Efficacy and tolerability of the new antiepileptic drugs, I: Treatment of new-onset 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), reviewed in the order in which these agents received approval by the U.S. 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 to 2003.

RESULTS:

Evidence exists, either from comparative or dose-controlled trials, that GBP, LTG, TPM, and OXC have efficacy as monotherapy in newly diagnosed adolescents and adults with either partial or mixed seizure disorders. Evidence also shows that LTG 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 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 Quality Standards Subcommittee, American Epilepsy Society Therapeutics and Technology Assessment Subcommittee
• Journal: Epilepsia (Epilepsia) Vol. 45 Issue 5 Pg. 401-9 (May 2004) ISSN: 0013-9580 [Print] United States
• PMID: 15101821 (Publication Type: Guideline, Journal Article, Practice Guideline, Review)

Chemical References

• Acetates
• Amines
• Antipsychotic Agents
• 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
• Antipsychotic Agents (therapeutic use)
• Carbamazepine (analogs & derivatives, therapeutic use)
• Child
• Clinical Trials as Topic (statistics & numerical data)
• Cyclohexanecarboxylic Acids
• Drug Approval
• Epilepsies, Partial (drug therapy)
• Epilepsy, Absence (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)
• Tiagabine
• Topiramate
• Triazines (therapeutic use)
• United States
• United States Food and Drug Administration
• Zonisamide
• gamma-Aminobutyric Acid