A recent comparative effectiveness study published in JAMA Neurology sheds light on the management of idiopathic generalised epilepsy (IGE) in young women of childbearing age. This study suggests that levetiracetam may be a more effective initial monotherapy option for female patients with Juvenile Myoclonic Epilepsy (JME).
With recent restrictions on prescribing valproate due to its potential for harm during pregnancy, alternative antiseizure medications (ASMs) have become crucial. This study, conducted by Irelli E C and colleagues across multiple centers and countries, aimed to compare the effectiveness and safety of levetiracetam and lamotrigine as initial monotherapy in this specific patient group.

Study Design: This was a multicenter, retrospective study that analyzed data from female patients with IGE who initiated either levetiracetam or lamotrigine as their initial monotherapy between 1994 and 2022. The study included 543 patients from 22 epilepsy centers.
Effectiveness Comparison: The study found that levetiracetam was associated with a reduced risk of treatment failure compared to lamotrigine when considering all baseline variables (IPTW-adjusted hazard ratio [HR], 0.77; 95% CI, 0.59-0.99; P = .04).
Syndrome-Specific Effectiveness: The study also stratified the results based on different IGE syndromes. Levetiracetam showed higher effectiveness in patients with juvenile myoclonic epilepsy (JME; IPTW-adjusted HR, 0.47; 95% CI, 0.32-0.68; P < .001) but no significant differences in other syndromes.
Adverse Effects: Patients treated with levetiracetam experienced adverse effects more frequently (28.2%) compared to those treated with lamotrigine (18.1%). However, the two ASMs had similar retention rates during follow-up (IPTW-adjusted HR, 0.91; 95% CI, 0.65-1.23; P = .60).
However, further research is needed to identify the most effective ASM alternatives for other IGE syndromes. This research contributes to the ongoing efforts to provide safer and more effective treatment options for women of childbearing age with epilepsy. These findings highlight the importance of personalised treatment decisions in epilepsy management, considering both effectiveness and potential side effects, especially for young women who may become pregnant during their treatment course.
Reference:
Cerulli Irelli, E., Cocchi, E., Morano, A., Gesche, J., Caraballo, R. H., Lattanzi, S., Strigaro, G., Catania, C., Ferlazzo, E., Pascarella, A., Casciato, S., Quarato, P., Pizzanelli, C., Pulitano, P., Giuliano, L., Viola, V., Mostacci, B., Fortunato, F., Marini, C., … Women With Epilepsy Treatment Options and Research (WETOR) Study Group. Levetiracetam vs lamotrigine as first-line antiseizure medication in female patients with idiopathic generalised epilepsy. JAMA Neurology,2023. https://doi.org/10.1001/jamaneurol.2023.3400