Newer Is Not Always Better

When used as substitution monotherapy in epilepsy patients who had failed initial anticonvulsant monotherapy, either of two older drugs (valproate and carbamazepine) is as tolerable and effective as a newer drug (levetiracetam).

The past 20 years have witnessed an explosion in available prescription antiepileptic drugs (AEDs) — and a concomitant lack of systematic comparative evidence to guide prescribing habits. Debate is ongoing regarding the merits of AEDs introduced in the early 1990s and later versus older drugs.

To provide such comparative data, researchers equally randomized 99 patients with epilepsy who had already failed initial AED monotherapy with phenytoin (PHT), carbamazepine (CBZ) or valproate (VPA), to levetiracetam (LEV) or to one of the older AEDs (VPA or CBZ). Psychosocial variables (quality of life and depression scores) and several secondary outcome measures (seizure response, AED adverse effects, neurocognitive performance) were assessed during …

Reviewing Author

Giridhar P. Kalamangalam, MD, DPhil, FRCP