Prevention of generalized tonic-clonic seizures in refractory focal epilepsy: a meta-analysis

Details

Serval ID
serval:BIB_1658610F0F40
Type
Article: article from journal or magazin.
Collection
Publications
Title
Prevention of generalized tonic-clonic seizures in refractory focal epilepsy: a meta-analysis
Journal
Epilepsia
Author(s)
Hemery C., Ryvlin P., Rheims S.
ISSN
1528-1167 (Electronic)
ISSN-L
0013-9580
Publication state
Published
Issued date
11/2014
Volume
55
Number
11
Pages
1789-99
Language
english
Notes
Hemery, Claire
Ryvlin, Philippe
Rheims, Sylvain
eng
Meta-Analysis
Epilepsia. 2014 Nov;55(11):1789-99. doi: 10.1111/epi.12765. Epub 2014 Sep 2.
Abstract
OBJECTIVES: Secondary generalized tonic-clonic seizures (SGTCS) are among the most severe forms of seizures, and the main risk factor for sudden unexpected death in epilepsy (SUDEP). Whether some antiepileptic drugs (AEDs) might be more efficacious than others on SGTCS in patients with drug-resistant focal epilepsy thus represents an important clinical issue for which no data are currently available. METHODS: We performed a meta-analysis of randomized controlled trials of adjunctive AED in which information on efficacy outcomes (i.e., responder rate and/or frequency per 28 days relative to baseline) were available both for all seizure types and for SGTCS. The primary analysis evaluated the efficacy of AEDs on all types of seizure and on SGTCS by comparing the responder rates for AED and for placebo. RESULTS: Responder rate was available both for all seizure types and for SGTCS in 13 of the 72 eligible trials, evaluating 7 AEDs. Only three AEDs--lacosamide, perampanel and topiramate--showed greater efficacy than placebo. However, confidence intervals of relative risks overlapped for all AEDs but pregabalin, which demonstrated significantly lower efficacy than lacosamide, perampanel, and topiramate. Moreover, there was a nonsignificant trend toward a lower relative risk of responder rate for SGTCS than for all seizure types, which appeared related to a greater response to placebo for this outcome. SIGNIFICANCE: Indirect comparison of AEDs using randomized placebo-controlled add-on trials does not support robust differences between AEDs to prevent SGTCS. Alternative designs for evaluation of therapeutic interventions in patients at risk for SGTCS-related complications are required.
Keywords
Acetamides/therapeutic use, Anticonvulsants/*therapeutic use, Chronic Disease, Death, Sudden/prevention & control, *Early Medical Intervention, Epilepsies, Partial/complications/*drug therapy, Fructose/analogs & derivatives/therapeutic use, Humans, Pyridones/therapeutic use, *Randomized Controlled Trials as Topic, Recurrence, Risk Factors, Seizures/complications/drug therapy/*prevention & control, Treatment Outcome, Antiepileptic drugs, Epilepsy, Generalized tonic-clonic seizures, Meta-analysis, Sudden unexpected death in epilepsy
Pubmed
Open Access
Yes
Create date
29/11/2018 12:36
Last modification date
20/08/2019 12:45
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