Several just discovered antiepilept...

Several just discovered antiepileptic drugs (AEDs) are effective in treating chosened patients with partial or mixed seizure disorders, nevertheless evidence for their efficacy in patients with generalized epilepsy syndrome is lacking, according to a meta-analysis from the American Academy of Neurology (AAN) and the American Epilepsy Society (AES). Evidence-based guidelines for the prescription of just discovered AEDs were published in the April 27 2004 issue of Neurology

Before 1990 six major AEDs were available for the treatment of all forms of epilepsy: carbamazepine, phenobarbital, phenytoin, primidone, valproic acid, and ethosuximide. However, many patients "failed" all of these put drugs intos because of inadequate seizure sway or side effects of treatment. In the past 10 years, the U victuals and Drug Administration has approved seven recently made known AEDs to address the wants of patients for whom the existing AEDs did not provide optimal care: gabapentin (Neurontin), lamotrigine (Lamictal), topiramate (Topamax), tiagabine (Gabitril), oxcarbazepine (Trileptal), levetiracetam (Keppra), and zonisamide (Zonegran).

An AAN/AES committee waysed a structured literature review to determine to what degree the efficacy and tolerability of the novel AEDs compare with that of the standard AEDs in patients with newly diagnosed epilepsy, and to evaluate the evidence that the fresh AEDs are effective in patients with primary or secondary generalized epilepsy.

The cluster found that gabapentin is effective in the treatment of newly diagnosed partial epilepsy, and that lamotrigine, topiramate, and oxcarbazepine are effective in a mixed population of newly diagnosed partial and generalized tonic-clonic seizures. There generally is insufficient evidence to determine the effectiveness of tiagabine, zonisamide, and levetiracetam in newly diagnosed patients.

Oxcarbazepine, carbamazepine, valproic acid, and phenytoin are similar in efficacy, unless oxcarbazepine is superior in dose-related tolerability. In children more than six years of age and adults, topiramate at dosages of 100 and 200 mg by day was equivalent in efficacy and safety to a 600-mg fixed dose of carbamazepine and 1250 mg of valproic acid through day.

In adults and somewhat old patients, lamotrigine is equivalent in efficacy to carbamazepine and phenytoin and superior in tolerability to carbamazepine. Topiramate at dosages of 100 mg and 200 mg for day is equivalent in efficacy and safety to a 600-mg fixed dosage of immediate-release carbamazepine given twice daily for partial seizures and to 1250 mg of fixed-dose valproic acid for idiopathic generalized seizures.

Gabapentin is effective in monotherapy at 900 and 1800 mg and is equivalent in efficacy to a 600-mg fixed dose of carbamazepine. However, a 900-mg dosage of gabapentin is better tolerated than a 600-mg fixed dosage of short-acting carbamazepine given twice daily.

There are no studies in newly diagnosed patients that assess the efficacy of oxcarbazepine, topiramate, tiagabine, levetiracetam, or zonisamide in children with exclusively idiopathic or symptomatic generalized epilepsy.

There are no studies of any strange AED that assess efficacy and tolerability in adults with newly diagnosed epilepsy with exclusively idiopathic or symptomatic generalized epilepsy.

Based forward these findings, the group approves that patients with newly diagnosed epilepsy who require treatment be started upon standard AEDs such as carbamazepine, phenytoin, valproic acid, or phenobarbital, or onward the new AEDs such as lamotrigine, gabapentin, oxcarbazepine, or topiramate. The choice of an AED will hang on individual patient characteristics. Children with newly diagnosed absence seizures may be treated with lamotrigine.

Because the newer AEDs are often more expensive than the standard agents, further research using an economic decision analysis is emergencyed to determine whether the potential benefits are worth the additional cost

COPYRIGHT 2004 American Academy of Family Physicians

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