Comment: The quality of evidence is downgraded by study quality (open-labelled studies) and imprecise results (one small trial for each comparison).
A Cochrane review included 4 studies with a total of 262 subjects. All evaluated different treatments. Sulthiame was significantly more likely to remain the seizure-free remission during the 3 and 6 months from commencement of treatment than placebo (3 months: RR 2.26, 95% CI 1.48 to 3.44; 6 months: RR 2.63, 95% CI 1.43 to 4.86; one trial, n= 66). The other 3 open-labelled trials did not show any significant differences in terms of seizure remission between antiepileptic drugs (AED). One compared levetiracetam with oxcarbazepine (3 months: RR 1.13, 95% CI of 0.93 – 1.36; 12 months: RR of 1.29 with 95% CI of 0.89 – 1.86; n=39), one clobazam with carbamazepine (4-40 weeks: RR of 1.04, 95% CI of 0.67 – 1.62; last 9 months: RR of 1.06 with 95% CI of 0.84, 1.34, n=45), and one carbamazepine with topiramate (28 weeks: RR 1.02 with 95% CI of 0.8 – 1.3, n=112). Other outcome measures assessed were time to the first seizure after randomisation which was only obtained in the sulthiame vs. placebo study as a hazard ratio of 7.8 (95% CI 2.66 – 22.87). There were no significant differences between the proportion of participants who had adverse events, apart from a higher incidence of rash in the carbamazepine group vs. topiramate group (14.8% vs. 1.7%), or the proportion who withdrew from treatment due to adverse events, when this was reported. Two trials (carbamazepine vs. topiramate and clobazam vs. carbamazepine) evaluated the effects on cognition without no clear differences at the end of the study periods.
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