TY - JOUR
T1 - Practice guideline update summary
T2 - Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy
AU - Kanner, Andres M.
AU - Ashman, Eric
AU - Gloss, David
AU - Harden, Cynthia
AU - Bourgeois, Blaise
AU - Bautista, Jocelyn F.
AU - Abou-Khalil, Bassel
AU - Burakgazi-Dalkilic, Evren
AU - Park, Esmeralda Llanas
AU - Stern, John
AU - Hirtz, Deborah
AU - Nespeca, Mark
AU - Gidal, Barry
AU - Faught, Edward
AU - French, Jacqueline
N1 - Funding Information:
This practice guideline was developed with financial support from the American Academy of Neurology (AAN). Authors who serve or served as AAN subcommittee members or methodologists (A.M.K., E.A., D.G., C.H., D.H., and J.F.) were reimbursed by the AAN for expenses related to travel to subcommittee meetings where drafts of manuscripts were reviewed.
Funding Information:
C. Harden receives royalties from UpToDate and Wiley; serves on the speakers bureau for UBC; and has received research support from the National Institute of Neurological Disorders and Stroke (NINDS) of the NIH and the Epilepsy Therapy Project.
Funding Information:
J. Bautista serves on the National Quality Forum Neurology Steering Committee and the Neurology Endorsement Maintenance Committee and has received research funding from the NIH and NINDS.
Funding Information:
B. Abou-Khalil has served on but declined honoraria from scientific advisory boards for Sunovion and GlaxoSmithKline; served on the editorial board for Epilepsy Research and Clinical Neurophysiology; and received royalties for Atlas of EEG & Seizure Semiology. His institution received research support from UCB, GlaxoSmithKline, Valeant, Sunovion, Upsher-Smith, Pfizer, Cy-beronics, and SK Life Science, from the NIH for the Epilepsy Phe-nome/Genome Project and from the Human Epilepsy Project.
Funding Information:
J. French receives New York University salary support from the Epilepsy Foundation and for consulting work on behalf of the Epilepsy Study Consortium for Eisai, GlaxoSmithKline, No-vartis, Pfizer, Sunovion, UCB, and Upsher Smith; has received research grants from Eisai Medical Research, Lundbeck, Pfizer, Sunovion, and UCB; has received grants from the Epilepsy Research Foundation, Epilepsy Study Consortium, Epilepsy Therapy Project, and the NINDS of the NIH; serves on the editorial boards of Lancet Neurology, Neurology Today, and Epileptic Disorders; serves as scientific officer for the Epilepsy Foundation for which New York University receives salary support; and has received travel reimbursement related to research, advisory meetings, or presentation of results at scientific meetings from the Epilepsy Study Consortium, the Epilepsy Foundation, Eisai, GlaxoSmithKline, Pfizer, UCB, and Upsher-Smith.
Publisher Copyright:
© 2018, American Epilepsy Society.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Objective: To update the 2004 American Academy of Neurology (AAN) guideline for treating new-onset focal or generalized epilepsy (GE) with second- and third-generation antiepileptic drugs (AEDs). Methods: The 2004 AAN criteria was used to systematically review literature (January 2003 to November 2015), classify pertinent studies according to the therapeutic rating scheme, and link recommendations to evidence strength. Results: Several second-generation AEDs are effective for new-onset focal epilepsy. Data are lacking on efficacy in new-onset generalized tonic-clonic seizures, juvenile myoclonic epilepsy, or juvenile absence epilepsy, and on efficacy of third-generation AEDs in new-onset epilepsy. Recommendations: Lamotrigine (LTG) should (Level B) and levetiracetam (LEV) and zonisamide (ZNS) may (Level C) be considered in decreasing seizure frequency in adults with new-onset focal epilepsy. LTG should (Level B) and gabapentin (GBP) may (Level C) be considered in decreasing seizure frequency in patients =60 years with new-onset focal epilepsy. Unless there are compelling adverse-effect-related concerns, ethosuximide (ETS) or valproic acid (VPA) should be considered before LTG to decrease seizure frequency in treating absence seizures in childhood absence epilepsy (Level B). No high-quality studies suggest clobazam, eslicarbazepine, ezogabine, felbamate, GBP, lacosamide, LEV, LTG, oxcarbazepine, perampanel, pregabalin, rufinamide, tiagabine, topiramate, vigabatrin, or ZNS is effective in treating new-onset epilepsy because no high-quality studies exist in adults of various ages. A recent FDA strategy allows extrapolation of efficacy across populations; therefore, for focal epilepsy, eslicarbazepine and lacosamide (oral only for pediatric use) as add-on or monotherapy in persons =4 years old and perampanel as monotherapy received FDA approval.
AB - Objective: To update the 2004 American Academy of Neurology (AAN) guideline for treating new-onset focal or generalized epilepsy (GE) with second- and third-generation antiepileptic drugs (AEDs). Methods: The 2004 AAN criteria was used to systematically review literature (January 2003 to November 2015), classify pertinent studies according to the therapeutic rating scheme, and link recommendations to evidence strength. Results: Several second-generation AEDs are effective for new-onset focal epilepsy. Data are lacking on efficacy in new-onset generalized tonic-clonic seizures, juvenile myoclonic epilepsy, or juvenile absence epilepsy, and on efficacy of third-generation AEDs in new-onset epilepsy. Recommendations: Lamotrigine (LTG) should (Level B) and levetiracetam (LEV) and zonisamide (ZNS) may (Level C) be considered in decreasing seizure frequency in adults with new-onset focal epilepsy. LTG should (Level B) and gabapentin (GBP) may (Level C) be considered in decreasing seizure frequency in patients =60 years with new-onset focal epilepsy. Unless there are compelling adverse-effect-related concerns, ethosuximide (ETS) or valproic acid (VPA) should be considered before LTG to decrease seizure frequency in treating absence seizures in childhood absence epilepsy (Level B). No high-quality studies suggest clobazam, eslicarbazepine, ezogabine, felbamate, GBP, lacosamide, LEV, LTG, oxcarbazepine, perampanel, pregabalin, rufinamide, tiagabine, topiramate, vigabatrin, or ZNS is effective in treating new-onset epilepsy because no high-quality studies exist in adults of various ages. A recent FDA strategy allows extrapolation of efficacy across populations; therefore, for focal epilepsy, eslicarbazepine and lacosamide (oral only for pediatric use) as add-on or monotherapy in persons =4 years old and perampanel as monotherapy received FDA approval.
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U2 - 10.5698/1535-7597.18.4.260
DO - 10.5698/1535-7597.18.4.260
M3 - Article
AN - SCOPUS:85052096998
VL - 18
SP - 260
EP - 268
JO - Epilepsy Currents
JF - Epilepsy Currents
SN - 1535-7597
IS - 4
ER -