Second-generation antiepileptic drugs' impact on balance: a meta-analysis.
OBJECTIVE
To systematically review available evidence regarding whether second-generation antiepileptic drugs (AEDs) contribute to the risk of balance disorders.


METHODS
We systematically evaluated data from randomized controlled trials that compared adjunctive therapy with a second-generation AED (gabapentin, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, tiagabine, topIramate, or zonisamide) vs placebo for partial epilepsy and that reported dose-specific rates of ataxia or Imbalance for each group. Random-effects meta-analysis was used to pool ratios (risk ratio [RR]) and associated 95% confidence Intervals to determine whether there was evidence of an overall AED class effect or a dose-response effect and whether there were differences between Individual AEDs.


RESULTS
Sixteen studies met inclusion criteria, representing 4279 individuals randomized to a second-generation AED and 1830 patients to placebo. Pooled analyses of all AEDs demonstrated that they Increase imbalance risk at any dose (RR, 2.73; 95% confidence interval, 2.07-3.61) and at lowest dose (RR, 1.76; 95% confidence interval, 1.26-2.46). The highest dose analysis showed heterogeneity; evaluation of individual AEDs revealed that oxcarbamazepine and topiramate increased imbalance risk at all doses, whereas gabapentin and levetiracetam did not increase imbalance risk at any dose. A dose-response effect was observed for most AEDs.


CONCLUSIONS
Second-generation AEDs at standard dosages, except for gabapentin and levetiracetam, increase the imbalance risk, and evidence exists for a dose-response effect. The mechanisms, risk factors, and consequences of this risk for individual AEDs warrant further study.
Sirven
Joseph I
JI
Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, Ariz, USA. sirven.joseph@mayo.edu
Fife
Terry D
TD
Wingerchuk
Dean M
DM
Drazkowski
Joseph F
JF
D000927:Anticonvulsants / Q000009:adverse effects* / Q000494:pharmacology; D001259:Ataxia / Q000139:chemically induced; D004305:Dose-Response Relationship, Drug; D004827:Epilepsy / Q000188:drug therapy; D006801:Humans; D004856:Postural Balance / Q000187:drug effects*; D016032:Randomized Controlled Trials as Topic; D012678:Sensation Disorders / Q000139:chemically induced*
D000927:Anticonvulsants