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Evidence-Based Guidelines For The Treatment of Epileptic Seizures With Aeds
Evidence-Based Guidelines For The Treatment of Epileptic Seizures With Aeds
Evidence-Based Guidelines For The Treatment of Epileptic Seizures With Aeds
• National
AAN (Efficacy and tolerability of the new AEDs I and II)
NICE (Diagnosis and management of the epilepsies in adults and
children in primary and secondary care)
SIGN (Diagnosis and management of epilepsy in adults)
Guideline
Methodology
• Topic
Optimal initial monotherapy for patients with newly
diagnosed or untreated epilepsy
• Team
10 members
• Epileptologists
• Clinical pharmacologists
• Statistician
• Methodologist
6 countries
ILAE Initial Monotherapy Guidelines
Clinical Questions (n=8) :
• Q1-Q3: Patients (adults/elderly/children) with partial-
onset seizures
• Q4-Q5: Patients (adults/children) with generalized-
onset tonic-clonic seizures
• Q6: Children with idiopathic localization-related
epilepsies and syndromes (BECTS)
• Q7-Q8: Children with idiopathic-generalized
epilepsies (CAE, JME)
Guideline
Methodology
• Recommendations – 6 Levels
Class I
Guerreiro (97) OXC, PHT
Class II 0
Class III
TPM (n=2), CBZ/CZP (n=1), CBZ/ CLB (n=1),
TPM/VPA/CBZ (n=1)
Partial Seizures: Children
Recommendations
Level A: OXC
Level B: None
Level C: CBZ, PB, PHT,
TPM, VPA
Level D: LTG,VGB
Level E: Others
Level F: None
Partial Seizures: Elderly
Available Evidence
Class II
Brodie ( 99) CBZ,LTG
Class III
Privitera (03) CBZ, TPM, VPA
• Division of trials
Class I (n=0)
Class II (n=0)
Class III (n=2)
BECTS:
Recommendations
Level A: None
Level B: None
Level C:CBZ, VPA
Level D: GBP,STM
Level E: Others
Level F: None
Initial Monotherapy
Idiopathic Generalized Epilepsy Syndromes:
Juvenile Myoclonic Epilepsy
Juvenile Myoclonic Epilepsy:
Available Evidence
• A total of 0 RCTs examined initial monotherapy of
children with Juvenile Myoclonic Epilepsy
• Division of trials
Class I (n=0)
Class II (n=0)
Class IIII (n=0)
Juvenile Myoclonic Epilepsy :
Recommendations
Level A: None
Level B: None
Level C: None
Level D: CZP, LTG*, LEV, TPM, VPA, ZNS
Level E: Others
Level F: CBZ*, GBP, OXC*, PHT*, TGB, VGB