Based on reported efficacy, what are the preferred anticonvulsants for the treatment of first adult seizure?

Updated: Nov 30, 2017
  • Author: Eissa Ibrahim AlEissa, MD, MBBS; Chief Editor: Selim R Benbadis, MD  more...
  • Print
Answer

The Standard and New Antiepileptic Drugs (SANAD) study reported that lamotrigine was significantly better in terms of time to treatment failure than the current standard treatment, carbamazepine, and the newer drugs gabapentin and topiramate for treatment of partial seizures. [47] (The study compared carbamazepine, gabapentin, lamotrigine, oxcarbazepine, and topiramate.) For time to 12-month remission from seizures, carbamazepine was not significantly advantageous compared with lamotrigine. [47] Lamotrigine also has the lowest incidence of treatment failure and has better outcome than all drugs except oxcarbazepine.

The same SANAD study compared valproate, lamotrigine, or topiramate for generalized and unclassifiable epilepsy seizures, and found that valproate is the drug of choice and is better tolerated than topiramate. [48]

Epilepsy monotherapy trial results

Another study compared 8 antiepileptic drugs used in 20 randomized trials and reported that in patients with partial seizures, the results favored carbamazepine, oxcarbazepine, and lamotrigine. [49] For generalized tonic-clonic seizures, the results favored valproate and phenytoin. [49]

NEAD study results

Regarding sodium valproate, the Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) Study Group recommended that sodium valproate not be used as a first-line drug in the treatment of epilepsy for women of child-bearing age because of its side effects. [50]


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!