Levetiracetam in the management of epilepsy

Epilepsy is one of the commonest neurological conditions. For historical reasons, this condition is often managed in the UK by non-specialists. Treatment options have increased markedly in the last 15 years, with a resultant increase in the potential for better seizure control and an enhanced quality of life for patients with epilepsy

Levetiracetam, oxcarbazepine, remacemide and zonisamide for drug resistant localization-related epilepsy: a systematic review

Objective: To undertake a systematic review and meta-analysis of placebo controlled add-on trials of levetiracetam, oxcarbazepine, remacemide and zonisamide for patients with drug resistant localization related epilepsy. Methods: We searched Medline, The Cochrane Library and contacted the relevant pharmaceutical companies. Outcomes were 50% or greater reduction in seizure frequency and treatment withdrawal for any reason. Data were synthesised in a meta-analysis. The effect of dose was explored in regression models for levetiracetam and remacemide. Results: We found four trials (1023 patients) of levetiracetam, two (961) of oxcarbazepine, two (388) of remacemide and three (499) of zonisamide. Ignoring dose, the relative risks (95% CI) for a 50% response were 3.78 (2.62–5.44), 2.51 (1.88–3.33), 1.59 (0.91–2.97) and 2.46 (1.61–3.79), respectively. There was evidence for increasing effect with increasing dose for levetiracetam, oxcarbazepine and remacemide. The relative risks for treatment withdrawal were 1.21 (0.88–1.66), 1.72 (1.35–2.18), 1.90 (1.00–3.60) and 1.64 (1.02–2.62), respectively. Conclusions: These data suggest a useful effect for levetiracetam, oxcarbazepine and zonisamide. Levetiracetam has the more favourable ‘responder-withdrawal ratio’ followed by zonisamide and oxcarbazepine