Lamotrigine may be most effective antiepileptic drug

Of 10 antiepileptic drugs (AEDs) studied in older adults with epilepsy, lamotrigine closely followed by levetiracetam is the most effective, as measured by 12-month retention and freedom from seizures, while oxcarbazepine is consistently less effective than other AEDs, according to research published in the April issue of the Archives of Neurology, as reported by HealthDay News.

Hiba Arif, MD, of Columbia University, New York, and colleagues conducted a retrospective review of 417 patients aged 55 years and older who were newly taking any of 10 commonly prescribed AEDs between 2000 and 2005. Twelve-month retention rates, seizure-free rates, and adverse effects leading to dose change were determined for each AED studied.

The researchers found that lamotrigine had the highest 12-month retention rate (79%) and the highest 12-month seizure-freedom rate (54%). Levetiracetam was second-highest in 12-month retention (73%) and 12-month seizure-freedom (43%). The retention rate was 48% for carbamazepine; 59% for gabapentin; 24% for oxcarbazepine; 59% for phenytoin; and 56% for topiramate. The most common intolerable adverse effects were drowsiness, imbalance, and gastrointestinal symptoms.

“This study underscores the need for further prospective trials for evaluating safety and effectiveness of multiple AEDs in older adults, a cohort that has been consistently underrepresented in prior studies, and suggests that lamotrigine and levetiracetam should be included in any future trials of treatment of epilepsy in older adults,” the authors write.

Several of the study authors reported financial relationships with the pharmaceutical industry.