Review of treatment options for refractory epilepsy: new medications and vagal nerve stimulation.
OBJECTIVE
the choices available for patients whose partial seizures are poorly controlled include seven new antiepileptic drugs (AEDs) or vagal nerve stimulation (VNS) as add-on therapy. Comparisons are needed to help physicians and patients select among the options for treatment.


METHODS
we compared efficacy and adverse events of new treatments from controlled clinical trials of patients with uncontrolled partial seizures. Response rates (> or =50% decrease in partial seizures) at doses recommended in product labeling for adjunct therapy were tabulated for overall success (placebo response rate subtracted from AED response rate). Adverse events listed in product labeling were tabulated as complaint rates (placebo events subtracted from AED events). VNS trials used low dose stimulation as a pseudo-placebo.


RESULTS
overall success rates fell into two general groups with ranges of 12-20% for gabapentin (GBP), lamotrigine (LTG), tiagabine (TGB), zonisamide and 27-29% for levetiracetam, oxcarbazepine, and topiramate (TPM). Summary Complaint Scores also fell into two general groups with ranges of -27 to -82 for GBP, levetiracetam, TGB, zonisamide and -113 to -205 for LTG, oxcarbazepine and TPM. VNS scores were in the lower or higher success and summary complaint categories depending on whether scores from the pseudo-placebo group were subtracted from the high dose group.


CONCLUSIONS
these data allow comparisons among AEDs and VNS using similar data from standard types of clinical trials.
Cramer
J A
JA
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. joyce.kramer@yale.edu
Ben Menachem
E
E
French
J
J
D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D004599:Electric Stimulation Therapy / Q000379:methods; D004827:Epilepsy / Q000628:therapy*; D020937:Epilepsy, Partial, Sensory / Q000628:therapy; D006801:Humans; D014630:Vagus Nerve
D000927:Anticonvulsants