ArticleCureus2026
Comparative Predictive Performance of Serum and Dose-Normalized Valproate Levels for Seizure Control in Adults With Epilepsy.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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3 authors.
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Abstract
Background Valproate is a widely used antiepileptic drug, but its clinical response shows considerable interindividual variability. Conventional therapeutic ranges may not reliably predict seizure control, and the role of dose-normalized valproate levels in forecasting seizure as an outcome remains unclear. Objective To evaluate the predictive performance of serum valproate levels for seizure control and compare it with dose-normalized valproate levels, and also to assess whether multivariable models incorporating demographic factors improve the prediction of seizures in adult patients with epilepsy. Methods This study was a secondary analysis of prospectively collected data from adult patients with epilepsy receiving valproate monotherapy at a tertiary care centre. Demographic and clinical data were recorded, and patients were followed for one month to assess seizure occurrence. Serum valproate levels and dose-normalized levels were analysed at the end of the follow-up period. Logistic regression models were constructed, and predictive performance was assessed using ROC analysis. Results A total of 137 patients were included, of whom 30 (21.9%) experienced seizures during follow-up. Serum valproate levels demonstrated good predictive performance for seizure control (AUC: 0.891, 95% CI: 0.814-0.969), with an optimal cutoff of 56.1 µg/mL (sensitivity 86.7%, specificity 86.9%). Dose-normalized levels showed lower predictive performance (AUC: 0.829, 95% CI: 0.734-0.923). Logistic regression analysis confirmed serum valproate level as a significant predictor of seizure control, while dose-normalized levels showed weaker associations. Model-based predictions demonstrated comparable performance but did not significantly outperform serum levels. Conclusion Serum valproate levels provide a clinically meaningful prediction of seizure control and outperform dose-normalized metrics. These findings may support the use of concentration-based monitoring to guide individualized therapy in epilepsy.
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