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.
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.
French
Jacqueline A
JA
Neurological Institute, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. jfrench@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; 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
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