Studies rate best drugs for epilepsyLamotrigine (Lamictal) is the drug of choice for epilepsy patients with partial-onset seizures, but valproate (Depakote) ranks first for most patients with generalized and unclassified seizures, head-to-head studies show.

In two randomized, controlled, multicenter, government-sponsored trials, doctors in the United Kingdom compared many commonly used epilepsy drugs (Lancet. 2007;369:1000-1015 and 1016-1026). In the first study, 1,721 patients with partial-onset seizures randomly received one of five agents—gabapentin (Neurontin), carbamazepine (Tegretol), oxcarbazepine (Trileptal), lamotrigine, or topiramate (Topamax). Lamotrigine proved to be the most effective, even beating out carbamazepine, currently the first-line therapy.

The companion study for generalized and unclassifiable epilepsy included 716 patients who were randomly given valproate, lamotrigine, or topiramate. Valproate proved to be “better tolerated than topiramate and more efficacious than lamotrigine,” retaining its long-held position as the drug of choice among broad-spectrum epilepsy medications. And even though valproate “has potential side effects during pregnancy, the benefits of seizure control in women of childbearing years should be considered,” the researchers said.

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