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.
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), 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.
French
Jacqueline A
JA
Neurological Institute, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. frenchj@mail.med.upenn.edu
Kanner
Andres M
AM
Bautista
Jocelyn
J
Abou-Khalil
Bassel
B
Browne
Thomas
T
Harden
Cynthia L
CL
Theodore
William H
WH
Bazil
Carl
C
Stern
John
J
Schachter
Steven C
SC
Bergen
Donna
D
Hirtz
Deborah
D
Montouris
Georgia D
GD
Nespeca
Mark
M
Gidal
Barry
B
Marks
William J
WJ
Turk
William R
WR
Fischer
James H
JH
Bourgeois
Blaise
B
Wilner
Andrew
A
Faught
R Edward
RE
Sachdeo
Rajesh C
RC
Beydoun
Ahmad
A
Glauser
Tracy A
TA
D000085:Acetates / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000588:Amines; D014150:Antipsychotic Agents / 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*; D004832:Epilepsy, Absence / 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; 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
D000085:Acetates; D000588:Amines; D014150:Antipsychotic Agents; 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