How does the efficacy of specific anticonvulsants for the treatment of epilepsy vary among patient groups?

Updated: May 30, 2019
  • Author: David Y Ko, MD; Chief Editor: Selim R Benbadis, MD  more...
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Answer

The VA Cooperative Study I clearly demonstrated similar efficacies for carbamazepine, phenytoin, primidone, and phenobarbital. [44] However, carbamazepine and phenytoin were tolerated better by men than women. The VA Cooperative Study II findings showed that carbamazepine and valproic acid had similar efficacies. [45] However, subset analysis for complex focal seizures suggested that carbamazepine may be a better choice than valproate. [45]

In elderly subjects (patients aged ≥60 years) in the VA Cooperative Study, lamotrigine and gabapentin were better tolerated than carbamazepine and were similarly effective. [46] However, gabapentin caused more adverse effects than lamotrigine. Those results led to the recommendation of lamotrigine as first-line monotherapy in elderly patients. [46]


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