Treatment Protocol

LTG use should be considered to decrease seizure frequency.

LEV use may be considered to decrease seizure frequency.

ZNS use may be considered to decrease seizure frequency.

VGB use appears to be less efficacious than CBZ-IR use and may not be offered; furthermore, toxicity profile precludes VGB use as first-line therapy.

PGB use at 150 mg/d is possibly less efficacious than LTG use at 100 mg/d.

Lamotrigine (LTG) use should be considered to decrease seizure frequency.

Levetiracetam (LEV) use may be considered to decrease seizure frequency.

Zonisamide (ZNS) use may be considered to decrease seizure frequency.

Seizure-free rates are almost identical at 6 months and 1 year, but depression and insomnia occur significantly more frequently with LEV, while back pain and weight gain occur with CBZ-CR.

Seizure-free rates for 26 weeks are nearly identical, with decreased appetite and weight loss occurring more frequently with ZNS and dizziness with CBZ-CR.

Vigabatrin (VGB) is probably less efficacious than CBZ-IR; time to 6-month remission is significantly shorter and time to first seizure significantly longer for CBZ-IR than for VGB.

Clinicians should be aware of significantly higher frequency of scintillating visual disturbances, myoclonic jerks, psychiatric symptoms, and weight gain.

Seizure freedom is achieved by significantly more patients taking LTG (100 mg/d) than PGB (150 mg/d), with weight gain occurring more often with PGB.

Time to recurrence of a first focal seizure with altered awareness or GTC seizure by study day 28 occurred in 18.9% of patients on TPM (100 mg/d) and 9.7% on PHT (1,000 mg load, 300 mg maintenance).

PHT use is associated with a higher incidence of rash leading to discontinuation, while paresthesia and cognitive AEs are more common with TPM.

Valproic acid (VPA) is superior to LTG and TPM for time to treatment failure and superior to LTG for 1-year remission.

The drugs are comparable regarding frequency of drug-related AEs and time to treatment failure; however, weight gain and tremor are associated with VPA, depression with LEV, and rash with CBZ-CR.

Only oxcarbazepine (OXC) has evidence from a Class I study suggesting efficacy in new-onset focal epilepsy.

FBM and VGB are not recommended for clinical use due to serious AEs, as there are other agents that are both safe and efficacious.