Discontinuing valproate may reverse PCOS in some women.(Gynecology)

BRECKENRIDGE, COLO. -- Hormonal evidence of polycystic ovary syndrome in patients on valproate is often reversed by a switch to one of the newer antiepileptic drugs, Jacci Bainbridge, Pharm.D., reported at a conference on epilepsy syndromes sponsored by the University of Texas at San Antonio.

Women with epilepsy are known to have an increased frequency of polycystic ovary syndrome (PCOS), a common complication of valproate therapy. Evidence that the associated adverse neuroendocrine changes are reversible with a change in seizure medication comes from a recent study by investigators at the University of Birmingham (England), said Dr. Bainbridge of the University of Colorado, Denver.

At the annual meeting of the American Epilepsy Society, the British investigators reported on 16 women with generalized epilepsy who had been taking valproate for longer than 2 years. They ranged in age from 16 to 27 years, and nine had been diagnosed with juvenile myoclonic epilepsy. All patients had the elevated testosterone and/or FSH levels that help define PCOS.

Patients were initially switched from valproate to lamotrigine (Lamictal). If their seizures worsened on the new medication, they were switched again, this time to levetiracetam (Keppra). Eleven women finished the study on lamotrigine. All five patients who were switched to levetiracetam became seizure free. Of the 16 patients, 15 lost hormonal evidence of PCOS during the switch from valproate.

Conference director Jose F. Cavazos, M.D., said that rather than doing routine hormone measurements in his valproate-treated patients in an effort to identify those with hyperandrogenism, he relies upon sudden weight gain as an early clinical tip-off to the presence of PCOS. Weight gain in this setting is often due to the insulin resistance that is one of the first manifestations of PCOS.

There are some data to suggest that there is a dose-dependent ...