Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Acade

Andres M Kanner, Eric Ashman, David Gloss, Cynthia Harden, Blaise Bourgeois, Jocelyn F. Bautista, Bassel Abou-Khalil, Evren Burakgazi-Dalkilic, Esmeralda Llanas Park, John Stern, Deborah Hirtz, Mark Nespeca, Barry Gidal, Edward Faught, Jacqueline French

Research output: Contribution to journalArticle

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Abstract

Objective: To update the 2004 American Academy of Neurology (AAN) guideline for treating new-onset focal or generalized epilepsy with second- and third-generation antiepileptic drugs (AEDs). Methods: The 2004 AAN criteria were used to systematically review literature (January 2003-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 of age with new-onset focal epilepsy. Unless there are compelling adverse effect-related concerns, ethosuximide or valproic acid 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 Food and Drug Administration (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.

Original languageEnglish (US)
Pages (from-to)74-81
Number of pages8
JournalNeurology
Volume91
Issue number2
DOIs
StatePublished - Jan 1 2018

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Partial Epilepsy
Absence Epilepsy
Practice Guidelines
zonisamide
etiracetam
Anticonvulsants
Epilepsy
Guidelines
Seizures
felbamate
United States Food and Drug Administration
Juvenile Myoclonic Epilepsy
Ethosuximide
Vigabatrin
Therapeutics
Drug Approval
Generalized Epilepsy
Valproic Acid
Neurology
Pediatrics

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Practice guideline update summary : Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Acade. / Kanner, Andres M; Ashman, Eric; Gloss, David; Harden, Cynthia; Bourgeois, Blaise; Bautista, Jocelyn F.; Abou-Khalil, Bassel; Burakgazi-Dalkilic, Evren; Park, Esmeralda Llanas; Stern, John; Hirtz, Deborah; Nespeca, Mark; Gidal, Barry; Faught, Edward; French, Jacqueline.

In: Neurology, Vol. 91, No. 2, 01.01.2018, p. 74-81.

Research output: Contribution to journalArticle

Kanner, AM, Ashman, E, Gloss, D, Harden, C, Bourgeois, B, Bautista, JF, Abou-Khalil, B, Burakgazi-Dalkilic, E, Park, EL, Stern, J, Hirtz, D, Nespeca, M, Gidal, B, Faught, E & French, J 2018, 'Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Acade', Neurology, vol. 91, no. 2, pp. 74-81. https://doi.org/10.1212/WNL.0000000000005755
Kanner, Andres M ; Ashman, Eric ; Gloss, David ; Harden, Cynthia ; Bourgeois, Blaise ; Bautista, Jocelyn F. ; Abou-Khalil, Bassel ; Burakgazi-Dalkilic, Evren ; Park, Esmeralda Llanas ; Stern, John ; Hirtz, Deborah ; Nespeca, Mark ; Gidal, Barry ; Faught, Edward ; French, Jacqueline. / Practice guideline update summary : Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Acade. In: Neurology. 2018 ; Vol. 91, No. 2. pp. 74-81.
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