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New Study Weighs Benefits of Epilepsy Drugs

In some cases, newer may not be better, researchers say

THURSDAY, March 22, 2007 (HealthDay News) -- Valproate should be the drug of first choice for patients with generalized and unclassifiable epilepsy, new research shows.

And lamotrigine should be the first choice for treating partial epilepsy, say British researchers who sought to clarify drug options for the disorder.

A large number of new antiepileptic drugs have become available in recent decades, but previous studies have not helped guide doctors or patients in terms of choosing between the newer and standard drugs, the study authors noted.

The Standard and New Antiepileptic Drugs (SANAD) study had two components. The first, with 1,721 patients, compared carbamazepine -- an established drug currently recommended as the first-line treatment for patients with partial onset seizures -- with gabapentin, lamotrigine, oxcarbazepine, and topiramate.

The researchers found that lamotrigine was significantly better for time to treatment failure than carbamazepine and the newer drugs gabapentin and topiramate. In addition, lamotrigine was not inferior to carbamazepine for time to 12-month remission from seizures. The findings show that lamotrigine is a cost-effective alternative for patients with partial onset seizures, the researchers concluded.

The second component of the study, with 716 patients, compared valproate -- the current standard treatment for patients with generalized and unclassifiable epilepsy -- with the newer drugs lamotrigine and topiramate.

Valproate was significantly better than topiramate for treatment failure and significantly better than lamotrigine for 12-month remission. The results indicate that valproate should remain the first-line treatment for this group of patients, but some individual circumstances -- such as drug interactions or family planning -- may favor the use of an alternative drug, the researchers said.

The findings are published in the March 24 issue of The Lancet.

In an accompanying comment in the journal, Jacqueline French, of the University of Pennsylvania, said physicians who are overwhelmed by the number of available antiepileptic drugs will welcome the results of the SANAD trial.

But, she noted that the SANAD study "was too small to address even the most common serious adverse event related to the drugs that were tested ... therefore, it might be wiser to conclude from SANAD that lamotrigine is the drug of first choice in patients with partial seizures, and valproate for patients with generalized or unclassified seizures in the absence of factors that would lead to an alternative choice."

Dr. Steven V. Pacia, director of the Lenox Hill Hospital Comprehensive Epilepsy Center in New York, agreed. Calling the studies well-conceived and a reasonable guideline to physicians, he added that caution should be exercised in applying the findings to all patients.

"We must be careful that these findings do not lead health-care systems and insurance carriers to exclude important medications that they consider 'second-line,' but may be vital for a patient that may not tolerate the 'first-line' medication," Pacia said in a prepared statement.

More information

The Epilepsy Foundation has more about medications for epilepsy.

SOURCE: The Lancet, news release, March 22, 2006
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