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Best First-Choice Drugs for Epilepsy ID'd

But Patient Differences Complicate Effort to Simplify Epilepsy Drug Choice
WebMD Health News
Reviewed by Louise Chang, MD

March 22, 2007 - Lamictal is the best first-choice drug for partial epilepsy, while valproic acid is the best first choice for generalized epilepsy, two major clinical trials show.

But for patients who learn they have epilepsy, finding the right drug to control their seizures will continue to be a complicated process. That's because each epilepsy drug has different benefits and different risks for different people.

The clinical trials offer lots of new information, notes neurologist Anthony G. Marson, MD, of the University of Liverpool, England, the leader of the Standard and New Antiepileptic Drugs (SANAD) studies.

"What these trials do is give you reliable data about the likelihood of a drug's success relative to seizure control," Marson tells WebMD. "So now we can talk to patients about the relative benefits they can expect when weighing the hazards of these drugs."

Epilepsy Drug Choice Simplified

As their names imply, the trials compared standard epilepsy treatments to a wide range of newer drugs. The two trials looked at two different groups of patients.

Epilepsy comes in a multitude of forms, but experts agree on two basic types. In partial or focal epilepsy, mixed-up electrical signals start in one area of the brain and spread out, causing a seizure. In generalized epilepsy, seizures result from a surge of electrical activity all across the brain.

The first trial looked at 1,721 patients newly diagnosed with partial epilepsy. It compared an older drug, carbamazepine (a common brand name is Tegretol) to gabapentin (Gabarone, Neurontin), Lamictal, Trileptal, and Topamax.

"[Lamictal] seems to be the winner," Marson says.

The second trial looked at 716 patients newly diagnosed with generalized epilepsy. It compared the older drug valproic acid (in the U.S., Depakote is the most popular member of this drug family) to Lamictal and Topamax.

"Valproate [the British term for valproic acid] is a much better drug at controlling generalized seizure than the others," Marson says.

But these drugs aren't necessarily the best first-choice treatment for all patients, argues Jacqueline French, MD, head of Penn Epilepsy Center at the University of Pennsylvania, Philadelphia.

"This is making simple something that is not so simple," French tells WebMD.

French's editorial accompanies the Marson reports in the March 24 issue of The Lancet.

Epilepsy Drug Choice Still Complex

Marson's study looked at how well the epilepsy drugs control seizures, their general tolerability, and their cost.

Those are important things, French says. But other things are equally important, such as the likelihood a drug will cause a serious health risk or a drug's interactions with other medications.

For example, some epilepsy drugs make oral contraceptives less effective. And oral contraceptives, French says, make Lamictal less effective.

"Patients with epilepsy should think about the things that are important for them," French advises. "Say I want to get pregnant in the next five years. Or I am very nervous about side effects that might seriously compromise my health. Or I need protection against seizures from day one, which Lamictal is not going to do."

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