Which anticonvulsant drugs are used to treat generalized and unclassified epilepsies?

Updated: May 30, 2019
  • Author: David Y Ko, MD; Chief Editor: Selim R Benbadis, MD  more...
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The SANAD trial investigators concluded that valproate should remain the drug of first choice for many patients with generalized and unclassified epilepsies, as it is better tolerated than topiramate and more efficacious than lamotrigine. [40] However, in women of childbearing age, the known potential adverse effects of valproate during pregnancy (ie, black box warnings of severe birth defects and impaired cognitive development) must be balanced against the benefits of seizure control. Levetiracetam and zonisamide were not included in SANAD, which tested only lamotrigine, topiramate, and valproate.

A 2014 study by Shallcross et al, however, indicated that whereas in utero exposure to the AED valproate is associated with language and motor development deficits in children, the same is not true for levetiracetam. In the study, valproate exposure resulted in children having lower scores on tests of comprehension, expressive language abilities, and motor skills compared with children exposed to levetiracetam. In fact, children exposed to levetiracetam did not differ from children unexposed to any AED on tests of thinking, movement, and language when tested at age 36-54 months. [41, 42]

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