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From the University of Pennsylvania (Dr. French), Philadelphia; Department of Neurological Sciences (Drs. Kanner and Bergen), Rush Medical College, Chicago, IL; The Cleveland Clinic Foundation (Dr. Bautista), OH; Vanderbilt University Medical Center (Dr. Abou-Khalil), Nashville, TN; Boston University Medical Center (Drs. Browne and Montouris), MA; Weill Medical College of Cornell University (Dr. Harden), New York, NY; National Institutes of Neurological Disorders and Stroke (Drs. Theodore and Hirtz), National Institutes of Health, Bethesda, MD; Columbia Presbyterian Medical Center (Dr. Bazil), New York, NY; Beth Israel Deaconess Medical Center and Harvard Medical School (Drs. Stern and Schachter), Boston, MA; Children’s Hospital San Diego (Dr. Nespeca), CA; School of Pharmacy and Department of Neurology (Dr. Gidal), University of Wisconsin Hospital and Clinics, Madison; University of California San Francisco Epilepsy Center (Dr. Marks); Nemours Children’s Clinic Division of Neurology (Dr. Turk), Jacksonville, FL; University of Illinois College of Pharmacy (Dr. Fischer), Dept. of Pharmacy Practice and Neurology, Colleges of Pharmacy and Medicine, Chicago; Department of Neurology (Dr. Bourgeois), Children’s Hospital, Boston, MA; Private practice (Dr. Wilner), Providence, RI; Department of Neurology (Dr. Faught), University of Alabama School of Medicine, Birmingham; Dept. of Neurology (Dr. Sachdeo), University of Medicine and Dentistry of New Jersey, New Brunswick; Dept. of Neurology (Dr. Beydoun), University of Michigan, Ann Arbor; and Dept. of Neurology (Dr. Glauser), Children’s Hospital Medical Center, Cincinnati, OH.
Address correspondence and reprint requests to TTA and QSS subcommittees, American Academy of Neurology, 1080 Montreal Ave., St. Paul, MN 55116
Objective: To assess the evidence demonstrating efficacy, tolerability, and safety of seven new antiepileptic drugs (AEDs) (gabapentin, lamotrigine, topiramate, tiagabine, oxcarbazepine, levetiracetam, and zonisamide—reviewed in the order in which these agents received approval by the US 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 until 2003.
Results: There is evidence either from comparative or dose-controlled trials that gabapentin, lamotrigine, topiramate, and oxcarbazepine have efficacy as monotherapy in newly diagnosed adolescents and adults with either partial or mixed seizure disorders. There is also evidence that lamotrigine 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 where more evidence is necessary.
Received September 3, 2003. Accepted in final form January 24, 2004.
Approved by the QSS on July 26, 2003. Approved by the TTA on October 17, 2003. Approved by the Practice Committee on November 16, 2003. Approved by the AAN Board of Directors on January 18, 2004.
This statement has been endorsed by the Epilepsy Foundation and the Child Neurology Society.
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Co-Chair.