Data_Sheet_1_Shifting Valproic Acid to Levetiracetam in Women of Childbearing Age With Epilepsy: A Retrospective Investigation and Review of the Literature.xlsx

Objective: Valproic acid is the most high-risk teratogenic antiepileptic drug, and it may lead to fetal major congenital malformations. However, it is still used in women of childbearing age with epilepsy. The aim of this study was to report our experience of discontinuing or lowering valproic acid by adding levetiracetam, a low-risk teratogenic antiepileptic drug.
Methods: We reviewed the medical records of childbearing age female patients with epilepsy who were treated with valproic acid initially and then switched to levetiracetam. The clinical profiles were recorded. The primary outcome was successful switching, which was defined as a decrease in the daily valproic acid dosage, after levetiracetam had been added.
Results: Twenty-four female patients were enrolled (median age 22 years). The successful switching rate was 83.3% (20/24), and 55% (11/20) discontinued valproic acid after levetiracetam had been added. There were no significant differences between the successful and unsuccessful groups in etiology, electroencephalogram, and magnetic resonance imaging findings. Pharmacoresistant to levetiracetam was much higher in the unsuccessful group (45 vs. 100%). The median switching duration was 19.5 months in the successful group. There were improvements in metrorrhagia and alopecia in all of the patients in the successful group after valproic acid had been tapered.
Conclusions: Our experience supports switching valproic acid to levetiracetam in childbearing age women with epilepsy as an effective strategy to lower the teratogenic rate and adverse effects. A long switching period was noted in this study. We suggest starting early in childbearing age women with epilepsy.

Objective: 丙戊酸（valproic acid）是致畸风险最高的抗癫痫药物（antiepileptic drug），可导致胎儿严重先天性畸形，但目前仍被应用于育龄期癫痫女性患者。本研究旨在汇报我们通过加用左乙拉西坦（levetiracetam）——一种低致畸风险的抗癫痫药物——来停用或减量丙戊酸的临床经验。
Methods: 我们回顾了初始接受丙戊酸治疗、后续换用左乙拉西坦的育龄期癫痫女性患者的病历资料，并记录其临床特征。本研究的主要结局指标为成功换药，定义为加用左乙拉西坦后丙戊酸日剂量降低。
Results: 本研究共纳入24例女性患者，中位年龄为22岁。总体换药成功率为83.3%（20/24），其中55%（11/20）的患者在加用左乙拉西坦后完全停用丙戊酸。成功换药组与换药失败组在病因、脑电图（electroencephalogram）及磁共振成像（magnetic resonance imaging）结果上均无显著差异。换药失败组对左乙拉西坦的药物耐药率显著高于成功换药组（45% vs. 100%）。成功换药组的中位换药周期为19.5个月。在丙戊酸减量后，成功换药组的所有患者均出现了子宫不规则出血与脱发症状的改善。
Conclusions: 本研究经验支持对育龄期癫痫女性患者将丙戊酸换为左乙拉西坦，该方案可有效降低致畸风险与不良反应发生率。本研究发现换药周期普遍较长，因此我们建议对育龄期癫痫女性尽早启动该换药策略。