Effectiveness of First Antiepileptic Drug

• DOI: 10.1046/j.1528-1157.2001.04501.x
• Publication Date: 2003-03-11T19:50:10Z
• Authors: Patrick Kwan; Martin J. Brodie
• Keywords: Tolerability; Valproic Acid

Summary: Purpose: To investigate the interaction among efficacy, tolerability, and overall effectiveness of first antiepileptic drug (AED) in patients with newly diagnosed epilepsy. Methods: The 470 were diagnosed, treated followed up from January 1984 at a single center. Outcome was classified as seizure freedom for least last year or failure initial treatment because inadequate control, adverse events, other reasons. Results: Overall, 47% became seizure‐free prescribed AED. A higher proportion (p = 0.025) symptomatic cryptogenic epilepsy changed intolerable side effects (17%), lower 0.007) (43.5%) compared those idiopathic (8.5% 58%, respectively). Most (83%) received carbamazepine (CBZ; n 212), sodium valproate (VPA; 101), lamotrigine (LTG; 78). majority required only moderate daily AED dose (93.1% ≤800 mg CBZ, 91.3% ≤1,500 VPA, 93.8% ≤300 LTG), commonest ranges being 400–600 600–1,000 125–200 LTG. withdrawals due to poor tolerability also occurred below these levels (CBZ: 98%; VPA: 100%; LTG: 75%). Patients taking CBZ (27%) had incidence events necessitating change than did VPA (13%) LTG (10%), resulting fewer becoming (CBZ vs. p 0.02; LTG, 0.002). Conclusions: Nearly 50% on first‐ever AED, >90% doing so even modest dosing. Tolerability important efficacy determining effectiveness.