Expanding Antiepileptic Drug Options: Clinical Efficacy of New Therapeutic Agents

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Abstract
Summary: Results of double‐blind, placebo‐controlled, add‐on trials of topiramate (TPM), lamotrigine (LTG), and vigabatrin (VGB) in refractory partial epilepsy were reviewed. In three European multicenter studies of TPM, the clinical efficacy of 400–, 600–, and 800‐mg/day target dosages was demonstrated. In a similarly designed United States trial, LTG was significantly superior to placebo at a 500‐mg/day dosage but not at a 300‐mg/day dosage. A meta‐analysis of a number of smaller trials of VGB suggests that a ≥50% reduction in seizures is observed in approximately 45% of patients with refractory partial epilepsy. All of these newer antiepileptic drugs have shown efficacy in well‐controlled trials and should contribute significantly to our ability to manage partial epilepsy.