Trends in antiseizure medication prescription in Idiopathic generalized epilepsy over the last 10 years.

Background: Idiopathic Generalized Epilepsies (IGE) are a subset of syndromes defined by the International League against Epilepsy (ILAE) with the particularity to respond to a narrow number of ASMs and particularly to valproic acid (VPA). Recommendations have changed in the last decade. We aimed to describe changes in antiseizure medication (ASM) in adult IGE over the last 10 years.

Methods: Cross-sectional study comparing two cohorts of patients ≥ 16 years receiving ASM for IGE in a tertiary center (year 2013 and 2023). We collected clinical-demographic variables and ASM, analysing diagnosis and ASM prescription.

Results: 249 patients were included in 2013 (53.8 % women; mean age 35.6 years ±14.6 standard deviation [SD]) and 278 in 2023 (61.2 % women, mean age 38.1 years ±16.1 SD). In 2023, the most frequent IGE subtype syndrome was juvenile myoclonic epilepsy (JME) (39.6 % vs 33.3 % in 2013), followed by epilepsy with generalized tonic-clonic seizures alone (28.4 % vs 42.6 %). Valproic acid (VPA) was the most used ASM in both periods, although it was prescribed less frequently in 2023 compared to 2013 (49.3 % vs. 69.1 %; p < 0.001). Lamotrigine (LTG) was the second most used ASM in 2013 (14.1 %), followed by levetiracetam (LEV) (12.4 %). By contrast, in 2023 LEV was the second most used ASM (29.5 %), followed by LTG (21.6 %) (LEV p < 0.001; LTG p = 0.025). VPA use decreased in women under 45 years (57.9 % vs 20.3 %, p < 0.001), with a subsequent increase of LEV (19.6 % vs 45.8 %, p < 0.001). In men we observed no significant differences in the use of VPA (80.0 % vs 75.9 %, p = 0.463).

Conclusions: The use of VPA has decreased during the last decade for all IGEs and particularly in women of childbearing potential, along with an increase in the use of LEV and LTG.