Indication |
Method/treatment mode |
Drug(s) |
Comments |
A. Professional organization recommendations: American Academy of Neurology1,2 |
Seizures—partial onset |
Add-on |
Standard AED: PB, PHT, CBZ, VPA Newer AED: GBP, LTG, TPM, TGB, OXC, LEV, ZNS |
Newer AEDs may be better tolerated than the standard, with equivalent efficacy; the data do not answer questions about other potential advantages of newer AEDs such as better pharmacokinetics, less disturbance of the hormonal milieu, improved safety, and less laboratory monitoring |
Seizures—primary Generalized |
Add-on |
TPM LTG (absence only) |
— |
Seizures—symptomatic generalized (Lennox–Gastaut syndrome) |
Add-on |
LTG, TPM |
— |
Seizures—partial-onset—children |
Add-on |
GBP, LTG, OXC, TPM |
— |
Seizures—mixed partial or generalized-onset |
Monotherapy |
TPM, LTG, OXC GBP (partial only) |
Insufficient evidence to make a recommendation on individual syndromes; insufficient evidence to make monotherapy recommendations on LEV, TGB, or ZNS |
B. Systematic reviews by the Cochrane collaboration3,4,5,6,7 |
Partial seizures |
VPA, GBP, LTG, TPM, TGB, OXC, LEV, ZNS |
|
— |
Absence seizures |
— |
— |
Insufficient evidence to inform clinical practice |
C. U.S. Food and Drug Administration (FDA) Indications |
Partial seizures |
Initial monotherapy |
PHT, OXC, TPM, PB, CBZ |
For topiramate, ages 10 years and older; for PB, PHT, CBZ there is no specific mention of monotherapy. |
|
Titration to monotherapy |
VPA, LTG, FBM |
— |
Partial seizures |
Add-on |
PHT, PB, CBZ, VPA, FBM, GBP, LTG, TPM, TGB, LEV, OXC, ZNS, PGB |
— |
Primary generalized tonic-clonic |
Add-on |
TPM, PHT, PB |
There is no specific mention of CBZ. |
Pediatric partial |
Add-on |
GBP, LTG, OXC, TPM |
PB, PHT, and CBZ are not specifically mentioned. |
Lennox–Gastaut |
Add-on |
LTG, TPM, FBM |
Felbamate is recommended for use only in those patients who respond inadequately to alternative treatments |
AED, antiepileptic drug; PB, phenobarbital; PHT, phenytoin; CBZ, carbamazepine; VPA, valproate; GBP, gabapentin; LTG, lamotrigine; TPM, topiramate; TGB, tiagabine; OXC, oxcarbazepine; LEV, levetiracetam; ZNS, zonisamide; PGB, pregabalin; FBM, felbamate. | |