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Valproate discontinuation in girls and women of childbearing age with epilepsy: An Italian multicenter retrospective study on prescribing patterns and outcomes.

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Title: Valproate discontinuation in girls and women of childbearing age with epilepsy: An Italian multicenter retrospective study on prescribing patterns and outcomes.
Authors: Esposto, Roberta (AUTHOR), Falcicchio, Giovanni (AUTHOR), Zambrelli, Elena (AUTHOR), Cerulli Irelli, Emanuele (AUTHOR), Monti, Giulia (AUTHOR), Ranzato, Federica (AUTHOR), Giuliano, Loretta (AUTHOR), La Neve, Angela (AUTHOR), Galimberti, Carlo Adrea (AUTHOR), Belotti, Laura Maria Beatrice (AUTHOR), Turner, Katherine (AUTHOR), Catania, Cecilia (AUTHOR), Polo, Diana (AUTHOR), Todaro, Valeria (AUTHOR), Bisulli, Francesca (AUTHOR), Mostacci, Barbara (AUTHOR)
Source: Epilepsia (Series 4). May2025, Vol. 66 Issue 5, p1529-1539. 11p.
Subjects: Valproic acid, Epilepsy, Polypharmacy, Drug prescribing, Withdrawal (Psychology), Seizures (Medicine), Childbearing age
Abstract: Objective: This study aimed to identify prescribing behaviors in women of childbearing potential (WOCP) with epilepsy already taking valproate (VPA), and to investigate the relationship between VPA maintenance, substitution, reduction, or withdrawal as part of polytherapy, and seizure worsening or relapse. Methods: We retrospectively reviewed the prescription behaviors and seizure outcomes in WOCP (16–50 years of age) with epilepsy, referred to eight Italian epilepsy centers, who were taking VPA for at least 1 year between 2014 and 2019. Results: Among 750 women (~12% of all WOCP), 528 (70.4%) maintained VPA unchanged throughout the observation period, 103 (13.7%) replaced VPA with another antiseizure medication (ASM), 90 (12%) reduced VPA, and 29 (3.9%) discontinued VPA in polytherapy. Focal epilepsy was most strongly associated with VPA withdrawal (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.38–6.38), whereas generalized epilepsy was most associated with its non‐withdrawal (reduction/switch/maintenance) (OR.31, 95% CI.14–.68). Intellectual disability, higher seizure frequency, and higher VPA doses were linked to VPA continuation. VPA withdrawal from polytherapy was associated with a higher risk of tonic–clonic seizure worsening (OR 2.91, 95% CI 1.09–7.77) compared to non‐withdrawal. Significance: VPA was rarely withdrawn or substituted in WOCP with epilepsy, in secondary and tertiary care settings following European regulatory restrictions. This likely reflects a population with severe epilepsies where VPA is difficult to replace; whereas women with milder epilepsies likely discontinued VPA earlier, as evidenced by its low overall prescription frequency. Withdrawal of VPA from a polytherapy regimen was associated with a threefold increased risk of seizure exacerbation. [ABSTRACT FROM AUTHOR]
Copyright of Epilepsia (Series 4) is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Label: Title
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  Data: Valproate discontinuation in girls and women of childbearing age with epilepsy: An Italian multicenter retrospective study on prescribing patterns and outcomes.
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  Data: <searchLink fieldCode="AR" term="%22Esposto%2C+Roberta%22">Esposto, Roberta</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Falcicchio%2C+Giovanni%22">Falcicchio, Giovanni</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Zambrelli%2C+Elena%22">Zambrelli, Elena</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Cerulli+Irelli%2C+Emanuele%22">Cerulli Irelli, Emanuele</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Monti%2C+Giulia%22">Monti, Giulia</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Ranzato%2C+Federica%22">Ranzato, Federica</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Giuliano%2C+Loretta%22">Giuliano, Loretta</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22La+Neve%2C+Angela%22">La Neve, Angela</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Galimberti%2C+Carlo+Adrea%22">Galimberti, Carlo Adrea</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Belotti%2C+Laura+Maria+Beatrice%22">Belotti, Laura Maria Beatrice</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Turner%2C+Katherine%22">Turner, Katherine</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Catania%2C+Cecilia%22">Catania, Cecilia</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Polo%2C+Diana%22">Polo, Diana</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Todaro%2C+Valeria%22">Todaro, Valeria</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Bisulli%2C+Francesca%22">Bisulli, Francesca</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Mostacci%2C+Barbara%22">Mostacci, Barbara</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Epilepsia+%28Series+4%29%22">Epilepsia (Series 4)</searchLink>. May2025, Vol. 66 Issue 5, p1529-1539. 11p.
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  Data: <searchLink fieldCode="DE" term="%22Valproic+acid%22">Valproic acid</searchLink><br /><searchLink fieldCode="DE" term="%22Epilepsy%22">Epilepsy</searchLink><br /><searchLink fieldCode="DE" term="%22Polypharmacy%22">Polypharmacy</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+prescribing%22">Drug prescribing</searchLink><br /><searchLink fieldCode="DE" term="%22Withdrawal+%28Psychology%29%22">Withdrawal (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Seizures+%28Medicine%29%22">Seizures (Medicine)</searchLink><br /><searchLink fieldCode="DE" term="%22Childbearing+age%22">Childbearing age</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: This study aimed to identify prescribing behaviors in women of childbearing potential (WOCP) with epilepsy already taking valproate (VPA), and to investigate the relationship between VPA maintenance, substitution, reduction, or withdrawal as part of polytherapy, and seizure worsening or relapse. Methods: We retrospectively reviewed the prescription behaviors and seizure outcomes in WOCP (16–50 years of age) with epilepsy, referred to eight Italian epilepsy centers, who were taking VPA for at least 1 year between 2014 and 2019. Results: Among 750 women (~12% of all WOCP), 528 (70.4%) maintained VPA unchanged throughout the observation period, 103 (13.7%) replaced VPA with another antiseizure medication (ASM), 90 (12%) reduced VPA, and 29 (3.9%) discontinued VPA in polytherapy. Focal epilepsy was most strongly associated with VPA withdrawal (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.38–6.38), whereas generalized epilepsy was most associated with its non‐withdrawal (reduction/switch/maintenance) (OR.31, 95% CI.14–.68). Intellectual disability, higher seizure frequency, and higher VPA doses were linked to VPA continuation. VPA withdrawal from polytherapy was associated with a higher risk of tonic–clonic seizure worsening (OR 2.91, 95% CI 1.09–7.77) compared to non‐withdrawal. Significance: VPA was rarely withdrawn or substituted in WOCP with epilepsy, in secondary and tertiary care settings following European regulatory restrictions. This likely reflects a population with severe epilepsies where VPA is difficult to replace; whereas women with milder epilepsies likely discontinued VPA earlier, as evidenced by its low overall prescription frequency. Withdrawal of VPA from a polytherapy regimen was associated with a threefold increased risk of seizure exacerbation. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Epilepsia (Series 4) is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
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      – Type: doi
        Value: 10.1111/epi.18281
    Languages:
      – Code: eng
        Text: English
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      Pagination:
        PageCount: 11
        StartPage: 1529
    Subjects:
      – SubjectFull: Valproic acid
        Type: general
      – SubjectFull: Epilepsy
        Type: general
      – SubjectFull: Polypharmacy
        Type: general
      – SubjectFull: Drug prescribing
        Type: general
      – SubjectFull: Withdrawal (Psychology)
        Type: general
      – SubjectFull: Seizures (Medicine)
        Type: general
      – SubjectFull: Childbearing age
        Type: general
    Titles:
      – TitleFull: Valproate discontinuation in girls and women of childbearing age with epilepsy: An Italian multicenter retrospective study on prescribing patterns and outcomes.
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              Text: May2025
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