title: 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: OBJECTIVE
  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.affiliation: Neurological Institute, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. jfrench@mail.med.upenn.edu
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: French
authors.forename: Andres M
authors.initials: AM
authors.lastname: Kanner
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Bautista
authors.forename: Bassel
authors.initials: B
authors.lastname: Abou-Khalil
authors.forename: Thomas
authors.initials: T
authors.lastname: Browne
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Harden
authors.forename: William H
authors.initials: WH
authors.lastname: Theodore
authors.forename: Carl
authors.initials: C
authors.lastname: Bazil
authors.forename: John
authors.initials: J
authors.lastname: Stern
authors.forename: Steven C
authors.initials: SC
authors.lastname: Schachter
authors.forename: Donna
authors.initials: D
authors.lastname: Bergen
authors.forename: Deborah
authors.initials: D
authors.lastname: Hirtz
authors.forename: Georgia D
authors.initials: GD
authors.lastname: Montouris
authors.forename: Mark
authors.initials: M
authors.lastname: Nespeca
authors.forename: Barry
authors.initials: B
authors.lastname: Gidal
authors.forename: William J
authors.initials: WJ
authors.lastname: Marks
authors.forename: William R
authors.initials: WR
authors.lastname: Turk
authors.forename: James H
authors.initials: JH
authors.lastname: Fischer
authors.forename: Blaise
authors.initials: B
authors.lastname: Bourgeois
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilner
authors.forename: R Edward
authors.initials: RE
authors.lastname: Faught
authors.forename: Rajesh C
authors.initials: RC
authors.lastname: Sachdeo
authors.forename: Ahmad
authors.initials: A
authors.lastname: Beydoun
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Glauser
mesh_terms: D000085:Acetates / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000588:Amines; D000927:Anticonvulsants / Q000627:therapeutic use*; D002220:Carbamazepine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002648:Child; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D003509:Cyclohexanecarboxylic Acids; D017277:Drug Approval; D004828:Epilepsies, Partial / Q000188:drug therapy*; D004829:Epilepsy, Generalized / Q000188:drug therapy*; D005632:Fructose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000077206:Gabapentin; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use; D000077213:Lamotrigine; D000077287:Levetiracetam; D009557:Nipecotic Acids / Q000627:therapeutic use; D000078330:Oxcarbazepine; D010889:Piracetam / Q000031:analogs & derivatives / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D000078308:Tiagabine; D000077236:Topiramate; D014227:Triazines / Q000627:therapeutic use; D014481:United States; D014486:United States Food and Drug Administration; D000078305:Zonisamide; D005680:gamma-Aminobutyric Acid
chemical_list: D000085:Acetates; D000588:Amines; D000927:Anticonvulsants; D003509:Cyclohexanecarboxylic Acids; D007555:Isoxazoles; D009557:Nipecotic Acids; D014227:Triazines; D000077236:Topiramate; D005632:Fructose; D002220:Carbamazepine; D000077287:Levetiracetam; D000078305:Zonisamide; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D000077213:Lamotrigine; D000078330:Oxcarbazepine; D000078308:Tiagabine; D010889:Piracetam