Valproate and female patients: Prescribing attitudes of Italian epileptologists

Loretta Giuliano, Angela La Neve, Carlo Andrea Galimberti, Umberto Aguglia, Leonilda Bilo, Caterina Ermio, Giulia Monti, Elena Zambrelli, Corrado Zenesini, Barbara Mostacci

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: After the European Medicines Agency (EMA) warning on the use of valproate (VPA) in female patients, we explored the antiepileptic drug (AED) prescribing attitudes of Italian epileptologists with regard to sex and VPA use in patients with epilepsy.

MATERIAL AND METHODS: A specifically designed 30-item questionnaire was distributed at the annual multicenter meeting of the Italian League Against Epilepsy (LICE), held in Rome on January 2018. One hundred and sixty-nine physicians answered the questionnaire.

RESULTS: In females, VPA was significantly less prescribed as first-choice AED in childhood absence epilepsy (22% females vs 64% males, p < 0.001), Dravet syndrome (54% vs 71%, p = 0.01), juvenile myoclonic epilepsy (JME) (2% vs 74%, p < 0.001), and undetermined epilepsy (0% vs 32%, p < 0.001). Ninety-six percent of the respondents inform teenage girls of the detrimental effects of intrauterine exposure to VPA; 74% recommend contraceptive measures when prescribing VPA. All the respondents stated that they were aware of the recommendations on VPA in female patients, and 64% claimed to have had difficulties in implementing them.

CONCLUSIONS: The main challenges were represented by women with JME, who were seizure-free on VPA and failed to respond to levetiracetam and lamotrigine, and by little girls for whom VPA was considered the best choice. According to many Italian epileptologists, the decision to withdraw VPA should be shared with the patient.

Original languageEnglish
Pages (from-to)182-186
Number of pages5
JournalEpilepsy and Behavior
Volume97
DOIs
Publication statusPublished - Jun 25 2019

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Valproic Acid
Juvenile Myoclonic Epilepsy
Epilepsy
etiracetam
Anticonvulsants
Myoclonic Epilepsy
Drug Prescriptions
Absence Epilepsy
Contraceptive Agents
Seizures
Physicians
Surveys and Questionnaires

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Valproate and female patients : Prescribing attitudes of Italian epileptologists. / Giuliano, Loretta; La Neve, Angela; Galimberti, Carlo Andrea; Aguglia, Umberto; Bilo, Leonilda; Ermio, Caterina; Monti, Giulia; Zambrelli, Elena; Zenesini, Corrado; Mostacci, Barbara.

In: Epilepsy and Behavior, Vol. 97, 25.06.2019, p. 182-186.

Research output: Contribution to journalArticle

Giuliano, Loretta ; La Neve, Angela ; Galimberti, Carlo Andrea ; Aguglia, Umberto ; Bilo, Leonilda ; Ermio, Caterina ; Monti, Giulia ; Zambrelli, Elena ; Zenesini, Corrado ; Mostacci, Barbara. / Valproate and female patients : Prescribing attitudes of Italian epileptologists. In: Epilepsy and Behavior. 2019 ; Vol. 97. pp. 182-186.
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abstract = "INTRODUCTION: After the European Medicines Agency (EMA) warning on the use of valproate (VPA) in female patients, we explored the antiepileptic drug (AED) prescribing attitudes of Italian epileptologists with regard to sex and VPA use in patients with epilepsy.MATERIAL AND METHODS: A specifically designed 30-item questionnaire was distributed at the annual multicenter meeting of the Italian League Against Epilepsy (LICE), held in Rome on January 2018. One hundred and sixty-nine physicians answered the questionnaire.RESULTS: In females, VPA was significantly less prescribed as first-choice AED in childhood absence epilepsy (22{\%} females vs 64{\%} males, p < 0.001), Dravet syndrome (54{\%} vs 71{\%}, p = 0.01), juvenile myoclonic epilepsy (JME) (2{\%} vs 74{\%}, p < 0.001), and undetermined epilepsy (0{\%} vs 32{\%}, p < 0.001). Ninety-six percent of the respondents inform teenage girls of the detrimental effects of intrauterine exposure to VPA; 74{\%} recommend contraceptive measures when prescribing VPA. All the respondents stated that they were aware of the recommendations on VPA in female patients, and 64{\%} claimed to have had difficulties in implementing them.CONCLUSIONS: The main challenges were represented by women with JME, who were seizure-free on VPA and failed to respond to levetiracetam and lamotrigine, and by little girls for whom VPA was considered the best choice. According to many Italian epileptologists, the decision to withdraw VPA should be shared with the patient.",
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T2 - Prescribing attitudes of Italian epileptologists

AU - Giuliano, Loretta

AU - La Neve, Angela

AU - Galimberti, Carlo Andrea

AU - Aguglia, Umberto

AU - Bilo, Leonilda

AU - Ermio, Caterina

AU - Monti, Giulia

AU - Zambrelli, Elena

AU - Zenesini, Corrado

AU - Mostacci, Barbara

N1 - Copyright © 2019 Elsevier Inc. All rights reserved.

PY - 2019/6/25

Y1 - 2019/6/25

N2 - INTRODUCTION: After the European Medicines Agency (EMA) warning on the use of valproate (VPA) in female patients, we explored the antiepileptic drug (AED) prescribing attitudes of Italian epileptologists with regard to sex and VPA use in patients with epilepsy.MATERIAL AND METHODS: A specifically designed 30-item questionnaire was distributed at the annual multicenter meeting of the Italian League Against Epilepsy (LICE), held in Rome on January 2018. One hundred and sixty-nine physicians answered the questionnaire.RESULTS: In females, VPA was significantly less prescribed as first-choice AED in childhood absence epilepsy (22% females vs 64% males, p < 0.001), Dravet syndrome (54% vs 71%, p = 0.01), juvenile myoclonic epilepsy (JME) (2% vs 74%, p < 0.001), and undetermined epilepsy (0% vs 32%, p < 0.001). Ninety-six percent of the respondents inform teenage girls of the detrimental effects of intrauterine exposure to VPA; 74% recommend contraceptive measures when prescribing VPA. All the respondents stated that they were aware of the recommendations on VPA in female patients, and 64% claimed to have had difficulties in implementing them.CONCLUSIONS: The main challenges were represented by women with JME, who were seizure-free on VPA and failed to respond to levetiracetam and lamotrigine, and by little girls for whom VPA was considered the best choice. According to many Italian epileptologists, the decision to withdraw VPA should be shared with the patient.

AB - INTRODUCTION: After the European Medicines Agency (EMA) warning on the use of valproate (VPA) in female patients, we explored the antiepileptic drug (AED) prescribing attitudes of Italian epileptologists with regard to sex and VPA use in patients with epilepsy.MATERIAL AND METHODS: A specifically designed 30-item questionnaire was distributed at the annual multicenter meeting of the Italian League Against Epilepsy (LICE), held in Rome on January 2018. One hundred and sixty-nine physicians answered the questionnaire.RESULTS: In females, VPA was significantly less prescribed as first-choice AED in childhood absence epilepsy (22% females vs 64% males, p < 0.001), Dravet syndrome (54% vs 71%, p = 0.01), juvenile myoclonic epilepsy (JME) (2% vs 74%, p < 0.001), and undetermined epilepsy (0% vs 32%, p < 0.001). Ninety-six percent of the respondents inform teenage girls of the detrimental effects of intrauterine exposure to VPA; 74% recommend contraceptive measures when prescribing VPA. All the respondents stated that they were aware of the recommendations on VPA in female patients, and 64% claimed to have had difficulties in implementing them.CONCLUSIONS: The main challenges were represented by women with JME, who were seizure-free on VPA and failed to respond to levetiracetam and lamotrigine, and by little girls for whom VPA was considered the best choice. According to many Italian epileptologists, the decision to withdraw VPA should be shared with the patient.

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SN - 1525-5050

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