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

Older broad-spectrum antiseizure medications

6 evidence topics · 6 sources

Position of valproate in the treatment sequence

“Sodium valproate was moved to a third-line add-on treatment option for focal seizures.” (opens the source at this quote in a new tab)

Pregnancy prevention conditions for valproate and topiramate

“These antiseizure medications should not be used in women and girls of childbearing potential unless the conditions of the Pregnancy Prevention Programme are fulfilled.” (opens the source at this quote in a new tab)

Efficacy levels of older broad-spectrum agents as initial monotherapy

“CBZ, LEV, PHT, and ZNS are established (level A); VPA is probably (level B); GBP, LTG, OXC, phenobarbital (PB), TPM, and vigabatrin (VGB) are possibly (level C); whereas clonazepam (CZP) and primidone (PRM) are potentially (level D) efficacious/effective as initial monotherapy for adults with newly diagnosed or untreated partial-onset seizures.” (opens the source at this quote in a new tab)

Adjunctive topiramate: pooled efficacy and withdrawal

“The RR for a 50% or greater reduction in seizure frequency with add-on topiramate compared to placebo was 2.71 (95% CI 2.05 to 3.59; 12 studies; high-certainty evidence).” (opens the source at this quote in a new tab)
“The proportion of participants achieving seizure freedom was also significantly increased with add-on topiramate compared to placebo (RR 3.67, 95% CI 1.79 to 7.54; 8 studies; moderate-certainty evidence).” (opens the source at this quote in a new tab)
“Treatment withdrawal was significantly higher for add-on topiramate compared to placebo (RR 2.37, 95% CI 1.66 to 3.37; 12 studies; high-certainty evidence).” (opens the source at this quote in a new tab)

Adjunctive zonisamide: pooled efficacy and withdrawal

“The overall RR with 95% confidence interval (CI) for at least a 50% reduction in seizure frequency for 300 mg to 500 mg/day of zonisamide compared to placebo was 1.90 (95% CI 1.63 to 2.22; 7 trials, 1371 participants; moderate-certainty evidence).” (opens the source at this quote in a new tab)
“The number needed to treat for an additional beneficial outcome was six (95% CI 4.1 to 6.8).” (opens the source at this quote in a new tab)
“The RR for treatment withdrawal for 300 mg to 500 mg/day of zonisamide compared to placebo was 1.59 (95% CI 1.18 to 2.13; 6 trials, 1099 participants; moderate-certainty evidence)” (opens the source at this quote in a new tab)

Teratogenic risk restricting use

“Valproate, phenobarbital, and topiramate increase the risk of major congenital malformations in babies born to people with epilepsy and should therefore be avoided in those planning to conceive or who are pregnant” (opens the source at this quote in a new tab)