 名已成功接受 VPA 单药治疗并转为另一种单药治疗的受试者。第二种单一疗法是 14 名受试者的 LEV 和其余 14 名受试者的 LTG。在达到最低有效剂量或最高耐受剂量后超过 12 个月的无癫痫发作来衡量药物疗效。结果 在癫痫控制方面，我们的分析显示，与 LTG（癫痫复发率分别为 14.3% 和 71.4%，p = 0.006）单药治疗相比，LEV 的结果明显更好。在 LTG 治疗后癫痫复发的受试者中证实了这种更高的疗效，这些受试者在转为 LEV 单药治疗后获得了良好的癫痫控制（89% 的病例）。关于耐受性，没有患者报告严重的副作用。结论 尽管是在一个小病例系列中获得的，但我们的分析显示，在对 VPA 有良好反应的 JME 患者中，LEV 与 LTG 相比在单药治疗中具有显着更好的疗效，包括肌阵挛和全身强直阵挛发作。