What is A female patient of childbearing age is on valproate for JME. Which drug should be used to replace valproate and can be prescribed as monotherapy? and explain in detail?
Ans. a. Levetiracetam (Ref: Harrison 19/e p2544, 18/e p3265, 3253; Current Management in Child Neurology 4/e p127, 163)Levetiracetam can be prescribed as monotherapy in a female patient of childbearing age is on valproate for JME, because of no known significant drug interactions.Drug of choice for the treatment of JME is sodium valproate.Valproate should be avoided in women of childbearing age, because of significantly increased risk of fetal malformations and neurodevelopmental delay.Levetiracetam or lamotrigine are alternative first-line options if valproate is contraindicated.Treatment of Juvenile Myoclonic Epilepsy:Valproate is often used to treat juvenile myoclonic epilepsy.Other epilepsy drugs are effective in juvenile myoclonic epilepsy:LevetiracetamTopiramateLamotrigineAntiepiieptic Drugs in the treatment sequence of Juvenile Myoclonic Epilepsy (JME)First choiceValproateQ, LamotrigineQSecond choiceLevetiracetamQ, ClonazepamConsiderTopiramate, Zonisamide, Phenobarital PrimidoneJuvenile Myoclonic EpilepsyJuvenile myoclonic epilepsy (JME) is a generalized seizure disorder of unknown cause that appears in early adolescenceCharacterized by bilateral myoclonic jerks that maybe single or repetitive.Myoclonic seizures are most frequent in the morning after awakening and can be provoked by sleep deprivationQ.Consciousness is preserved unless the myoclonus is especially severe.Many patients also experience generalized tonic-clonic seizures, and up to one-third have absence seizures.Although complete remission is relatively uncommon, the seizures respond well to appropriate anticonvulsant medication.There is often a family history of epilepsy, and genetic linkage studies suggest a polygenic cause.Treatment:Valproate is often used to treat juvenile myoclonic epilepsy.Other epilepsy drugs are effective in juvenile myoclonic epilepsy:LevetiracetamQTopiramateQLamotrigineQFor most people with JME, treatment is long-term, and often lifelongQ.However, treatment is effective, allowing most people with juvenile myoclonic epilepsy to go five years or more between seizures.