Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society.

Abstract

OBJECTIVE:

To assess the evidence demonstrating efficacy, tolerability, and safety of seven new antiepileptic drugs (AEDs) (gabapentin, lamotrigine, topiramate, tiagabine, oxcarbazepine, levetiracetam, and zonisamide-reviewed in the order in which these agents received approval by the US Food and Drug Administration) in the treatment of children and adults with newly diagnosed 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 until September 2002, with selected manual searches up until 2003.

RESULTS:

There is evidence either from comparative or dose-controlled trials that gabapentin, lamotrigine, topiramate, and oxcarbazepine have efficacy as monotherapy in newly diagnosed adolescents and adults with either partial or mixed seizure disorders. There is also evidence that lamotrigine is effective for newly diagnosed absence seizures in children. Evidence for effectiveness of the new AEDs in newly diagnosed patients with other generalized epilepsy syndromes is lacking.

CONCLUSIONS:

The results of this evidence-based assessment provide guidelines for the prescription of AEDs for patients with newly diagnosed epilepsy and identify those seizure types and syndromes where more evidence is necessary.

• Authors: J A French, A M Kanner, J Bautista, B Abou-Khalil, T Browne, C L Harden, W H Theodore, C Bazil, J Stern, S C Schachter, D Bergen, D Hirtz, G D Montouris, M Nespeca, B Gidal, W J Marks Jr, W R Turk, J H Fischer, B Bourgeois, A Wilner, R E Faught Jr, R C Sachdeo, A Beydoun, T A Glauser, Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology, Quality Standards Subcommittee of the American Academy of Neurology, American Epilepsy Society
• Journal: Neurology (Neurology) Vol. 62 Issue 8 Pg. 1252-60 (Apr 27 2004) ISSN: 1526-632X [Electronic] United States
• PMID: 15111659 (Publication Type: Comparative Study, Guideline, Journal Article, Practice Guideline, Review)

Chemical References

• Acetates
• Amines
• Anticonvulsants
• Cyclohexanecarboxylic Acids
• Triazines
• Topiramate
• Fructose
• Carbamazepine
• gamma-Aminobutyric Acid
• Gabapentin
• Lamotrigine
• Oxcarbazepine

Topics

• Acetates (adverse effects, pharmacokinetics, therapeutic use)
• Acute Disease
• Adolescent
• Adult
• Amines
• Anticonvulsants (adverse effects, pharmacokinetics, therapeutic use)
• Carbamazepine (adverse effects, analogs & derivatives, pharmacokinetics, therapeutic use)
• Child
• Controlled Clinical Trials as Topic (statistics & numerical data)
• Cyclohexanecarboxylic Acids
• Drug Interactions
• Epilepsy (drug therapy)
• Evidence-Based Medicine (statistics & numerical data)
• Fructose (adverse effects, analogs & derivatives, pharmacokinetics, therapeutic use)
• Gabapentin
• Humans
• Lamotrigine
• Oxcarbazepine
• Topiramate
• Treatment Outcome
• Triazines (adverse effects, pharmacokinetics, therapeutic use)
• gamma-Aminobutyric Acid