{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:49:33Z","timestamp":1787014173157,"version":"build-2736575974"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T00:00:00Z","timestamp":1737936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T00:00:00Z","timestamp":1737936000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed the prescription behaviors and seizure outcomes in WOCP (16\u201350\u2009years of age) with epilepsy, referred to eight Italian epilepsy centers, who were taking VPA for at least 1\u2009year between 2014 and 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u20136.38), whereas generalized epilepsy was most associated with its non\u2010withdrawal (reduction\/switch\/maintenance) (OR .31, 95% CI .14\u2013.68). 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\u2013clonic seizure worsening (OR 2.91, 95% CI 1.09\u20137.77) compared to non\u2010withdrawal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/epi.18281","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T10:40:01Z","timestamp":1737974401000},"page":"1529-1539","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Valproate discontinuation in girls and women of childbearing age with epilepsy: An Italian multicenter retrospective study on prescribing patterns and outcomes"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5972-2102","authenticated-orcid":false,"given":"Roberta","family":"Esposto","sequence":"first","affiliation":[{"name":"IRCCS Institute of Neurological Sciences of Bologna, Full Member of the European Reference Network EpiCARE  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0745-5246","authenticated-orcid":false,"given":"Giovanni","family":"Falcicchio","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, Neurosciences and Sense Organs University of Bari  Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Zambrelli","sequence":"additional","affiliation":[{"name":"Epilepsy Center, Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit ASST Santi Paolo e Carlo, San Paolo Hospital  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3906-555X","authenticated-orcid":false,"given":"Emanuele","family":"Cerulli Irelli","sequence":"additional","affiliation":[{"name":"Department of Human Neurosciences Sapienza University  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Monti","sequence":"additional","affiliation":[{"name":"Neurology Unit Ospedale Ramazzini di Carpi, AUSL di Modena  Carpi Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Ranzato","sequence":"additional","affiliation":[{"name":"Epilepsy Center Neurology Unit  Vicenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2512-6972","authenticated-orcid":false,"given":"Loretta","family":"Giuliano","sequence":"additional","affiliation":[{"name":"Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, Section of Neurosciences University of Catania  Catania Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"La Neve","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, Neurosciences and Sense Organs University of Bari  Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo Adrea","family":"Galimberti","sequence":"additional","affiliation":[{"name":"Epilepsy Center Mondino Foundation, IRCCS  Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura Maria Beatrice","family":"Belotti","sequence":"additional","affiliation":[{"name":"Epidemiology and Statistics Unit, IRCCS Istituto Delle Scienze Neurologiche Di Bologna  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7268-4681","authenticated-orcid":false,"given":"Katherine","family":"Turner","sequence":"additional","affiliation":[{"name":"Epilepsy Center, Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit ASST Santi Paolo e Carlo, San Paolo Hospital  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Catania","sequence":"additional","affiliation":[{"name":"Department of Human Neurosciences Sapienza University  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Polo","sequence":"additional","affiliation":[{"name":"Epilepsy Center Neurology Unit  Vicenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Todaro","sequence":"additional","affiliation":[{"name":"Department of Medical, Surgical Sciences and Advanced Technologies G.F. 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