Avaliação da dose mínima de Valproato de sódio com eficácia no controle de crises epilépticas nas epilepsias generalizadas genéticas
Data
2023-03-14
Autores
Marques, Vanessa Dinis 
Orientadores
Guaranha, Mirian Salvadori Bittar
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: O objetivo deste trabalho é definir a menor dose eficaz de valproato de sódio (VPA) na qual os pacientes com epilepsias generalizadas genéticas (EGGs) tenham controle das crises. Métodos: Este é um estudo de coorte, retrospectivo e observacional, que incluiu pacientes com o diagnóstico clínico e eletroencefalográfico de EGGs baseado nos critérios da International League Against Epilepsy (ILAE) (Hirsch et al., 2022), acompanhados no Ambulatório de Epilepsia da Universidade Federal de São Paulo. Foram incluídos pacientes com EGGs e no mínimo dois anos de acompanhamento, em uso de VPA em mono ou politerapia. Analisaram-se os dados clínicos relacionados à epilepsia, dose do VPA, além dos fármacos anticrise (FACs) usados em associação. Foram observados ainda os efeitos adversos e o emprego durante a gestação. O controle de crises foi classificado de acordo com Prasad et al. Foram feitas análises estatísticas uni e multivariadas. Resultados: O cutoff a distinguir os grupos bom e mau controle foi aquele de pacientes em uso de doses de até 1000 mg/dia (Fisher; p=0,006). Avaliando os pacientes em politerapia, nenhum cutoff foi capaz de separar os grupos (Fisher, p≥0,05). Quando realizada a análise multivariada, as variáveis politerapia e dose de VPA foram significativas (p < 0,001). Pacientes que fazem uso de politerapia em doses >1800mg/dia tiveram pior desfecho. Para pacientes em monoterapia, doses < 700mg/dia tiveram maior probabilidade de bom controle de crises. Conclusões: A menor dose que separa adequadamente pacientes em bom e mau controle de crises é a de até 700mg/dia, a qual deve ser empregada em trabalhos que avaliem diferença de efeitos entre as faixas terapêuticas do VPA.
Objective: The aim of this study is to define the lowest effective dose of sodium valproate (VPA) at which patients with genetic generalized epilepsies (GGEs) have seizure control. Methods: This is a cohort, retrospective, observational study that included patients with a clinical and electroencephalographic diagnosis of GGE based on the ILAE criteria (Hirsch et al., 2022), and followed at the Epilepsy Ambulatory of the Universidade Federal de São Paulo for at least two years using VPA in mono or polytherapy. Clinical data, VPA dose, and other associated antiseizure medications were analyzed. Adverse effects and use during pregnancy were also observed. The classification of seizure control was according to Prasad et al. (2003). We performed univariate and multivariate statistical analyses. Results: The cutoff to distinguish most patients with good seizure control was doses up to 1000 mg/day (Fisher; p=0.006). For patients on polytherapy, no cutoff was able to separate the groups (Fisher, p≥0.05). In the multivariate analysis, polytherapy and VPA doses were significant (p < 0.001). The outcome was worse for those in polytherapy at doses > 1800mg/day. For patients on monotherapy, those in doses < 700mg/day were more likely to have good seizure control. Conclusions: The lowest VPA dose in monotherapy able to control seizures for the majority of GGE patients was up to 700 mg/day, a value that can be used as a low dose criteria in studies assessing the therapeutic ranges of VPA.
Objective: The aim of this study is to define the lowest effective dose of sodium valproate (VPA) at which patients with genetic generalized epilepsies (GGEs) have seizure control. Methods: This is a cohort, retrospective, observational study that included patients with a clinical and electroencephalographic diagnosis of GGE based on the ILAE criteria (Hirsch et al., 2022), and followed at the Epilepsy Ambulatory of the Universidade Federal de São Paulo for at least two years using VPA in mono or polytherapy. Clinical data, VPA dose, and other associated antiseizure medications were analyzed. Adverse effects and use during pregnancy were also observed. The classification of seizure control was according to Prasad et al. (2003). We performed univariate and multivariate statistical analyses. Results: The cutoff to distinguish most patients with good seizure control was doses up to 1000 mg/day (Fisher; p=0.006). For patients on polytherapy, no cutoff was able to separate the groups (Fisher, p≥0.05). In the multivariate analysis, polytherapy and VPA doses were significant (p < 0.001). The outcome was worse for those in polytherapy at doses > 1800mg/day. For patients on monotherapy, those in doses < 700mg/day were more likely to have good seizure control. Conclusions: The lowest VPA dose in monotherapy able to control seizures for the majority of GGE patients was up to 700 mg/day, a value that can be used as a low dose criteria in studies assessing the therapeutic ranges of VPA.