Comparative effectiveness of levetiracetam, valproate and carbamazepine among elderly patients with newly diagnosed epilepsy: subgroup analysis of the randomized, unblinded KOMET study

Pohlmann‐Eden, Bernd; Marson, Anthony G; Noack‐Rink, Matthias; Ramirez, Francisco C.; Tofighy, Azita; Werhahn, Konrad J.; Wild, Imane; Trinka, Eugen

doi:10.1186/s12883-016-0663-7

Cited by 56 publications

(54 citation statements)

References 40 publications

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“…These were counted as two separate studies in our narrative synthesis. Three studies were post hoc analyses that pooled elderly participants’ data from previous randomized‐controlled trials . Two studies conducted on younger participants provided sufficient data about individuals older than 65 years to be analyzed separately as a subgroup .…”

Section: Resultsmentioning

confidence: 99%

“…The raw primary data are outlined in Table S1. Studies examined the efficacy of brivaracetam (BRV), 33 carbamazepine (CBZ), 20,21,23,31,32,[35][36][37][38]40 gabapentin (GBP), 23 lacosamide (LAC), 35 levetiracetam (LEV), 20,21,37,39,41 lamotrigine (LTG), 21,23,31,32,36,[38][39][40][41] perampanel (PER), 34 phenobarbital (PB), 39 phenytoin (PHT), 42 topiramate (TPM), 22,43 valproic acid (VPA), 20,42 and zonisamide (ZNS). 44…”

Section: Narrative Synthesis Of the Resultsmentioning

confidence: 99%

“…There is disagreement between studies on whether there is a difference in the probability of trial discontinuation (for any reason) between LEV and CBZ. Individual studies have shown better tolerability of LEV in the elderly when compared with CBZ, as shown by a lower probability of trial discontinuation in new onset epilepsy (not included in our meta‐analysis because of significant heterogeneity between studies) . One study of poststroke epilepsy showed a lower probability of AEs for those treated with LEV as opposed to CBZ .…”

Section: Discussionmentioning

confidence: 96%

“…Individual studies have shown better tolerability of LEV in the elderly when compared with CBZ, as shown by a lower probability of trial discontinuation in new onset epilepsy (not included in our meta-analysis because of significant heterogeneity between studies). 20,21,37 One study of poststroke epilepsy showed a lower probability of AEs for those treated with LEV as opposed to CBZ. 37 Our meta-analysis additionally failed to demonstrate a significant difference in the probability of any AE for this comparison.…”

Section: Discussionmentioning

confidence: 99%

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The medical treatment of epilepsy in the elderly: A systematic review and meta‐analysis

et al. 2019

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Objective To evaluate the efficacy and tolerability of antiepileptic drugs (AEDs) in elderly individuals with epilepsy. Methods We searched four electronic databases as well as bibliographies and conference abstracts. Published and unpublished, randomized, or quasirandomized trials reporting the use of AEDs in people aged at least 60 years with epilepsy were eligible for inclusion. Two authors independently carried out each stage of the review. Meta‐analyses were performed using random‐effects models. Results Three thousand four hundred seventeen titles and abstracts were reviewed. Eighteen studies evaluating 12 AEDs met all eligibility criteria. Ten studies, comprising 1999 subjects, were suitable for meta‐analysis. Among the elderly with epilepsy, lamotrigine (LTG) is better tolerated relative to carbamazepine (pooled weighted risk ratio [RR] of experiencing withdrawal due to adverse events = 1.83, 95% confidence interval [CI] = 1.23‐2.43). There is a higher probability, although with a 95% CI of borderline importance, of seizure freedom when comparing levetiracetam to LTG (RR = 0.83, 95% CI = 0.68‐0.97). Single studies provide evidence for the efficacy and/or tolerability of other AEDs in the elderly, including brivaracetam, gabapentin, lacosamide, perampanel, and topiramate. The risk of bias of the included studies was frequently low or unclear, although there was on occasion a high risk of bias (especially with regard to selective reporting). Significance There is some evidence for AED use in the elderly with epilepsy. More evidence is required, comparing newer AEDs to prior generations as well as examining the effects of determinants such as frailty, to guide clinicians when treating this rapidly growing patient population.

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Section: Resultsmentioning

confidence: 99%

Section: Narrative Synthesis Of the Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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The medical treatment of epilepsy in the elderly: A systematic review and meta‐analysis

et al. 2019

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“…We systematically searched and critically appraised the efficacy and tolerability of AEDs used for treating post-stroke seizures, relying on data from RCTs. Several RCTs have assessed the role of different AEDs in elderly with epilepsy of various etiologies, including stroke [24][25][26][27][28][29][30][31]. However, it is somewhat astonishing that so far only two RCTs have specifically evaluated AEDs in post-stroke seizures, despite cerebrovascular disease is one of the most common causes of acquired epilepsy in adults and elderly [1].…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled trials of antiepileptic drugs for the treatment of post-stroke seizures: A systematic review with network meta-analysis

Brigo

Lattanzi

Zelano

et al. 2018

Seizure

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New-Onset Seizure in Adults and Adolescents

Gavvala

Schuele

2016

JAMA

101

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nance imaging (MRI) of the brain, 5,6 emphasizing the importance of access to and quality of additional testing. This review will focus on the evaluation of new-onset seizure in adults and adolescents, which includes history and physical examination, the differential diagnosis, characteristic features of each etiology, and features of a rational diagnostic workup. The choice of treatment includes discussion of the consideration of efficacy, adverse effects, dosing, and patient counseling. MethodsThe literature published through November 2016 was reviewed by searching PubMed. The following keywords were used: epilepsy, first time seizure, unprovoked seizures, first time unprovoked seizure, acute symptomaticseizure,antiepileptictreatment,seizureepidemiology,epilepsy epidemiology, women with epilepsy, epilepsy in the elderly, sudden unexplained death in epilepsy, and refractory epilepsy. No language restriction was applied. Review articles, primary literature, and meta-analysis were included in this review. Articles were reviewed if they were published between 1976 and 2016. Articles were rated using IMPORTANCE Approximately 8% to 10% of the population will experience a seizure during their lifetime. Only about 2% to 3% of patients go on to develop epilepsy. Understanding the underlying etiology leading to an accurate diagnosis is necessary to ensure appropriate treatment and that patients with low risk for recurrence are not treated unnecessarily.OBSERVATIONS Patients can present with new-onset seizure for a variety of reasons such as acute symptomatic seizures due to acute brain injury or metabolic derangements, or unprovoked seizures that are the initial manifestation of epilepsy. A patient history and physical examination may identify features more consistent with an epileptic event and laboratory studies and brain imaging can identify an acute insult contributing to the presentation. Patients diagnosed with first-time unprovoked seizure require electroencephalography and epilepsy protocol-specific magnetic resonance imaging of the brain, which includes thin-cut coronal slices to determine risk of recurrence and the need for long-term treatment. In patients who meet the criteria for diagnosis of epilepsy, a carefully selected antiepileptic medication with consideration of comorbidities, adverse effect profile, and type of epilepsy is essential along with appropriate counseling.CONCLUSIONS AND RELEVANCE Approximately 3% of the population will develop epilepsy but 2 to 3 times as many patients will experience a single seizure or seizure-like event. A diagnosis of epilepsy has significant medical, social, and emotional consequences. A careful patient history and physical examination, electroencephalography, and brain imaging are necessary to separate patients with acute symptomatic seizures, single unprovoked seizures, and nonepileptic events from those with new-onset epilepsy.

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Comparative effectiveness of levetiracetam, valproate and carbamazepine among elderly patients with newly diagnosed epilepsy: subgroup analysis of the randomized, unblinded KOMET study

Cited by 56 publications

References 40 publications

The medical treatment of epilepsy in the elderly: A systematic review and meta‐analysis

The medical treatment of epilepsy in the elderly: A systematic review and meta‐analysis

Randomized controlled trials of antiepileptic drugs for the treatment of post-stroke seizures: A systematic review with network meta-analysis

New-Onset Seizure in Adults and Adolescents

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