Definitions of the strength of the recommendations (A, B, C, U) and classification of the evidence (Class I through Class IV) are provided at the end of the "Major Recommendations" field.
Efficacy and Tolerability of the New Antiepileptic Drugs (AEDs) Compared with That of Older AEDs in Patients with Newly Diagnosed Epilepsy
- Patients with newly diagnosed epilepsy who require treatment can be initiated on standard AEDs such as carbamazepine, phenytoin, valproic acid, phenobarbital, or on the new AEDs lamotrigine, gabapentin, oxcarbazepine, or topiramate. Choice of AED will depend on individual patient characteristics (Level A).
Note: At present, there is insufficient evidence to determine effectiveness in newly diagnosed patients for tiagabine, zonisamide, or levetiracetam
Effectiveness of New AEDs in Adults or Children with Primary or Secondary Generalized Epilepsy
- Lamotrigine can be included in the options for children with newly diagnosed absence seizures (Level B).
Note: At present there is insufficient evidence to determine effectiveness in newly diagnosed primary or secondary generalized epilepsy for topiramate, oxcarbazepine, tiagabine, zonisamide, or levetiracetam.
Table: Summary of American Academy of Neurology (AAN) Evidence-Based Guidelines Level A or B Recommendation for Use
Drug |
Newly diagnosed monotherapy
partial/mixed |
Newly diagnosed
absence |
Gabapentin |
Yes* |
No |
Lamotrigine |
Yes* |
Yes* |
Topiramate |
Yes* |
No |
Tiagabine |
No |
No |
Oxcarbazepine |
Yes |
No |
Levetiracetam |
No |
No |
Zonisamide |
No |
No |
* Not Food and Drug Administration-approved for this indication.
Definitions:
Rating of Recommendations
A = Established as effective, ineffective, or harmful for the given condition in the specified population.
B = Probably effective, ineffective, or harmful for the given condition in the specified population.
C = Possibly effective, ineffective, or harmful for the given condition in the specified population.
U = Data inadequate or conflicting; given current knowledge, treatment is unproven.
Translation of Evidence to Recommendations
Level A rating requires at least one convincing class I study or at least two consistent, convincing class II studies.
Level B rating requires at least one convincing class II study or at least three consistent class III studies.
Level C rating requires at least two convincing and consistent class III studies.
Rating of Therapeutic Article
Class I: Prospective, randomized, controlled clinical trial (RCT) with masked outcome assessment, in a representative population. The following are required:
- Primary outcome(s) is/are clearly defined.
- Exclusion/inclusion criteria are clearly defined.
- Adequate accounting for dropouts and crossovers with numbers sufficiently low to have minimal potential for bias
- Relevant baseline characteristics are presented and substantially equivalent among treatment groups or there is appropriate statistical adjustment for differences.
Class II: Prospective matched group cohort study in a representative population with masked outcome assessment that meets a–d above OR a RCT in a representative population that lacks one criterion a–d.
Class III: All other controlled trials (including well-defined natural history controls or patients serving as own controls) in a representative population, where outcome assessment is independent of patient treatment.
Class IV: Evidence from uncontrolled studies, case series, case reports, or expert opinion.