TONIC-CLONIC SEIZURES - A SYSTEMATIC, REVIEW OF ANTIEPILEPSY DRUG EFFICACY AND SAFETY

This systematic review of studies of patients with generalized tonic-c lonic seizures is an effort to evaluate whether one therapeutic agent is superior to another in terms of reducing seizures and tolerability. Recognizing that assessing relative efficacy is dependent on controll ing the specific type of seizure or epilepsy treated, we restricted ou r review to studies in which the seizure types were clearly identified . Overall, complete control of generalized tonic-clonic seizures was a chieved in 53% of treated patients. The percentage of patients who bec ame seizure free was not significantly different with carbamazepine, p henytoin, or valproate. When patients who had a partial onset of their generalized tonic-clonic seizures were grouped, complete control was achieved in 48% with carbamazepine, 49% with phenytoin, and 52% with v alproate. Overall, carbamazepine, phenytoin, and valproate appear to h ave similar efficacy in the treatment of tonic-clonic seizures, with c omplete control reported in 51%, 50%, and 55% of patients, respectivel y. The best response in primary generalized seizures was with valproat e, with 61% reported as seizure free. Acute and dose-related central n ervous system side effects occurred with equal frequency with carbamaz epine, phenytoin, and valproate treatment. These side effects diminish ed after chronic exposure. Overall, 9.9% of patients discontinued trea tment due to adverse effects. The lowest incidences of clinically impo rtant side effects and rash were reported in patients treated with val proate. Key words: tonic-clonic seizures, efficacy, adverse effects, r eview antiepileptic drug.