High-dose versus low-dose valproate for the treatment of juvenile myoclonic epilepsy: Going from low to high

Juvenile myoclonic epilepsy (JME) is a genetic generalized epilepsy accounting for 3-12% of adult cases of epilepsy. Valproate has proven to be the first-choice drug in JME for controlling the most common seizure types: myoclonic, absence, and generalized tonic-clonic (GTC). In this retrospective study, we analyzed seizure outcome in patients with JME using valproate monotherapy for a minimum period of one year. Low valproate dose was considered to be 1000 mg/day or lower, while serum levels were considered to be low if they were at or below 50 mcg/dl. One hundred three patients met the inclusion criteria. Fifty-six patients (54.4%) were female. The current average age was 28.4 ± 7.4 years, while the age of epilepsy onset was 13.6 ± 2.9 years. Most patients corresponded to the subsyndrome of classic JME. Forty-six (44.7%) patients were free from all seizure types, and 76 (73.7%) patients were free from GTC seizures. No significant difference was found in seizure freedom among patients using a low dose of valproate versus a high dose (p = 0.535) or among patients with low blood levels versus high blood levels (p = 0.69). In patients with JME, it seems appropriate to use low doses of valproate (500 mg to 1000 mg) for initial treatment and then to determine if freedom from seizures was attained.