Andres M Kanner1, Eric Ashman2, David Gloss3, Cynthia Harden4, Blaise Bourgeois5, Jocelyn F Bautista6, Bassel Abou-Khalil7, Evren Burakgazi-Dalkilic8, Esmeralda Llanas Park9, John Stern10, Deborah Hirtz11, Mark Nespeca12, Barry Gidal13, Edward Faught14, Jacqueline French15. 1. 1Miller School of Medicine, University of Miami, FL. 2. 2Bronson Neuroscience Center, Bronson Methodist Hospital, Kalamazoo, MI. 3. 3Department of Neurology, Charleston Area Medical Center, Charleston, WV. 4. 4Department of Neurology, Mount Sinai Beth Israel, New York, NY. 5. 5Children's Hospital, Harvard Medical School, Boston, MA. 6. 6Epilepsy Center, Cleveland Clinic Foundation, OH. 7. 7Department of Neurology, Vanderbilt University, Nashville, TN. 8. 8Department of Neurology, Cooper Medical School, Rowan University, Cherry Hill, NJ. 9. 9AMITA Health Medical Group, Hoffman Estates, IL. 10. 10School of Medicine, University of California, Los Angeles. 11. 11School of Medicine, University of Vermont, Burlington. 12. 12Children's Hospital, University of California San Diego School of Medicine. 13. 13School of Pharmacy, University of Wisconsin, Madison. 14. 14School of Medicine, Emory University, Atlanta, GA. 15. 15Department of Neurology, New York University Langone Comprehensive Epilepsy Center, New York.
Abstract
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.
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.
Authors: M M Guerreiro; U Vigonius; H Pohlmann; M L de Manreza; N Fejerman; S A Antoniuk; A Moore Journal: Epilepsy Res Date: 1997-06 Impact factor: 3.045
Authors: Tracy A Glauser; Avital Cnaan; Shlomo Shinnar; Deborah G Hirtz; Dennis Dlugos; David Masur; Peggy O Clark; Peter C Adamson Journal: Epilepsia Date: 2012-11-21 Impact factor: 5.864
Authors: Tracy A Glauser; Avital Cnaan; Shlomo Shinnar; Deborah G Hirtz; Dennis Dlugos; David Masur; Peggy O Clark; Edmund V Capparelli; Peter C Adamson Journal: N Engl J Med Date: 2010-03-04 Impact factor: 91.245
Authors: Eugene Ramsay; Edward Faught; Allan Krumholz; Dean Naritoku; Michael Privitera; Lesley Schwarzman; Lian Mao; Frank Wiegand; Joseph Hulihan Journal: Epilepsia Date: 2010-10 Impact factor: 5.864
Authors: J A French; A M Kanner; J Bautista; B Abou-Khalil; T Browne; C L Harden; W H Theodore; C Bazil; J Stern; S C Schachter; D Bergen; D Hirtz; G D Montouris; M Nespeca; B Gidal; W J Marks; W R Turk; J H Fischer; B Bourgeois; A Wilner; R E Faught; R C Sachdeo; A Beydoun; T A Glauser Journal: Neurology Date: 2004-04-27 Impact factor: 9.910
Authors: F G Gilliam; F Veloso; M A M Bomhof; S K Gazda; V Biton; J P Ter Bruggen; W Neto; C Bailey; G Pledger; S-C Wu Journal: Neurology Date: 2003-01-28 Impact factor: 9.910
Authors: Anthony G Marson; Asya M Al-Kharusi; Muna Alwaidh; Richard Appleton; Gus A Baker; David W Chadwick; Celia Cramp; Oliver C Cockerell; Paul N Cooper; Julie Doughty; Barbara Eaton; Carrol Gamble; Peter J Goulding; Stephen J L Howell; Adrian Hughes; Margaret Jackson; Ann Jacoby; Mark Kellett; Geoffrey R Lawson; John Paul Leach; Paola Nicolaides; Richard Roberts; Phil Shackley; Jing Shen; David F Smith; Philip E M Smith; Catrin Tudur Smith; Alessandra Vanoli; Paula R Williamson Journal: Lancet Date: 2007-03-24 Impact factor: 79.321
Authors: Kyle Morrow; Keith A Young; Shawn Spencer; Edgar Samuel Medina; Michaela A Marziale; Alejandro Sanchez; James A Bourgeois Journal: Proc (Bayl Univ Med Cent) Date: 2020-10-06