Monotherapy with valproic acid for newly diagnosed epilepsy in adults
DOI: 10.32364/2587-6821-2020-4-9-552-559
A.B. Kozhokaru1,3, A.S. Orlova2, V.I. Shmyrev3, E.S. Akarachkova4, D.I. Lebedeva5
1Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russian Federation
2Sechenov University, Moscow, Russian Federation
3Central State Medical Academy of the Administrative Department of the President of the Russian Federation, Moscow, Russian Federation
4International Society of Stress «Stress Under Control», Moscow, Russian Federation
5Tumen State Medical University, Tumen, Russian Federation
Background: valproic acid (VA) is a classic, well-proven medication for the epilepsy treatment, but there have not been enough studies to evaluate its effecacy and tolerability in correlation with the epileptiform activity index (EAI) during initial monotherapy.
Aim: to evaluate the efficacy and tolerability of monotherapy with VA medications in patients with newly diagnosed epilepsy.
Patients and Methods: 63 patients (including 37 (58.7%) men) with focal epilepsy (FE; 24 (38.1%)) and idiopathic (genetic) generalized epilepsy (IGE; 39) over the age of 18 years (average age — 31.49±12.29 years) were included in the single-arm study (61.9%)). All patients at each visit (initially, after 1, 3, 6 and 12 months of therapy) had EEG-video monitoring with an evaluation of EAI (total; before sleep; during sleep; during fragmented awakenings; after sleep). Therapy efficacy was evaluated considering the frequency of seizures: no seizures (medically induced remission); reduced frequency by more than 50% (responders) / less than 50% (lack of effect); therapy retention; increased frequency of seizures relative to the basic level; emergence of a new seizure type (aggravation). Total duration of the study was 12 months.
Results: total EAI i n patients with IGE before treatment was 2.7 times higher than in patients with FE (37.41 and 13.69, respectively). 1 month after the treatment initiation, it decreased to 4.08 and 2.56 in IGE and FE, respectively (p<0.001), and continued to decrease during the entire follow-up period. Monotherapy retention was achieved in 51 (81%) patients, including 15 (62.5%) with FE and 36 (92.3%) with IGE. Intolerable adverse events developed in only 6 (9.8%) patients.
Conclusion: VA is an effective medicine for the initial treatment of FE and IGE in monotherapy.
Keywords: idiopathic epilepsy, genetic generalized epilepsy, focal epilepsy, epileptiform activity index, valproic acid, monotherapy, adverse events.
For citation: Kozhokaru A.B., Orlova A.S., Shmyrev V.I. et al. Monotherapy with valproic acid for newly diagnosed epilepsy in adults. Russian Medical Inquiry. 2020;4(9):552–559. DOI: 10.32364/2587-6821-2020-4-9-552-559.
About the authors:
Angela B. Kozhokaru — Can. of Sci. (Med.), Head of the Laboratory of Clinical Neurophysiology, Burnasyan Federal Medical Biophysical Center of Federal Medical Biological
Agency: 46, Zhivopisnaya str., Moscow 123182, Russian Federation; Associate Professor of the Department of Neuro-logy, Central State Medical Academy of the Administrative Department of the President of the Russian Federation: 1A build., 19, Marshala Timoshenko str., Moscow, 121359, Russian Federation; ORCID iD 0000-0001-9306-1686.
Alexandra S. Orlova — Can. of Sci. (Med.), Associate Professor of the Department of Human Pathology at the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University): 2 build. 8, Trubetskaya str., Moscow, 119991, Russian Federation; ORCID iD 0000-0001-9725-7491.
Vladimir I. Shmyrev — Dr. of Sci. (Med.), Professor, Head of the Department of Neurology, Central State Medical Academy of the Administrative Department of the President of the Russian Federation: 1A build., 19, Marshala Timoshenko str., Moscow, 121359, Russian Federation; ORCID iD 0000-0002-6802-2789.
Elena S. Akarachkova — Dr. of Sci. (Med.), Professor, Chairman, International Society “Stress Under Control”: 40, Musy Jalilya str., Moscow, 115573, Russian Federation; ORCID iD 0000-0002-7629-3773.
Jinna I. Lebedeva — Associate Professor of the Department of Preventive & Rehabilitation Medicine at the Institute of Continuing Professional Education, Tumen State Medical University: 54, Odesskaya str., Tumen, 625023, Russian Federation; ORCID iD 0000-0003-2478-9619.
Contact information: Angela B. Kozhokaru, e-mail: angela.neural@gmail.com. Financial Disclosure: no authors have a financial or property interest in any material or method mentioned. There is no conflict of interests. Received 10.07.2020, revised 24.07.2020, accepted 07.08.2020.
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