Name: Azetukalner (XEN1101) in Focal onset seizures: GABAergic medications
Published: 2026-09-21T21:41:53-04:00

Product information and disease description Place of product in therapy Approaches to treatment Current treatment options and standard of care

GABAergic medications

5 evidence topics · 5 sources

Position in the third-line add-on tier

“If second-line add-on treatments tried are unsuccessful in people with focal seizures, consider 1 of the following third-line add-on treatment options:” (opens the source at this quote in a new tab)
“If the first choice is unsuccessful, consider the other third-line add-on options.” (opens the source at this quote in a new tab)

Vigabatrin and rufinamide in treatment-resistant focal epilepsy

“VGB and RFN should be considered established as effective for decreasing seizure frequency in TRAFE (Level A) but are not first-line agents (retinopathy risk with VGB and modest benefit with RFN).” (opens the source at this quote in a new tab)
“Clobazam and OXC-XR use may be considered to decrease seizure frequency in TRAFE (Level C).” (opens the source at this quote in a new tab)

Vigabatrin is not first-line in new-onset focal epilepsy

“VGB use appears to be less efficacious than CBZ-IR use and may not be offered (Level C); furthermore, toxicity profile precludes VGB use as first-line therapy” (opens the source at this quote in a new tab)

Adjunctive tiagabine: pooled efficacy and withdrawal

“The overall risk ratio (RR) with 95% confidence intervals (CIs) for a 50% or greater reduction in seizure frequency (tiagabine versus placebo) was 3.16 (95% CI 1.97 to 5.07; 3 trials; 769 participants; high-certainty evidence).” (opens the source at this quote in a new tab)
“The RR for treatment withdrawal (tiagabine versus placebo) was 1.81 (95% CI 1.25 to 2.62; 3 trials, 769 participants; moderate-certainty evidence).” (opens the source at this quote in a new tab)
“Tiagabine reduced seizure frequency but was associated with some adverse effects when used as an add-on treatment in people with drug-resistant focal epilepsy.” (opens the source at this quote in a new tab)

Vigabatrin: mechanism, vision loss, and restricted distribution

“Vigabatrin is an irreversible inhibitor of gamma-amino-butyric acid transaminase (GABA-T), an enzyme that degrades GABA, an inhibitory neurotransmitter.” (opens the source at this quote in a new tab)
“Vigabatrin can cause permanent bilateral concentric visual field constriction (ie, tunnel vision), which may lead to disability and reduced visual acuity.” (opens the source at this quote in a new tab)
“Vigabatrin is available only through a restricted program called the Risk Evaluation and Mitigation Strategy (REMS).” (opens the source at this quote in a new tab)