| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
From VA Medical Center (Dr. Rowan), Bronx, NY; VA Medical Center (Dr. Ramsay, F. Pryor), Miami, FL; VA Medical Center (Dr. Collins), Perry Point, MD; VA Cooperative Studies Program (K.D. Boardman), Albuquerque, NM; VA Medical Center (Dr. Uthman), Gainesville, FL; VA Medical Center (Dr. Spitz), Denver, CO; VA Medical Center (Dr. Frederick), New Orleans, LA; VA Medical Center (Dr. Towne), Richmond, VA; VA Medical Center (Dr. Carter), Dallas, TX; VA Medical Center (Dr. Marks), San Francisco, CA; VA Medical Center (Dr. Felicetta), Phoenix, AZ; and VA Medical Center (Dr. Tomyanovich), Chicago, IL.
* To whom correspondence should be addressed. E-mail: aj.rowan{at}med.va.gov.
Abstract-- Objective: To determine the relative tolerability and efficacy of two newer antiepileptic drugs, lamotrigine (LTG) and gabapentin (GBP), as compared to carbamazepine (CBZ) in older patients with epilepsy. Methods: This was an 18-center, randomized, double-blind, double dummy, parallel study of 593 elderly subjects with newly diagnosed seizures. Patients were randomly assigned to one of three treatment groups: GBP 1,500 mg/day, LTG 150 mg/day, CBZ 600 mg/day. The primary outcome measure was retention in trial for 12 months. Results: Mean age was 72 years. The most common etiology was cerebral infarction. Patients had multiple medical conditions and took an average of seven comedications. Mean plasma levels at 6 weeks were as follows: GBP 8.67 ± 4.83 µg/mL, LTG 2.87 ± 1.60 µg/mL, CBZ 6.79 ± 2.92 µg/mL. They remained stable throughout the trial. Early terminations: LTG 44.2%, GBP 51%, CBZ 64.5% (p = 0.0002). Significant paired comparisons: LTG vs CBZ: p < 0.0001; GBP vs CBZ: p = 0.008. Terminations for adverse events: LTG 12.1%, GBP 21.6%, CBZ 31% (p = 0.001). Significant paired comparisons: LTG vs CBZ: p < 0.0001; LTG vs GBP: p = 0.015. There were no significant differences in seizure free rate at 12 months. Conclusions: The main limiting factor in patient retention was adverse drug reactions. Patients taking lamotrigine (LTG) or gabapentin (GBP) did better than those taking carbamazepine. Seizure control was similar among groups. LTG and GBP should be considered as initial therapy for older patients with newly diagnosed seizures.
This article has been cited by other articles:
|
|
 |
|
  B M Soeder, U Gleissner, H Urbach, H Clusmann, C E Elger, A Vincent, and C G Bien Causes, presentation and outcome of lesional adult onset mediotemporal lobe epilepsy J. Neurol. Neurosurg. Psychiatry, August 1, 2009; 80(8): 894 - 899. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Perucca, J. Carter, V. Vahle, and F. G. Gilliam Adverse antiepileptic drug effects: Toward a clinically and neurobiologically relevant taxonomy Neurology, April 7, 2009; 72(14): 1223 - 1229. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. L Smith, A. Baldwin, L. L Cunningham Jr, and A. M Cook Rash Associated with Pregabalin Use Ann. Pharmacother., December 1, 2008; 42(12): 1899 - 1902. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. E. Ahn, J. C. Cloyd, R. C. Brundage, S. E. Marino, J. M. Conway, R. E. Ramsay, J. R. White, L. C. Musib, J. O. Rarick, A. K. Birnbaum, et al. Phenytoin half-life and clearance during maintenance therapy in adults and elderly patients with epilepsy Neurology, July 1, 2008; 71(1): 38 - 43. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.J.V. Pugh, A. C. Van Cott, J. A. Cramer, J. E. Knoefel, M. E. Amuan, J. Tabares, R. E. Ramsay, D. R. Berlowitz, and Treatment In Geriatric Epilepsy Research (TIGER) t Trends in antiepileptic drug prescribing for older patients with new-onset epilepsy: 2000-2004 Neurology, May 27, 2008; 70(22_Part_2): 2171 - 2178. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Punyawudho, R. E. Ramsay, F. M. Macias, A. J. Rowan, J. F. Collins, R. C. Brundage, and A. K. Birnbaum Population Pharmacokinetics of Lamotrigine in Elderly Patients J. Clin. Pharmacol., April 1, 2008; 48(4): 455 - 463. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.J.V. Pugh, D. R. Berlowitz, G. Montouris, B. Bokhour, J. A. Cramer, V. Bohm, M. Bollinger, S. Helmers, A. Ettinger, K. J. Meador, et al. What constitutes high quality of care for adults with epilepsy? Neurology, November 20, 2007; 69(21): 2020 - 2027. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Arif, R. Buchsbaum, D. Weintraub, S. Koyfman, C. Salas-Humara, C. W. Bazil, S. R. Resor Jr, and L. J. Hirsch Comparison and predictors of rash associated with 15 antiepileptic drugs Neurology, May 15, 2007; 68(20): 1701 - 1709. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. E. Ramsay, W. D. Shields, and S. Shinnar Special Issues in the Management of Young Children, Older Adults, and the Developmentally Disabled J Child Neurol, May 1, 2007; 22(5_suppl): 53S - 60S. [Abstract] [PDF]
|
|
|
|
|
|
M. J. Brodie, E. Perucca, P. Ryvlin, E. Ben-Menachem, H.-J Meencke, and for the Levetiracetam Monotherapy Study Group Comparison of levetiracetam and controlled-release carbamazepine in newly diagnosed epilepsy Neurology, February 6, 2007; 68(6): 402 - 408. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Ryvlin, A. Montavont, and N. Nighoghossian Optimizing therapy of seizures in stroke patients Neurology, December 26, 2006; 67(12_suppl_4): S3 - S9. [Abstract] [Full Text]
|
|
|
|
 |
|
 Additional articles abstracted in ACP Journal Club Evid. Based Med., February 1, 2006; 11(1): 30 - 30. [Full Text] [PDF]
|
|
|
|
 |
|
 M. J Brodie and P. Kwan Epilepsy in elderly people BMJ, December 3, 2005; 331(7528): 1317 - 1322. [Full Text] [PDF]
|
|
|
|
 |
|
 Antiepileptic Drugs for the Elderly Journal Watch Neurology, September 8, 2005; 2005(908): 4 - 4. [Full Text]
|
|
|
|
 |
|
 Antiseizure Drug Therapy in Older Patients Journal Watch (General), July 12, 2005; 2005(712): 3 - 3. [Full Text]
|
|
|
|
|
|
J. A. French and D. W. Chadwick Antiepileptic drugs for the elderly: Using the old to focus on the new Neurology, June 14, 2005; 64(11): 1834 - 1835. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
