Context The past decade has brought many advances to the treatment of epilepsy,
including many new pharmacological agents. Primary care physicians often care
for patients with epilepsy and therefore should be familiar with the new options
Objective To review data regarding the efficacy and tolerability of antiepileptic
drugs introduced in the past decade.
Data Sources A search of the Cochrane Central Register of Controlled Trials was performed
to identify all published human and English-language randomized controlled
trials evaluating the efficacy and tolerability of the antiepileptic drugs
that have been approved for use in the United States since 1990. Additional
reports evaluating pharmacokinetic properties were identified through a MEDLINE
search as well as review of article bibliographies.
Study Selection and Data Extraction Search terms included felbamate, gabapentin, lamotrigine, topiramate, tiagabine, levetiracetam, oxcarbazepine, and zonisamide. Studies were selected if efficacy and tolerability were
reported as major outcome measures. Included studies (n = 55) enrolled a minimum
of 20 adult subjects and had a treatment period of at least 6 weeks.
Data Synthesis Eight new antiepileptic drugs have been approved for use in the United
States in the past decade. Each new antiepileptic drug is well tolerated and
demonstrates statistically significant reductions in seizure frequency over
baseline. No randomized controlled trials have compared the new antiepileptic
drugs with each other or against the traditional antiepileptic drugs. Although
there is no evidence to suggest that the newer medications are more efficacious,
several studies have demonstrated broader spectrum of activity, fewer drug
interactions, and overall better tolerability of the new agents.
Conclusions New antiepileptic drugs offer many options in the treatment of epilepsy,
each with unique mechanisms of action as well as adverse effect profiles.
The new antiepileptic drugs are well tolerated with few adverse effects, minimal
drug interactions, and a broad spectrum of activity.