What are some anti-seizure drugs

Cochrane

background

Epilepsy is a common neurological condition that causes recurrent seizures due to abnormal electrical discharges in the brain. We examined two types of epileptic seizures in this review: focal seizures that start in one area of ​​the brain and generalized tonic-clonic seizures that start in both hemispheres at the same time.

Around 70% of people with epileptic seizures can control their seizures, and most people can do this with a single anti-epileptic drug. Currently in the UK, according to the guidelines of the National Institute for Health and Care Excellence (NICE) for adults and children, carbamazepine or lamotrigine are recommended as the first line drug for people with newly diagnosed partial seizures. Sodium valproate is recommended for people with newly diagnosed generalized tonic-clonic seizures. However, there are a number of other drug anti-epileptic treatments available.

The choice of the first anti-epileptic drug for a person with newly diagnosed epilepsy is of great importance and should be made with consideration of good quality evidence describing how effective the drugs are in controlling the seizures and whether they are associated with side effects. It is also important that medicines for different types of seizures are compared.

Methods

The anti-epileptics of interest for this review were carbamazepine, phenytoin, sodium valproate, phenobarbital, oxcarbazepine, lamotrigine, gabapentin, topiramate, levetiracetam, zonisamide. In this review, we examined the evidence from 77 randomized controlled clinical trials that compared two or more drugs with regard to their effectiveness in seizure control (i.e. whether patients had recurrent seizures or had no seizures for a long time (remission)) and the tolerability of their side effects. We were able to merge the data from 12,391 patients from 36 of the 77 studies; the remaining data from 5570 patients from the other 41 studies were not available for this review.

We performed two types of analysis in this review; For one thing, we combined available data when two drugs were compared directly in clinical trials. On the other hand, we carried out an analysis in order to bring together all the information from the clinical studies on a "network" of 10 drugs. This analysis allows us to compare drugs on the network that have not previously been compared in clinical trials.

Main results

Of the 45 possible pair comparisons of the 10 drugs of interest for this review, clinical trial data were only available for just over half of these comparisons. But for many comparisons, there was only a single study comparing the two drugs, and the comparison involved only a few people.

Our "network" analysis showed that the oldest drugs on the network (phenobarbital and phenytoin) were better ways of controlling seizures than the other drugs. However, these older drugs were the worst in terms of long-term therapy maintenance (discontinuation of treatment) compared to the newer drugs, such as lamotrigine and levetiracetam.

The most common side effects reported for all drugs were drowsiness or fatigue, headache or migraine, gastrointestinal upset (upset stomach), dizziness or fainting, and rash or skin disorders.

Quality of the evidence

This review provides high quality evidence for people with partial seizures and moderate to high quality evidence for people with generalized tonic-clonic seizures, as there was less information on some drugs of interest for people with this type of seizure.

Conclusions

The results of this review support the NICE guidelines that carbamazepine and lamotrigine are suitable options for the initial treatment of people with partial seizures and also indicate that levetiracetam would also be an appropriate treatment. The results of this review also support the use of sodium valproate as the first choice for people with generalized tonic-clonic seizures, and also indicate that lamotrigine and levetiracetam would be suitable alternatives - especially for pregnant women or women trying to conceive, for whom sodium valproate may not be suitable Represents treatment option.

How current is this review?

The review authors searched for studies published by July 27, 2016.