Efficacy and tolerability of the new antiepileptic drugs, II: Treatment of refractory epilepsy: report of the TTA and QSS Subcommittees of the American Academy of Neurology and the American Epilepsy Society.

Abstract

PURPOSE:

To assess the evidence demonstrating efficacy, tolerability, and safety of seven new antiepileptic drugs (AEDs) [gabapentin (GBP), lamotrigine (LTG), topiramate (TPM), tiagabine (TGB), oxcarbazepine (OXC), levetiracetam (LEV), and zonisamide (ZNS)] in the treatment of children and adults with refractory partial and generalized epilepsies.

METHODS:

A 23-member committee, including general neurologists, pediatric neurologists, epileptologists, and doctors in pharmacy, evaluated the available evidence based on a structured literature review including MEDLINE, Current Contents, and Cochrane Library for relevant articles from 1987 to March 2003.

RESULTS:

All of the new AEDs were found to be appropriate for adjunctive treatment of refractory partial seizures in adults. GBP can be effective for the treatment of mixed seizure disorders, and GBP, LTG, OXC, and TPM for the treatment of refractory partial seizures in children. Limited evidence suggests that LTG and TPM also are effective for adjunctive treatment of idiopathic generalized epilepsy in adults and children, as well as treatment of the Lennox-Gastaut syndrome.

CONCLUSIONS:

The choice of AED depends on seizure and/or syndrome type, patient age, concomitant medications, and AED tolerability, safety, and efficacy. The results of this evidence-based assessment provide guidelines for the prescription of AEDs for patients with refractory epilepsy and identify those seizure types and syndromes for which more evidence is necessary.

• Authors: Jacqueline A French, Andres M Kanner, Jocelyn Bautista, Bassel Abou-Khalil, Thomas Browne, Cynthia L Harden, William H Theodore, Carl Bazil, John Stern, Steven C Schachter, Donna Bergen, Deborah Hirtz, Georgia D Montouris, Mark Nespeca, Barry Gidal, William J Marks Jr, William R Turk, James H Fischer, Blaise Bourgeois, Andrew Wilner, R Edward Faught Jr, Rajesh C Sachdeo, Ahmad Beydoun, Tracy A Glauser, American Academy of Neurology Therapeutics and Technology Assessment Subcommittee, American Academy of Neurology Quality Standards Subcommittee, American Epilepsy Society Therapeutics and Technology Assessment Subcommittee, American Epilepsy Society Quality Standards Subcommittee
• Journal: Epilepsia (Epilepsia) Vol. 45 Issue 5 Pg. 410-23 (May 2004) ISSN: 0013-9580 [Print] United States
• PMID: 15101822 (Publication Type: Guideline, Journal Article, Practice Guideline, Review)

Chemical References

• Acetates
• Amines
• Anticonvulsants
• Cyclohexanecarboxylic Acids
• Isoxazoles
• Nipecotic Acids
• Triazines
• Topiramate
• Fructose
• Carbamazepine
• Levetiracetam
• Zonisamide
• gamma-Aminobutyric Acid
• Gabapentin
• Lamotrigine
• Oxcarbazepine
• Tiagabine
• Piracetam

Topics

• Acetates (therapeutic use)
• Adolescent
• Adult
• Age Factors
• Amines
• Anticonvulsants (therapeutic use)
• Carbamazepine (analogs & derivatives, therapeutic use)
• Child
• Clinical Trials as Topic (statistics & numerical data)
• Cyclohexanecarboxylic Acids
• Drug Approval
• Epilepsies, Partial (drug therapy)
• Epilepsy, Generalized (drug therapy)
• Fructose (analogs & derivatives, therapeutic use)
• Gabapentin
• Humans
• Isoxazoles (therapeutic use)
• Lamotrigine
• Levetiracetam
• Nipecotic Acids (therapeutic use)
• Oxcarbazepine
• Piracetam (analogs & derivatives, therapeutic use)
• Practice Patterns, Physicians'
• Tiagabine
• Topiramate
• Triazines (therapeutic use)
• United States
• United States Food and Drug Administration
• Zonisamide
• gamma-Aminobutyric Acid