Treatment of epilepsy in adults – Related resources

Cochrane reviews

• There appears to be no difference between phenytoin and valproate for partial onset seizures and generalized onset tonic-clonic seizures .
• Remacemide appears to have a modest effect on seizure frequency and a significant withdrawal rate in patients with drug-resistant epilepsy .
• Self-management education programmes, based on increasing understanding through psychosocial methods, may improve knowledge about epilepsy, certain behavioural outcomes, and reduce seizure frequency .
• Carbamazepine and phenobarbitone appear to have similar overall efficacy for epilepsy, however phenobarbitone was more effective for partial onset seizures and carbamazepine for generalized onset tonic-clonic seizures .
• Carbamazepine and phenytoin may have equal efficacy as monotherapy for epilepsia and there may be no differences between them in serious side effects. .
• Vagal nerve stimulation appears to be effective and well tolerated for partial seizures in patients with drug-resistant seizures .
• Tiagabine reduces seizures frequency but is associated with some side effects when used as an add-on for people with drug-resistant localization related seizures .
• Lamotrigine in monotherapy for epilepsy may be inferior to carbamazepine for seizure control but has improved tolerability .
• Oxcarbazepine, when used as a single treatment for partial epilepsy, may be withdrawn less likely than phenytoin for reasons of efficacy (seizure control) or tolerability (adverse effects) .
• There is no evidence from randomized controlled trials to support routine therapeutic monitoring of antiepileptic drugs in the treatment of epilepsy .
• There is limited evidence for the effectiveness of interventions to improve the health and quality of life in people with epilepsy.
• Pregabalin 150–600 mg daily as an add-on drug for treatment-resistant partial epilepsy appears to significantly reduce seizure frequency as compared to placebo, but at the risk of adverse effects .
• Oxcarbazepine and carbamazepine may be similarly effective and well tolerated in patients with partial onset seizures .
• There is no evidence to support the use of felbamate as an add-on therapy in patients with refractory partial-onset epilepsy.
• Intensive reminders and 'implementation intention' interventions might possibly be promising in enhancing adherence to antiepileptic mediations in epilepsy .
• Flunarizine might possibly have a weak effect on seizure frequency as add-on treatment for drug-resistant epilepsy, but had a significant withdrawal rate probably due to adverse effects. Similarly, the evidence is insufficient to support the use of nifedipine or nimodipine .
• Eslicarbazepine at a daily dose of 800-1200 mg appears to reduce seizure frequency when used as an add-on treatment for drug-resistant partial epilepsy. Dizziness, nausea and diplopia appear to be the most common adverse events .
• Pregabalin appears to have inferior efficacy and tolerability in comparison to lamotrigine for newly diagnosed partial seizures .
• There is probably no difference between phenytoin and phenobarbitone in the control of the seizure types investigated, but phenytoin is less likely to be withdrawn, presumably because due to fewer adverse effects .
• Vitamin supplementation appears not to improve seizure control or prevent side effects in epilepsy .
• Zonisamide appears to be effective as an add-on treatment in drug-resistant partial epilepsy, but is associated with an increase in adverse effects.
• Topiramate at a dose of 300 to 400 mg daily appears to be effective as an add-on treatment for drug-resistant partial epilepsy. It appears to be three times more effective than placebo in reducing seizures at least in a short term, but is associated with side effects .
• Clobazam might possibly not be more effective than carbamazepine for retention at 12 months in drug-naïve children with seizures but there might be a slight advantage of clobazam over phenytoin for retention at 6 months in adolescents and adults with neurocysticercosis in a single clinical trial each, although the evidence is insufficient .
• There is no evidence available to inform the choice of antidepressant in treating depression in people with epilepsy. Selective serotonin reuptake inhibitors might possibly be safe in terms of seizure exacerbation .
• Lacosamide is effective and fairly well tolerated in the short term when used as add-on treatment for drug-resistant partial epilepsy in adults .
• The evidence in epilepsy surgery is insufficient for guiding in patient selection and prediction of likely surgical outcome .

Other evidence summaries

• Antiepileptic drugs after a single seizure appear to reduce the number of subsequent seizures, but they may not significantly increase the proportion of people remaining totally seizure-free at 2 years .
• Educational programmes may reduce seizure frequency and improve psychological functioning and knowledge in people with epilepsy .

Literature

Clinical practice reviews

• French JA, Pedley TA. Clinical practice. Initial management of epilepsy. N Engl J Med 2008 Jul 10;359(2):166-76.