Treatment of epilepsy in adults: Expert opinion in China

Yu, Peimin; Zhu, Guangfa; Ding, Ding; Xu, Lan; Zhao, Ting; Tang, Xiaolin; Shi, Yunbo; Zhao, Hong

doi:10.1016/j.yebeh.2011.10.018

Cited by 17 publications

(7 citation statements)

References 9 publications

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“…More recently, a retrospective analysis of 2008‐2010 US Medicare claims demonstrated that the most commonly prescribed initial AED was LEV (45.5%) followed by PHT (30.6%) . Similarly, epilepsy expert opinion studies, conducted in European and Asian countries in the past 10 years, showed a rising preference to prescribe newer AEDs (LTG, LEV, GBP, CBZ, oxcarbazepine) in the elderly with new onset epilepsy.…”

Section: Discussionmentioning

confidence: 99%

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 Published and unpublished, randomized, or quasirandomized trials reporting the use of AEDs in people aged at least 60 years with epilepsy were eligible for inclusion.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: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…However, patients taking part in the trials used for the development of these evidence‐based guidelines were largely from Western populations. In contrast, a survey of 49 experts in tertiary hospitals in China identified valproate as the treatment of choice for initial monotherapy and lamotrigine as second monotherapy for patients with idiopathic generalized epilepsy, whereas topiramate and LEV were treatments of choice for patients with idiopathic generalized epilepsy and concomitant hepatitis B . Clinical guidelines from the Japanese Society of Neurology in 2010 also recommend valproate for monotherapy in new‐onset generalized epilepsy…”

Section: Discussionmentioning

confidence: 99%

Adjunctive levetiracetam in the treatment of Chinese and Japanese adults with generalized tonic–clonic seizures: A double‐blind, randomized, placebo‐controlled trial

Yagi

Hong

et al. 2018

Epilepsia Open

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SummaryObjectiveTo assess the efficacy, safety, and tolerability of adjunctive levetiracetam (LEV) in Chinese and Japanese adults with generalized tonic–clonic (GTC) seizures (N01159; NCT01228747).MethodsThis double‐blind, randomized, placebo‐controlled, multicenter phase III trial comprised: 4‐week retrospective and 4‐week prospective baseline, 12‐week dose‐adjustment, and 16‐week evaluation periods. Chinese and Japanese patients ≥16 years old with idiopathic generalized, symptomatic generalized, or undetermined epilepsy with GTC seizures received a single‐blind placebo during the prospective baseline, and then were randomized 1:1 to placebo or LEV 1,000 mg/day administered twice daily. Patients reporting GTC seizures up to week 8 had the LEV dosage increased to 3,000 mg/day. The primary efficacy variable was percent reduction from combined baseline in GTC seizures/week during the 28‐week treatment period.ResultsOverall, 251 patients were randomized (208 from China; 43 from Japan); 141 (56.2%) completed the 28‐week treatment period. Least‐squares mean percent reduction from combined baseline in GTC seizures/week (treatment period) was placebo 12.6% versus LEV 68.8% (95% confidence interval, 44.0–68.2; p < 0.0001). GTC seizure frequency reduction occurred in both patients with idiopathic and symptomatic generalized epilepsy. The 50% responder rate (treatment period) was placebo 28.4% versus LEV 77.8%. Freedom from GTC seizures (evaluation period) was placebo 3.1% versus LEV 29.6%. Incidence of treatment‐emergent adverse events (TEAEs; treatment period) was placebo 52.0% versus LEV 57.1%; most frequently nasopharyngitis, protein in urine, decreased platelet count, and pyrexia. Incidence of TEAEs leading to discontinuation was 4.8% versus 3.2%; incidence of serious TEAEs was 3.2% versus 0.8% for placebo and LEV, respectively; 3 patients taking placebo died versus none taking LEV.SignificanceIn this trial, adjunctive LEV 1,000–3,000 mg/day was effective in reducing GTC seizure frequency in Chinese and Japanese patients ≥16 years old with GTC seizures. Seizure reduction occurred in both patients with idiopathic and symptomatic generalized epilepsy. LEV was well tolerated in this population.

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“…45 Epilepsy expert opinion studies, from Europe and Asia in the past decade have shown an increasing preference to prescribe newer AEDs in the elderly. [46][47][48] The most commonly prescribed initial AED was Levetiracetam (45.5%) followed by Phenytoin (30.6%). 49…”

Section: Studies With Focal and Generalized Epilepsymentioning

confidence: 99%

Recent updates on Levetiracetam

Panchal¹,

Uppal²,

Uppal³

2022

IJN

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To review recent clinical evidence available for levetiracetam in the treatment of various types of epileptic seizures. A literature search was conducted to identify clinical studies conducted after 2015 with Levetiracetam. In patients with focal epilepsy, Levetiracetam was found to be as effective as Carbamazepine, Clobazam, and Valproic acid but with better tolerability than Carbamazepine. Levetiracetam could be used as monotherapy in the treatment of new-onset focal epilepsy. It probably has a neuroprotective benefit, particularly important in neonates and children. The safety and tolerability of Levetiracetam are more apparent during pregnancy. Thus, the adverse event profile is largely in favor of Levetiracetam in comparison to standard older AEDs. Meta-analysis has confirmed that Levetiracetam is significantly better in terms of withdrawal rates compared to the older AEDs, hence may be considered as the first line in new-onset focal epilepsy in adults and the elderly. Levetiracetam may be a better option as an add-on treatment in children with partial seizures, due to its favorable efficacy and insignificant toxicity than Oxcarbazepine and Topiramate. Recent evidence suggests that Levetiracetam could be a potential first-choice, second-line AED for Benzodiazepine resistance status epilepticus with efficacy comparable to established older AEDs. It improves the quality of life due to higher rates of seizure freedom and favorable tolerability profile. Levetiracetam has the potential for being a first-line AED and has also proven to be a better adjunctive considering the recent efficacy and safety outcomes.

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Treatment of epilepsy in adults: Expert opinion in China

Cited by 17 publications

References 9 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

Adjunctive levetiracetam in the treatment of Chinese and Japanese adults with generalized tonic–clonic seizures: A double‐blind, randomized, placebo‐controlled trial

Recent updates on Levetiracetam

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