SynthesisBritish journal of clinical pharmacology2013
Comparative efficacy and tolerability of anti-epileptic drugs for refractory focal epilepsy: systematic review and network meta-analysis reveals the need for long term comparator trials.
Synthesis in British journal of clinical pharmacology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 4 syntheses or guidelines pooled it, 52 citations in OpenAlex.
- Effectiveness and safety of single anti-seizure medication as adjunctive therapy for drug-resistant focal epilepsy based on network meta-analysis.Frontiers in pharmacology · 2025Pooled it
- Pooled it
- Gabapentin add-on treatment for drug-resistant focal epilepsy.The Cochrane database of systematic reviews · 2021Pooled it
- Gabapentin add-on treatment for drug-resistant focal epilepsy.The Cochrane database of systematic reviews · 2018Pooled it
- Trial
- Trial
- Topiramate for smoking cessation: a randomized, placebo-controlled pilot study.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2014Trial
- Gliomagenesis, Epileptogenesis, and Remodeling of Neural Circuits: Relevance for Novel Treatment Strategies in Low- and High-Grade Gliomas.International journal of molecular sciences · 2024Review
- Efficacy, tolerability and safety of add-on third-generation antiseizure medications in treating focal seizures worldwide: a network meta-analysis of randomised, placebo-controlled trials.EClinicalMedicine · 2024Article
- Review
- Effectiveness and tolerability of perampanel monotherapy in children with newly diagnosed focal epilepsy.Frontiers in neurology · 2023Article
- Sodium Valproate Combined With Topiramate vs. Sodium Valproate Alone for Refractory Epilepsy: A Systematic Review and Meta-Analysis.Frontiers in neurology · 2021Article
- Review
- Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles.Neuropsychiatric disease and treatment · 2019Article
- Efficacy and safety of Levetiracetam vs. other antiepileptic drugs in Hispanic patients with glioblastoma.Journal of neuro-oncology · 2018Article
- Efficacy and safety of antiepileptic drugs for refractory partial-onset epilepsy: a network meta-analysis.Journal of neurology · 2018Review
- Tolerability of new antiepileptic drugs: a network meta-analysis.European journal of clinical pharmacology · 2017Review
- Seizures and gliomas--towards a single therapeutic approach.Nature reviews. Neurology · 2016Review
- Epilepsy and brain tumors.Handbook of clinical neurology · 2016Review
- What is New in the Management of Epilepsy in Gliomas?Current treatment options in neurology · 2015Article
Corrections and comments
- Commented on by
Authors and funding
9 authors at 5 institutions in 1 country.
Funding
Abstract
aimsTo evaluate the comparative efficacy (50% reduction in seizure frequency) and tolerability (premature withdrawal due to adverse events) of anti-epileptic drugs (AEDs) for refractory epilepsy.
methodsWe searched Cochrane Central Register of Controlled Trials (Cochrane Library 2009, issue 2) including Epilepsy Group's specialized register, MEDLINE (1950 to March 2009), EMBASE (1980 to March 2009), and Current Contents Connect (1998 to March 2009) to conduct a systematic review of published studies, developed a treatment network and undertook a network meta-analysis.
resultsForty-three eligible trials with 6346 patients and 12 interventions, including placebo, contributed to the analysis. Only three direct drug comparator trials were identified, the remaining 40 trials being placebo-controlled. Conventional random-effects meta-analysis indicated all drugs were superior in efficacy to placebo (overall odds ratio (OR] 3.78, 95% CI 3.14, 4.55) but did not permit firm distinction between drugs on the basis of the efficacy or tolerability. A Bayesian network meta-analysis prioritized oxcarbazepine, topiramate and pregabalin on the basis of short term efficacy. However, sodium valproate, levetiracetam, gabapentin and vigabatrin were prioritized on the basis of short-term efficacy and tolerability, with the caveat that vigabatrin is recognized as being associated with serious visual disturbance with chronic use.
conclusionOf the wide range of AEDs licensed for the treatment of refractory epilepsy, sodium valproate, levetiracetam and gabapentin demonstrated the best balance of efficacy and tolerability. Until regulators mandate greater use of active comparator trials with longer term follow-up, network meta-analysis provides the only available means to quantify these clinically important parameters.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.