Alternatives to valproate in girls and women of childbearing potential with Idiopathic Generalized Epilepsies: state of the art and guidance for the clinician proposed by the Epilepsy and Gender Commission of the Italian League Against Epilepsy (LICE)

Mostacci, Barbara; Ranzato, Federica; Giuliano, Loretta; Neve, Angela La; Aguglia, Umberto; Bilo, Leonilda; Durante, Vania; Ermio, Caterina; Monti, Giulia; Zambrelli, Elena; Lodi, Monica; Galimberti, Carlo

doi:10.1016/j.seizure.2020.12.005

Cited by 18 publications

(10 citation statements)

References 107 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite the decrease in the prescription prevalence, valproic acid was still among the AEDs most commonly prescribed to women with childbearing potential, concerning 1 out of 5 AED users. Moreover, the proportion of pregnant women taking valproate is not negligible, and this is not consistent with recommendations from regulatory agencies and experts 24,26 …”

Section: Discussionmentioning

confidence: 92%

“…Moreover, the proportion of pregnant women taking valproate is not negligible, and this is not consistent with recommendations from regulatory agencies and experts. 24,26 The incidence of congenital malformations among neonates exposed to AEDs decreased in 2012-2019 vs. 2005-2011. It is not possible to evaluate if this was influenced by the change in the prescribing pattern, with a decrease in valproic acid and carbamazepine prescriptions and increase in levetiracetam and lamotrigine use, but it is likely that this switch had at least a partial impact.…”

Section: Discussionmentioning

confidence: 99%

“…On the contrary, the drugs' licensing status may be an obstacle to the prescription: for example, in Italy, levetiracetam is not authorised as monotherapy for some type of epilepsies (e.g. juvenile myoclonic epilepsy, generalized tonic–clonic seizures) and its off‐label prescription may limit the reimbursement by the Italian national health service 26 …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Changes in antiepileptic drug prescriptions over a decade in childbearing women in Lombardy region, Italy

Clavenna

Campi

Putignano

et al. 2021

Brit J Clinical Pharma

View full text Add to dashboard Cite

Aims To describe the antiepileptic drug (AED) prescription pattern in pregnant women and women of childbearing age in the 2010–2019 period in the Lombardy region, Italy. Methods The Lombardy region administrative healthcare databases (2010–2019) were analysed. AEDs were classified as drugs belonging to the N03A subgroup of the Anatomical Therapeutic Chemical Classification System. Women aged 15–49 years were considered as being of childbearing age, while exposure during pregnancy was estimated taking into account the 12 months before delivery (International Classification of Diseases, Ninth Revision, Clinical Modification, ICD‐9‐CM codes in the diagnosis record from 650 to 659). Results During 2019, 16 605 women of childbearing age (prevalence: 14.8‰) received at least 1 AED prescription. Pregabalin was the most widely used antiepileptic in women of childbearing age (22.3%), followed by valproic acid (20.0%). In 2010, the prevalence of valproic acid prescription to women of childbearing age was 30.2%; in 2019 this was 20.0%. In pregnant women, this prevalence was 24.9% in 2010 and 14.1% in 2019. Starting from 2017, levetiracetam and lamotrigine were the most commonly drugs prescribed to pregnant women. Conclusion Despite the decrease in valproic acid prescription over time, this drug is still among the most used AEDs, in particular in women of childbearing age. Educational interventions for healthcare professionals and women are needed in order to reduce the risk of unplanned pregnancy.

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Changes in antiepileptic drug prescriptions over a decade in childbearing women in Lombardy region, Italy

Clavenna

Campi

Putignano

et al. 2021

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…This aspect must be kept in mind when evaluating sex-related prognosis, since the decreased use of VPA in girls and women of childbearing potential, linked to the drug's teratogenic effects [44], might have repercussions on the disease outcome. Indeed, the choice of alternative treatments for women of childbearing potential, and in particular in those with IGE, is not a simple issue since, with the exception of lamotrigine and levetiracetam, prescription of other ASMs is limited by the lack of data both as regard to efficacy and possible teratogenic effects [45].…”

Section: Discussionmentioning

confidence: 99%

Long-term prognosis of juvenile myoclonic epilepsy: A systematic review searching for sex differences

Giuliano

Mainieri

Aguglia

et al. 2021

Seizure

Self Cite

View full text Add to dashboard Cite

“…The beneficial effect of ethosuximide acid in pure absence epilepsy may reflect the specific pathophysiological composition in cases of absences not belonging to an exclusively focal cortical or a universal excitation in the brain. The use of valproic acid, which represents the most useful broad-spectrum ASM for IGE, is restricted in women of childbearing age [90,91]. When considering new treatment approaches in IGE, there is a clear unmet need for better, well-tolerated, and effective treatments to overcome drug resistance and neuropsychiatric comorbidities of IGE with absences [92].…”

Section: Treatment Responsesmentioning

confidence: 99%

Generalized absence seizures: Where do we stand today?

Stefan

Trinka

2022

Z. Epileptol.

View full text Add to dashboard Cite

Generalized absence seizures are discussed here with respect to changing scientific concepts and newer findings, challenging the strict dichotomy of “generalized” vs. “focal” which may be counterproductive to the development of new ideas and treatments. Data from semiology, structural, and functional studies using quantitative electroencephalography (EEG), video-EEG monitoring, magnetoencephalography, magnetic resonance imaging, and positron emission tomography as well as neuropathology suggest a nosological spectrum from focal to generalized seizure-generating mechanisms. The terms “focal” and “generalized” as used to describe seizures represent abstractions and idealizations rather than ontological entities. The new terminology and classification of the ILAE (2017), despite its enormous merits, unfortunately also facilitates and fosters reductionist thinking, which may be pragmatic from a utilitarian perspective, but risks hindering scientific developments for the future. For instance, the seizure semiology of absences as a paradigmatic generalized seizure type is now classified as “non-motor seizure.” A detailed phenomenological analysis reveals that motor activity is an integral part of this seizure type. Many motor and so-called automatic absence symptoms can be understood as correlated elements of a general organization plan of the cortex. Corresponding functional and structural changes seen in imaging and high-resolution electrophysiology studies indicate focal contributions to seizure generation and a combination of focal and generalized features. Functional findings indicate that the frontal lobe with its projections to other brain areas may play an important role in generalized absence seizures. In this critical review we assess the evolution of pathophysiological concepts through the ages and present new research approaches for diagnosis and treatment.

show abstract

Alternatives to valproate in girls and women of childbearing potential with Idiopathic Generalized Epilepsies: state of the art and guidance for the clinician proposed by the Epilepsy and Gender Commission of the Italian League Against Epilepsy (LICE)

Cited by 18 publications

References 107 publications

Changes in antiepileptic drug prescriptions over a decade in childbearing women in Lombardy region, Italy

Changes in antiepileptic drug prescriptions over a decade in childbearing women in Lombardy region, Italy

Long-term prognosis of juvenile myoclonic epilepsy: A systematic review searching for sex differences

Generalized absence seizures: Where do we stand today?

Contact Info

Product

Resources

About