Rapid ReviewEfficacy and tolerability of the new antiepileptic drugs: comparison of two recent guidelines
Section snippets
US and UK guidelines
Guidelines for the pharmacological treatment of epilepsy and, more specifically, for the use of the newer antiepileptic drugs, have been devised recently in the USA3, 4 and in the UK.5, 6 In the USA, the Therapeutic and Technology Assessment Subcommittee and the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society did a literature search for relevant articles on the efficacy, tolerability, and safety of seven new antiepileptic drugs (gabapentin,
Newly diagnosed partial epilepsy
The new antiepileptic drugs seemed to be similar to the older compounds in efficacy, but superior in tolerability. Overall, evidence is insufficient to assess the effect of old and new drugs on quality of life. There is insufficient evidence to suggest differences in efficacy among newer antiepileptic drugs. On this basis, the US panel recommended patients with newly diagnosed (previously untreated) epilepsy to be treated with an older drug or with a new drug among lamotrigine, gabapentin,
Children and patients with learning disabilities and intellectual deficits
Although these patients have been shown to benefit from new antiepileptic drugs to the same extent as adults with epilepsy, and beneficial effects were obtained on behavioural symptoms with lamotrigine and gabapentin, safety and tolerability concerns have been raised by the UK panel. In addition, there is no strong or consistent evidence of a difference between drugs in their effects on cognitive functions. However, none of the guidelines mentioned differential modes of treatment in these
Discrepancies between the US and UK guidelines and other recommendations
The UK guidelines seem to contrast with the Scottish Intercollegiate Network Guidelines (SIGN),11 which expand on the use of drugs in a synthesised management of epilepsy and suggest using lamotrigine and oxcarbazepine as first-line treatments for partial and symptomatic generalised seizures and lamotrigine as first-line treatment for idiopathic generalised seizures. However, a revised version of the UK guidelines is forthcoming, having a format comparable to the SIGN guidelines. The US
Conclusions
The US and the UK guidelines on the use of the new antiepileptic drugs for the treatment of epilepsy are both useful instruments for practising physicians (epileptologists, neurologists, child neurologists, neurosurgeons and—to some extent—family practitioners) because they are evidence-based, fairly comprehensive, and up-to-date. However, the guidelines diverge on the management of newly diagnosed epilepsy. As compared with the US guidelines, which links the choice of a new antiepileptic drug
References (12)
- et al.
The development of antiepileptic drugs for children: report from the NIH workshop, Bethesda, MD, Feb 17–18, 1994
Epilepsy Res
(1996) - et al.
The expert consensus guideline series: treatment of epilepsy
Epilepsy Behav
(2001) - et al.
Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984
Epilepsia
(1993) - et al.
Prevalence of epilepsy in Rochester, Minnesota: 1940–1980
Epilepsia
(1991) - et al.
Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy
Neurology
(2004) - et al.
Efficacy and tolerability of the new antiepileptic drugs II: treatment of refractory epilepsy
Neurology
(2004)
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