Initial Seizure Monotherapy: Lamotrigine for Partial Seizures, and Valproate When Generalized

For patients with seizures, clinicians are increasingly using newer antiseizure medications that have not been rigorously compared with older standard drugs. Researchers in the U.K. conducted two concurrent unblinded randomized trials comparing standard to newer drugs for seizure monotherapy.

In arm A, 1721 patients (89% had partial seizures) for whom clinicians thought carbamazepine to be the standard treatment received monotherapy with carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate. In arm B, 716 patients (90% had generalized or unclassified seizures) for whom valproate was thought to be the standard treatment received monotherapy with valproate, lamotrigine, or topiramate. In both arms, clinicians were encouraged to …