الفهرس 
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Abstract
Epilepsy is one of the prevalent neurological diseases that affect children and adults. It is characterized by frequent seizures of abnormal neuronal discharges in the brain, and categorized into focal and generalized epilepsy according to the type of seizures.
Anti-epileptic medications are the mainstay of epilepsy treatment for people of all ages and can be prescribed as a monotherapy or add-on medication to manage seizures without adverse effects. The efficacy and safety of AEDs differ according to the extent of their seizures and adverse drug reactions occurring.
This study was performed to compare the efficacy and safety of LEV to VPA as monotherapy in epileptic patients. Additionally, this study examined the impact of LEV on cognitive functions of patients with epilepsy as opposed to VPA.
Patients were chosen from the outpatient clinic of Neurology department, Minia University Hospital and from epilepsy outpatient clinic, Minia Psychiatric Hospital and they were suffering from focal and generalized epilepsy, treatment with LEV and VPA as monotherapy, excluding patients who were diagnosed as drug resistant epilepsy, Patients presented with any neurological, psychiatric or systemic disorder associated with epilepsy and pregnant and lactating females. Patients were divided into two groups of 25 each. The first group treated with LEV in doses 1000-2000 mg/day for LEV, and the second group treated with VPA in doss 1000-1500 mg/day for LEV both as monotherapy.
Duration of the study was three months.
• Methods
Patients were subjected to full medical history , general physical and neurological examinations were performed for each patient, seizures were classified according to ILAE classification of seizures, 2017, Electroencephalography (EEG) was done for confirmation of seizure type.
The comparative efficacy of LEV and VPA therapy has been assessed by recording seizures frequency monthly and measuring the seizure outcomes before treatment and one, two and three months after treatment, while the comparative safety of LEV and VPA therapy has been assessed by recording the occurrence of adverse effects.
Assessment of cognitive functions was based on the Simple Reaction Time test, the Choice Reaction Time test, Trail making test A, B, and Wisconsin Card Sorting test. Patients were evaluated before treatment , one month and three months after treatment
• Results:
• Regarding efficacy and safety of LEV and VPA:
Throughout this study, the patients who treated with LEV reported less seizure frequency at three months after treatment, However this difference was not statistically significant. Both drugs as monotherapy showed similar seizure frequency reduction.
from these results the patients in LEV group achieved better seizure control than VPA group, the percentage of seizure freedom was 80% at three months after treatment for LEV group and 72% for VPA group. However this difference was not statistically significant.
In this study it was found that the presence of adverse events in LEV group was lower than VPA group. The most common adverse events in LEV group were somnolence, nausea, headache, and dizziness.
Regarding effects of LEV and VPA on cognitive functions:
On comparing the cognitive functions test score changes between two groups, there was deterioration in the cognitive measure scores in patients of group VPA when compared to the cognitive measure scores in patients of group LEV which showed improvements in scores, there was a significant difference in between groups three months after treatment.
from this study we concluded that both groups of patients showed reduction in seizure frequency. However, Patients on LEV group showed significant improvement in the measured cognitive functions three months after starting treatment, while patients in the VPA group showed a significant impairment in the measured cognitive functions three months after starting treatment.
Conclusions
This study was conducted to evaluate the safety and efficacy of VPA and LEV as monotherapy, and the impact of LEV on cognitive functions of patients with epilepsy compared to VPA.
It can be concluded from this study that epileptic patients who were treated by monotherapy with LEV or VPA had good outcome. Safety of LEV is greater than VPA in terms of less adverse drug reactions. But LEV showed higher efficacy than VPA in terms of seizure freedom percentage, seizure frequency and reduction of seizures.
The findings from this study demonstrated obvious effects of antiseizure medications as monotherapy on neuropsychological measures of attention and memory, as the results established that LEV can improve cognitive functions compared to VPA. On the light of the current results, it can be concluded that using Levetiracetam as a monotherapy in patients with epilepsy was effective in controlling seizures with the additional benefit of improving cognitive functions.
Limitations
The limitations of the present study were that:
1- It had a limited sample size from number of patients in each group.
2- It should also be mentioned that the period of follow up was limited.
Recommendation
A- Recommendations based on the results of the study:
1. LEV is effective as monotherapy in both focal and generalized seizures with high safety profile.
2. LEV had the additional benefit of improving cognitive functions which is important issue in patients with epilepsy especially in children and young population.
B- Recommendations based on limitations of the study:
1- Redirect the future studies of large number of patients of different population as children.
2- Longer length of the research may provide useful details about the long-term effects of medication, and may assist in decision making when selecting an appropriate drug for patients with epilepsy.
3- Comparison between different generations of AEDs.