Treatment Protocol

Unless there are compelling reasons based on AE profile, ETS or VPA use should be considered before LTG use to decrease seizure frequency.

TPM monotherapy is possibly more efficacious at 400 mg/d than at 50 mg/d; however, no recommendations can be made regarding TPM use at the studied doses, particularly in new-onset epilepsy and pediatric patients.

Unless there are compelling reasons based on AE profile, ETS or VPA use should be considered before LTG use to decrease seizure frequency.

Children randomized to ETS (60 mg/kg/d) and VPA (60 mg/kg/d) have comparable freedom-from-failure rates at 16 weeks, which are significantly higher than LTG (12 mg/kg/d) rates.

Attention disturbances are significantly more common with VPA than with ETS.

The probability of seizure freedom is significantly higher with high-dose TPM (400 mg/d) than low-dose TPM (50 mg/d) (90% vs 78% at 6 months; 85% vs 62% at 12 months).

Clinicians should monitor for increased AEs (14% vs 4% at low dose), including headache, decreased appetite, weight loss, somnolence, dizziness, paresthesia, and concentration/attention problems.

Eslicarbazepine and lacosamide (oral only) may be used as add-on or monotherapy, following FDA extrapolation of efficacy across populations.

VPA outperforms TPM for time to treatment failure and is superior to LTG when restricted to GE.

Rash is the most common AE leading to discontinuation (4%).