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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), CA; Nemours Children’s Clinic Div. 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) 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 until March 2003.
Results: All of the new AEDs were found to be appropriate for adjunctive treatment of refractory partial seizures in adults. Gabapentin can be effective for the treatment of mixed seizure disorders, and gabapentin, lamotrigine, oxcarbazepine, and topiramate for the treatment of refractory partial seizures in children. Limited evidence suggests that lamotrigine and topiramate are also 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 upon seizure and/or syndrome type, patient age, concomitant medications, 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 where more evidence is necessary.
Received September 3, 2003. Accepted in final form January 24, 2004.
See also page 1252
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.
* NB: In a previous parameter, felbamate was recommended for "intractable partial seizures in patients over 18 years old who had failed standard AEDs."
* NB: In a previous AAN parameter, felbamate was recommended in "Lennox-Gastaut patients over age 4 unresponsive to primary AEDs."3
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