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Preliminary Comparison of Four Antiepileptics Finds Levetiracetam Superior for Intractable Epilepsy: Presented at AES

By Bonnie Darves

BOSTON, MA -- December 19, 2003 -- A large Dutch study found that levetiracetam is more effective than lamotrigene, topiramate or gabapentin in the treatment of patients with strongly therapy-resistant epilepsy.

Preliminary results of the study were reported here December 8^th at the American Epilepsy Society Annual Meeting.

To help determine which treatments might be the best alternative for patients who have failed initial therapy, Martijn Engelsman, MD, Nine de Beer-Pawlikowski Neurology, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands, and colleagues conducted a retrospective study of 1,080 patients treated at an outpatient epilepsy center in Utrecht.

Dr. Engelsman said that only patients who had initially failed lamotrigene were switched to one of the other drugs, per protocol.

The ongoing study included 456 patients on lamotrigene, 219 on topiramate, 166 on gabapentin, and 239 on levetiracetam. Most patients in the study were taking at least two additional antiepileptic agents at the time add-on therapy was initiated.

To date, 12.5% of the levetiracetam patients are seizure free, compared with 9.6% in the topiramate group, 7.7% in the lamotrigene group, and 7.3% of those on gabapentin. In addition, 35.6% of levetiracetam patients discontinued because of side effects or lack of efficacy, versus 57.5% of topiramate, 57.8% of gabapentin and 32.5% of lamotrigene patients.

Regarding the specific drugs' efficacy for specific seizure types, Dr. Engelsman noted that in preliminary analysis "no association was found between the more favourable outcomes and particular seizure types." He added that the centre's researchers will continue to follow the patients to determine whether therapy dropout rates change with longer-term treatment.


[Study title: Clinical Efficacy of Lamotrigine (LTG), Topiramate (TPM), Gabapentin (GBP) And Levetiracetam (LEV) in a Large Group of Strongly Therapy-Resistant Patients With Epilepsy. Abstract 1.280]

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