my personal edition > epilepsy > news


  E-Mail this DGReview to a colleague

DGReview

Lamotrigine, Topiramate Effective Equally To Valproic Acid For Treatment Of Juvenile Myoclonic Epilepsy

Lamotrigine and topiramate are effective alternative options to valproic acid for treatment of juvenile myoclonic epilepsy.

Valproic acid is the drug of choice for the treatment of juvenile myoclonic epilepsy (JME). Carbamazepine and phenytoin, traditionally used as supplemental therapy for additional control of generalised tonic-clonic (GTC) seizures, may actually worsen seizure control, according to recent reports, and lamotrigine and topiramate have been suggested as alternatives.

Avinash Prasad, M.D., of the University of Alabama School of Medicine, United States, and colleagues performed a retrospective cohort study comparing the efficacy of valproic acid, lamotrigine, and topiramate as monotherapy and polytherapy in the treatment of JME. In addition, their efficacy and tolerability were compared to phenytoin and carbamazepine.

The study group included 72 patients (age, 21 to 55; 45 females) who received valproic acid, lamotrigine, topiramate, phenytoin, or carbamazepine monotherapy or polytherapy as treatment for JME between 1991 and 2001. Efficacy of treatment was defined as control of GTC, myoclonic and absence seizures.

No difference in seizure control was detected between patients receiving valproic acid (n=36) or lamotrigine (n=14) monotherapy, or when patients receiving valproic acid (n=22), lamotrigine (n=21), and topiramate (n=15) polytherapy were compared (P>0.05 for all). Topiramate monotherapy was not included in the comparative analysis due to the inadequate number or patients.

Valproic acid, lamotrigine, and topiramate did not differ significantly for control of GTC, myoclonic and absence seizures (P>0.02). However, the combined data for myoclonic seizure control by all 3 treatments were poorer than GTC seizure control (P=0.03), but not when compared to absence seizure control (P=0.43).

Valproic acid, lamotrigine, and topiramate demonstrated significantly better control of myoclonic seizures (P<0.01), but not GTC seizures (P>0.11), compared to phenytoin or carbamazepine.
"Our data suggest that older anti-epileptic drugs...may not be indicated in JME patients because newer [ones], such as lamotrigine and topiramate, offer advantages with regard to improved myoclonic seizure control," the researchers conclude.
Arch Neurol 2003 Aug;60:8:1100-1105. "Evolving Antiepileptic Drug Treatment in Juvenile Myoclonic Epilepsy"

E-Mail this DGReview to a colleague

To print, use this version