Review Supports Current NICE Guidelines for Tx of Partial Onset Seizures
First-line treatment sodium valproate performed significantly better than carbamazepine, topiramate, and phenobarbitone for individuals with generalized onset seizures.
HealthDay News — Levetiracetam performs better than carbamazepine and lamotrigine for individuals with partial seizures, according to a review and meta-analysis published in the Cochrane Library.
Sarah J. Nevitt, from the University of Liverpool in the United Kingdom, and colleagues conducted a systematic literature review to compare the time to withdrawal of allocated treatment, remission, and first seizure of 10 antiepileptic drugs currently used as monotherapy in children and adults with partial onset seizures or generalized onset tonic-clonic seizures. Individual participant data were provided for at least one outcome for 69% of the 17,961 eligible participants and for 47% of the 77 eligible trials.
The researchers found that for individuals with partial seizures, levetiracetam performed statistically significantly better than carbamazepine and lamotrigine for time to withdrawal of allocated treatment; lamotrigine performed better than all other treatments aside from levetiracetam, and carbamazepine performed significantly better than gabapentin and phenobarbitone.
First-line treatment sodium valproate performed significantly better than carbamazepine, topiramate, and phenobarbitone for individuals with generalized onset seizures. Phenobarbitone seemed to perform worse than all other treatments for both partial and generalized onset seizures.
"Overall, the high-quality evidence provided by this review supports current guidance (eg, UK National Institute for Health and Care Excellence) that carbamazepine and lamotrigine are suitable first-line treatments for individuals with partial onset seizures and also demonstrates that levetiracetam may be a suitable alternative," the authors write.
Nevitt SJ, Sudell M, Weston J, Tudur Smith C, Marson AG. Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data [published online June 29, 2017]. Cochrane Database Syst Rev. 6:CD011412.