Multicentre, double-blind, randomised comparison between lamotrigine and carbamazepine in elderly patients with newly diagnosed epilepsy

In a multicentre, double-blind trial 150 elderly patients (mean age 77 year s) with newly diagnosed epilepsy were randomised in a 2:1 ratio to treatmen t with lamotrigine (LTG) or carbamazepine (CBZ). Following a short titratio n period, the dosage was individualised for each patient while maintaining the blind over the next 24 weeks. The main difference between the groups wa s the rate of drop-out due to adverse events (LTG 18% versus CBZ 42%). This was in part a consequence of the lower rash rate with LTG (LTG 3%, CBZ 19% ; 95% CI 7-25%). LTG-treated patients also complained less frequently of so mnolence (LTG 12%, CBZ 29%; 95% CI 4-30%). Although there was no difference between the drugs in time to first seizure, a greater percentage of LTG-tr eated patients remained seizure-free during the last 16 weeks of treatment (LTG 39%, CBZ 21%; P = 0.027). Overall, more patients continued on treatmen t with LTG than CBZ (LTG 71%, CBZ 42%; P < 0.001) for the duration of the s tudy. The hazard ratio for withdrawal was 2.4 (95% CI 1.4-4.0) indicating t hat a patient treated with CBZ was more than twice as likely to come off me dication than one taking LTG. In conclusion, LTG can be regarded as an acce ptable choice as initial treatment for elderly patients with newly diagnose d epilepsy. (C) 1999 Elsevier Science B.V. All rights reserved.