Valproate and lamotrigine are better tolerated than carbamazepine among patients newly diagnosed with epilepsy and are also more effective at controlling seizures, researchers have told the annual meeting of the American Epilepsy Society.
Speaking in Los Angeles, Dr Martin Brodie and Dr Patrick Kwan of the Western Infirmary in Glasgow analysed the response of patients to their first anti-epilepsy drug (AED). Between 1984 and 1997, 470 patients with ages ranging from 9 to 93 were studied for an average of two years.
For 83 per cent of patients, their first drug was carbamazepine, valproate or lamotrigine. The researchers reported that 47 per cent of patients became seizure free with their first AED, with 90 per cent of those doing so at a moderate dosage.
61 per cent of those studied who took lamotrigine as their first AED became seizure free, compared to 57 per cent of those on valproate and 41 per cent of those on carbamazepine. This lower seizure free rate for carbamazpine was partially due to the higher incidence of adverse side effects which led to a change in therapy for more patients.
"A well-tolerated antiepileptic drug has the potential to make more patients with newly diagnosed epilepsy seizure-free," Drs. Brodie and Kwan reported. "If seizure control remains suboptimal despite a moderate dose of the first anti-epileptic drug, alternative or combination therapy should be considered instead of escalating the dose to toxicity."