Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society

Andres M Kanner; Eric Ashman; David Gloss; Cynthia Harden; Blaise Bourgeois; Jocelyn F Bautista; Bassel Abou-Khalil; Evren Burakgazi-Dalkilic; Esmeralda Llanas Park; John Stern; Deborah Hirtz; Mark Nespeca; Barry Gidal; Edward Faught; Jacqueline French

doi:10.1212/WNL.0000000000005755

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Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society

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Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society

Andres M Kanner, Eric Ashman, David Gloss, Cynthia Harden, Blaise Bourgeois, Jocelyn F Bautista, Bassel Abou-Khalil, Evren Burakgazi-Dalkilic, Esmeralda Llanas Park, John Stern, …

Neurology, Vol.91(2), pp.74-81

2018-07-10

DOI: https://doi.org/10.1212/WNL.0000000000005755

PMID: 29898971

Abstract

Epilepsy, Generalized - drug therapy

Epilepsies, Partial - drug therapy

Humans

Seizures - drug therapy

Anticonvulsants - therapeutic use

Adult

Epilepsy, Absence - drug therapy

Child

To update the 2004 American Academy of Neurology (AAN) guideline for treating new-onset focal or generalized epilepsy with second- and third-generation antiepileptic drugs (AEDs). The 2004 AAN criteria were used to systematically review literature (January 2003-November 2015), classify pertinent studies according to the therapeutic rating scheme, and link recommendations to evidence strength. Several second-generation AEDs are effective for new-onset focal epilepsy. Data are lacking on efficacy in new-onset generalized tonic-clonic seizures, juvenile myoclonic epilepsy, or juvenile absence epilepsy, and on efficacy of third-generation AEDs in new-onset epilepsy. Lamotrigine (LTG) should (Level B) and levetiracetam (LEV) and zonisamide (ZNS) may (Level C) be considered in decreasing seizure frequency in adults with new-onset focal epilepsy. LTG should (Level B) and gabapentin (GBP) may (Level C) be considered in decreasing seizure frequency in patients ≥60 years of age with new-onset focal epilepsy. Unless there are compelling adverse effect-related concerns, ethosuximide or valproic acid should be considered before LTG to decrease seizure frequency in treating absence seizures in childhood absence epilepsy (level B). No high-quality studies suggest clobazam, eslicarbazepine, ezogabine, felbamate, GBP, lacosamide, LEV, LTG, oxcarbazepine, perampanel, pregabalin, rufinamide, tiagabine, topiramate, vigabatrin, or ZNS is effective in treating new-onset epilepsy because no high-quality studies exist in adults of various ages. A recent Food and Drug Administration (FDA) strategy allows extrapolation of efficacy across populations; therefore, for focal epilepsy, eslicarbazepine and lacosamide (oral only for pediatric use) as add-on or monotherapy in persons ≥4 years old and perampanel as monotherapy received FDA approval.

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Collaboration types: Domestic collaboration
Citation topics: 1 Clinical & Life Sciences; 1.222 Epilepsy & Seizures; 1.222.143 Epilepsy
Web Of Science research areas: Clinical Neurology
ESI research areas: Neuroscience & Behavior

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Title: Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society
Creators: Andres M Kanner - From the Miller School of Medicine (A.M.K.), University of Miami, FL; Bronson Neuroscience Center (E.A.), Bronson Methodist Hospital, Kalamazoo, MI; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Neurology (C.H.), Mount Sinai Beth Israel, New York, NY; Children's Hospital (B.B.), Harvard Medical School, Boston, MA; Epilepsy Center (J.F.B.), Cleveland Clinic Foundation, OH; Department of Neurology (B.A.-K.), Vanderbilt University, Nashville, TN; Department of Neurology (E.B.-D.), Cooper Medical School, Rowan University, Cherry Hill, NJ; AMITA Health Medical Group (E.L.P.), Hoffman Estates, IL; School of Medicine (J.S.), University of California, Los Angeles; School of Medicine (D.H.), University of Vermont, Burlington; Children's Hospital (M.N.), University of California San Diego School of Medicine; School of Pharmacy (B.G.), University of Wisconsin, Madison; School of Medicine (E.F.), Emory University, Atlanta, GA; and Department of Neurology (J.F.), New York University Langone Comprehensive Epilepsy Center, New York
Eric Ashman - From the Miller School of Medicine (A.M.K.), University of Miami, FL; Bronson Neuroscience Center (E.A.), Bronson Methodist Hospital, Kalamazoo, MI; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Neurology (C.H.), Mount Sinai Beth Israel, New York, NY; Children's Hospital (B.B.), Harvard Medical School, Boston, MA; Epilepsy Center (J.F.B.), Cleveland Clinic Foundation, OH; Department of Neurology (B.A.-K.), Vanderbilt University, Nashville, TN; Department of Neurology (E.B.-D.), Cooper Medical School, Rowan University, Cherry Hill, NJ; AMITA Health Medical Group (E.L.P.), Hoffman Estates, IL; School of Medicine (J.S.), University of California, Los Angeles; School of Medicine (D.H.), University of Vermont, Burlington; Children's Hospital (M.N.), University of California San Diego School of Medicine; School of Pharmacy (B.G.), University of Wisconsin, Madison; School of Medicine (E.F.), Emory University, Atlanta, GA; and Department of Neurology (J.F.), New York University Langone Comprehensive Epilepsy Center, New York
David Gloss - From the Miller School of Medicine (A.M.K.), University of Miami, FL; Bronson Neuroscience Center (E.A.), Bronson Methodist Hospital, Kalamazoo, MI; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Neurology (C.H.), Mount Sinai Beth Israel, New York, NY; Children's Hospital (B.B.), Harvard Medical School, Boston, MA; Epilepsy Center (J.F.B.), Cleveland Clinic Foundation, OH; Department of Neurology (B.A.-K.), Vanderbilt University, Nashville, TN; Department of Neurology (E.B.-D.), Cooper Medical School, Rowan University, Cherry Hill, NJ; AMITA Health Medical Group (E.L.P.), Hoffman Estates, IL; School of Medicine (J.S.), University of California, Los Angeles; School of Medicine (D.H.), University of Vermont, Burlington; Children's Hospital (M.N.), University of California San Diego School of Medicine; School of Pharmacy (B.G.), University of Wisconsin, Madison; School of Medicine (E.F.), Emory University, Atlanta, GA; and Department of Neurology (J.F.), New York University Langone Comprehensive Epilepsy Center, New York
Cynthia Harden - From the Miller School of Medicine (A.M.K.), University of Miami, FL; Bronson Neuroscience Center (E.A.), Bronson Methodist Hospital, Kalamazoo, MI; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Neurology (C.H.), Mount Sinai Beth Israel, New York, NY; Children's Hospital (B.B.), Harvard Medical School, Boston, MA; Epilepsy Center (J.F.B.), Cleveland Clinic Foundation, OH; Department of Neurology (B.A.-K.), Vanderbilt University, Nashville, TN; Department of Neurology (E.B.-D.), Cooper Medical School, Rowan University, Cherry Hill, NJ; AMITA Health Medical Group (E.L.P.), Hoffman Estates, IL; School of Medicine (J.S.), University of California, Los Angeles; School of Medicine (D.H.), University of Vermont, Burlington; Children's Hospital (M.N.), University of California San Diego School of Medicine; School of Pharmacy (B.G.), University of Wisconsin, Madison; School of Medicine (E.F.), Emory University, Atlanta, GA; and Department of Neurology (J.F.), New York University Langone Comprehensive Epilepsy Center, New York
Blaise Bourgeois - From the Miller School of Medicine (A.M.K.), University of Miami, FL; Bronson Neuroscience Center (E.A.), Bronson Methodist Hospital, Kalamazoo, MI; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Neurology (C.H.), Mount Sinai Beth Israel, New York, NY; Children's Hospital (B.B.), Harvard Medical School, Boston, MA; Epilepsy Center (J.F.B.), Cleveland Clinic Foundation, OH; Department of Neurology (B.A.-K.), Vanderbilt University, Nashville, TN; Department of Neurology (E.B.-D.), Cooper Medical School, Rowan University, Cherry Hill, NJ; AMITA Health Medical Group (E.L.P.), Hoffman Estates, IL; School of Medicine (J.S.), University of California, Los Angeles; School of Medicine (D.H.), University of Vermont, Burlington; Children's Hospital (M.N.), University of California San Diego School of Medicine; School of Pharmacy (B.G.), University of Wisconsin, Madison; School of Medicine (E.F.), Emory University, Atlanta, GA; and Department of Neurology (J.F.), New York University Langone Comprehensive Epilepsy Center, New York
Jocelyn F Bautista - From the Miller School of Medicine (A.M.K.), University of Miami, FL; Bronson Neuroscience Center (E.A.), Bronson Methodist Hospital, Kalamazoo, MI; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Neurology (C.H.), Mount Sinai Beth Israel, New York, NY; Children's Hospital (B.B.), Harvard Medical School, Boston, MA; Epilepsy Center (J.F.B.), Cleveland Clinic Foundation, OH; Department of Neurology (B.A.-K.), Vanderbilt University, Nashville, TN; Department of Neurology (E.B.-D.), Cooper Medical School, Rowan University, Cherry Hill, NJ; AMITA Health Medical Group (E.L.P.), Hoffman Estates, IL; School of Medicine (J.S.), University of California, Los Angeles; School of Medicine (D.H.), University of Vermont, Burlington; Children's Hospital (M.N.), University of California San Diego School of Medicine; School of Pharmacy (B.G.), University of Wisconsin, Madison; School of Medicine (E.F.), Emory University, Atlanta, GA; and Department of Neurology (J.F.), New York University Langone Comprehensive Epilepsy Center, New York
Bassel Abou-Khalil - From the Miller School of Medicine (A.M.K.), University of Miami, FL; Bronson Neuroscience Center (E.A.), Bronson Methodist Hospital, Kalamazoo, MI; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Neurology (C.H.), Mount Sinai Beth Israel, New York, NY; Children's Hospital (B.B.), Harvard Medical School, Boston, MA; Epilepsy Center (J.F.B.), Cleveland Clinic Foundation, OH; Department of Neurology (B.A.-K.), Vanderbilt University, Nashville, TN; Department of Neurology (E.B.-D.), Cooper Medical School, Rowan University, Cherry Hill, NJ; AMITA Health Medical Group (E.L.P.), Hoffman Estates, IL; School of Medicine (J.S.), University of California, Los Angeles; School of Medicine (D.H.), University of Vermont, Burlington; Children's Hospital (M.N.), University of California San Diego School of Medicine; School of Pharmacy (B.G.), University of Wisconsin, Madison; School of Medicine (E.F.), Emory University, Atlanta, GA; and Department of Neurology (J.F.), New York University Langone Comprehensive Epilepsy Center, New York
Evren Burakgazi-Dalkilic - From the Miller School of Medicine (A.M.K.), University of Miami, FL; Bronson Neuroscience Center (E.A.), Bronson Methodist Hospital, Kalamazoo, MI; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Neurology (C.H.), Mount Sinai Beth Israel, New York, NY; Children's Hospital (B.B.), Harvard Medical School, Boston, MA; Epilepsy Center (J.F.B.), Cleveland Clinic Foundation, OH; Department of Neurology (B.A.-K.), Vanderbilt University, Nashville, TN; Department of Neurology (E.B.-D.), Cooper Medical School, Rowan University, Cherry Hill, NJ; AMITA Health Medical Group (E.L.P.), Hoffman Estates, IL; School of Medicine (J.S.), University of California, Los Angeles; School of Medicine (D.H.), University of Vermont, Burlington; Children's Hospital (M.N.), University of California San Diego School of Medicine; School of Pharmacy (B.G.), University of Wisconsin, Madison; School of Medicine (E.F.), Emory University, Atlanta, GA; and Department of Neurology (J.F.), New York University Langone Comprehensive Epilepsy Center, New York
Esmeralda Llanas Park - From the Miller School of Medicine (A.M.K.), University of Miami, FL; Bronson Neuroscience Center (E.A.), Bronson Methodist Hospital, Kalamazoo, MI; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Neurology (C.H.), Mount Sinai Beth Israel, New York, NY; Children's Hospital (B.B.), Harvard Medical School, Boston, MA; Epilepsy Center (J.F.B.), Cleveland Clinic Foundation, OH; Department of Neurology (B.A.-K.), Vanderbilt University, Nashville, TN; Department of Neurology (E.B.-D.), Cooper Medical School, Rowan University, Cherry Hill, NJ; AMITA Health Medical Group (E.L.P.), Hoffman Estates, IL; School of Medicine (J.S.), University of California, Los Angeles; School of Medicine (D.H.), University of Vermont, Burlington; Children's Hospital (M.N.), University of California San Diego School of Medicine; School of Pharmacy (B.G.), University of Wisconsin, Madison; School of Medicine (E.F.), Emory University, Atlanta, GA; and Department of Neurology (J.F.), New York University Langone Comprehensive Epilepsy Center, New York
John Stern - From the Miller School of Medicine (A.M.K.), University of Miami, FL; Bronson Neuroscience Center (E.A.), Bronson Methodist Hospital, Kalamazoo, MI; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Neurology (C.H.), Mount Sinai Beth Israel, New York, NY; Children's Hospital (B.B.), Harvard Medical School, Boston, MA; Epilepsy Center (J.F.B.), Cleveland Clinic Foundation, OH; Department of Neurology (B.A.-K.), Vanderbilt University, Nashville, TN; Department of Neurology (E.B.-D.), Cooper Medical School, Rowan University, Cherry Hill, NJ; AMITA Health Medical Group (E.L.P.), Hoffman Estates, IL; School of Medicine (J.S.), University of California, Los Angeles; School of Medicine (D.H.), University of Vermont, Burlington; Children's Hospital (M.N.), University of California San Diego School of Medicine; School of Pharmacy (B.G.), University of Wisconsin, Madison; School of Medicine (E.F.), Emory University, Atlanta, GA; and Department of Neurology (J.F.), New York University Langone Comprehensive Epilepsy Center, New York
Deborah Hirtz - From the Miller School of Medicine (A.M.K.), University of Miami, FL; Bronson Neuroscience Center (E.A.), Bronson Methodist Hospital, Kalamazoo, MI; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Neurology (C.H.), Mount Sinai Beth Israel, New York, NY; Children's Hospital (B.B.), Harvard Medical School, Boston, MA; Epilepsy Center (J.F.B.), Cleveland Clinic Foundation, OH; Department of Neurology (B.A.-K.), Vanderbilt University, Nashville, TN; Department of Neurology (E.B.-D.), Cooper Medical School, Rowan University, Cherry Hill, NJ; AMITA Health Medical Group (E.L.P.), Hoffman Estates, IL; School of Medicine (J.S.), University of California, Los Angeles; School of Medicine (D.H.), University of Vermont, Burlington; Children's Hospital (M.N.), University of California San Diego School of Medicine; School of Pharmacy (B.G.), University of Wisconsin, Madison; School of Medicine (E.F.), Emory University, Atlanta, GA; and Department of Neurology (J.F.), New York University Langone Comprehensive Epilepsy Center, New York
Mark Nespeca - From the Miller School of Medicine (A.M.K.), University of Miami, FL; Bronson Neuroscience Center (E.A.), Bronson Methodist Hospital, Kalamazoo, MI; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Neurology (C.H.), Mount Sinai Beth Israel, New York, NY; Children's Hospital (B.B.), Harvard Medical School, Boston, MA; Epilepsy Center (J.F.B.), Cleveland Clinic Foundation, OH; Department of Neurology (B.A.-K.), Vanderbilt University, Nashville, TN; Department of Neurology (E.B.-D.), Cooper Medical School, Rowan University, Cherry Hill, NJ; AMITA Health Medical Group (E.L.P.), Hoffman Estates, IL; School of Medicine (J.S.), University of California, Los Angeles; School of Medicine (D.H.), University of Vermont, Burlington; Children's Hospital (M.N.), University of California San Diego School of Medicine; School of Pharmacy (B.G.), University of Wisconsin, Madison; School of Medicine (E.F.), Emory University, Atlanta, GA; and Department of Neurology (J.F.), New York University Langone Comprehensive Epilepsy Center, New York
Barry Gidal - From the Miller School of Medicine (A.M.K.), University of Miami, FL; Bronson Neuroscience Center (E.A.), Bronson Methodist Hospital, Kalamazoo, MI; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Neurology (C.H.), Mount Sinai Beth Israel, New York, NY; Children's Hospital (B.B.), Harvard Medical School, Boston, MA; Epilepsy Center (J.F.B.), Cleveland Clinic Foundation, OH; Department of Neurology (B.A.-K.), Vanderbilt University, Nashville, TN; Department of Neurology (E.B.-D.), Cooper Medical School, Rowan University, Cherry Hill, NJ; AMITA Health Medical Group (E.L.P.), Hoffman Estates, IL; School of Medicine (J.S.), University of California, Los Angeles; School of Medicine (D.H.), University of Vermont, Burlington; Children's Hospital (M.N.), University of California San Diego School of Medicine; School of Pharmacy (B.G.), University of Wisconsin, Madison; School of Medicine (E.F.), Emory University, Atlanta, GA; and Department of Neurology (J.F.), New York University Langone Comprehensive Epilepsy Center, New York
Edward Faught - From the Miller School of Medicine (A.M.K.), University of Miami, FL; Bronson Neuroscience Center (E.A.), Bronson Methodist Hospital, Kalamazoo, MI; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Neurology (C.H.), Mount Sinai Beth Israel, New York, NY; Children's Hospital (B.B.), Harvard Medical School, Boston, MA; Epilepsy Center (J.F.B.), Cleveland Clinic Foundation, OH; Department of Neurology (B.A.-K.), Vanderbilt University, Nashville, TN; Department of Neurology (E.B.-D.), Cooper Medical School, Rowan University, Cherry Hill, NJ; AMITA Health Medical Group (E.L.P.), Hoffman Estates, IL; School of Medicine (J.S.), University of California, Los Angeles; School of Medicine (D.H.), University of Vermont, Burlington; Children's Hospital (M.N.), University of California San Diego School of Medicine; School of Pharmacy (B.G.), University of Wisconsin, Madison; School of Medicine (E.F.), Emory University, Atlanta, GA; and Department of Neurology (J.F.), New York University Langone Comprehensive Epilepsy Center, New York
Jacqueline French - From the Miller School of Medicine (A.M.K.), University of Miami, FL; Bronson Neuroscience Center (E.A.), Bronson Methodist Hospital, Kalamazoo, MI; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Neurology (C.H.), Mount Sinai Beth Israel, New York, NY; Children's Hospital (B.B.), Harvard Medical School, Boston, MA; Epilepsy Center (J.F.B.), Cleveland Clinic Foundation, OH; Department of Neurology (B.A.-K.), Vanderbilt University, Nashville, TN; Department of Neurology (E.B.-D.), Cooper Medical School, Rowan University, Cherry Hill, NJ; AMITA Health Medical Group (E.L.P.), Hoffman Estates, IL; School of Medicine (J.S.), University of California, Los Angeles; School of Medicine (D.H.), University of Vermont, Burlington; Children's Hospital (M.N.), University of California San Diego School of Medicine; School of Pharmacy (B.G.), University of Wisconsin, Madison; School of Medicine (E.F.), Emory University, Atlanta, GA; and Department of Neurology (J.F.), New York University Langone Comprehensive Epilepsy Center, New York
Publication Details: Neurology, Vol.91(2), pp.74-81
Publisher: United States
Academic Unit: Miller School of Medicine; UMMG Department of Neurology; UMMG Dept of Neurology - Epilepsy Div
Language: English
Resource Type: Journal article
PMID: 29898971
Record Identifier: 991031560286702976