The Current Role of Valproic Acid in the Treatment of Epilepsy: A Glimpse into the Present of an Old Ally

Abstract

Purpose of the review: The primary purpose of this review is to explore the specific clinical scenarios where valproic acid demonstrates superiority over other antiseizure medications. We aim to examine how the pharmacological properties, efficacy, safety, and therapeutic effects of valproic acid on associated comorbidities make its choice a precision prescription strategy in certain contexts. Recent findings: In addition to the well-known efficacy superiority of valproic acid in patients with idiopathic generalized epilepsies and epileptic and developmental encephalopathies, recent findings have shown that it has benefits in the management of patients with interictal dysphoric disorder due to its mood-stabilizing properties, and epilepsy related to primary neoplasms of the central nervous system due to its potential anticancer and radioprotective effects. Summary: A narrative review was conducted using the following databases: PubMed, EMBASE, Google Scholar and through exhaustive review of the most relevant related bibliography. Valproic acid remains an effective broad-spectrum antiseizure medication with unique advantages in specific clinical scenarios. The review aims to explore the pharmacological properties and advantages of valproic acid, along with its efficacy and safety, positioning it as a precision prescription strategy in contexts such as idiopathic generalized epilepsies, developmental and epileptic encephalopathies, epilepsy related to impulsivity and aggressiveness, and brain tumor-related epilepsy. Furthermore, valproic acid exhibits synergistic effects when combined with certain other ASMs. However, we acknowledge the risks of teratogenicity and neurocognitive adverse effects in children exposed prenatally to valproic acid, emphasizing the need to weigh the benefits of adequate seizure control against potential negative outcomes. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024.