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Evidence-based Anti-seizure Monotherapy in Newly Diagnosed Epilepsy: a New Approach

COMPAGNO STRANDBERG, MARIA LU ; Söderberg-Löfdal, Karin ; Kimland, Elin ; Dahlin, Maria and Kallen, Kristina LU (2020) In Acta Neurologica Scandinavica 142(4). p.323-332
Abstract
Objectives
To describe the process and results of the updated Swedish practice guidelines for monotherapy in epilepsy.

Materials and Methods
The Swedish Medical Products Agency led the process together with medical experts. Evidence rating in accordance with the International League Against Epilepsy (ILAE) template was linked to the Cochrane group's GRADE system. Evidence from recently published trials and meta‐analyses was added. A national expert panel participated in the project and contributed their clinical experience.

Results
In seizures with focal onset, carbamazepine, lamotrigine, or levetiracetam is recommended for children and adults (ILAE level A‐C for adults/Cochrane level strong for children and... (More)
Objectives
To describe the process and results of the updated Swedish practice guidelines for monotherapy in epilepsy.

Materials and Methods
The Swedish Medical Products Agency led the process together with medical experts. Evidence rating in accordance with the International League Against Epilepsy (ILAE) template was linked to the Cochrane group's GRADE system. Evidence from recently published trials and meta‐analyses was added. A national expert panel participated in the project and contributed their clinical experience.

Results
In seizures with focal onset, carbamazepine, lamotrigine, or levetiracetam is recommended for children and adults (ILAE level A‐C for adults/Cochrane level strong for children and adults). Oxcarbazepine is an alternative for children, although its level A evidence, in a single class I trial, could relate to poor phenytoin tolerability. Eslicarbazepine acetate, lacosamide, and zonisamide are alternatives for adults and gabapentin for the elderly (ILAE level A). Carbamazepine is not a first choice for the elderly due to its high potential for interactions. In generalized epilepsy with tonic‐clonic seizures (GTC), lamotrigine, levetiracetam, and sodium valproate are recommended for children and adults (ILAE level C‐D/Cochrane level moderate‐strong) although sodium valproate is contraindicated in girls and women of childbearing age unless special considerations are met. Ethosuximide is the first choice in absence epilepsy without GTC (ILAE level A).

Conclusions
Lamotrigine and levetiracetam can be used as first choice for focal seizures and generalized epilepsy with GTC, suitable in all age‐groups and for both men and women. Recommendations for GTC seizures have lower evidence than those for focal seizures. (Less)
Please use this url to cite or link to this publication:
author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Neurologica Scandinavica
volume
142
issue
4
pages
10 pages
publisher
Wiley-Blackwell
external identifiers
  • pmid:32627842
  • scopus:85088127341
  • pmid:32627842
ISSN
1600-0404
DOI
10.1111/ane.13312
language
English
LU publication?
yes
additional info
Kristina Källén and Maria Dahlin should be considered joint senior authors. Corresponding author: Kristina Källén MD, Associate Professor
id
4e08f549-77c0-46ae-bf1e-44b733ef5e44
date added to LUP
2020-07-03 14:22:45
date last changed
2022-04-18 23:20:32
@article{4e08f549-77c0-46ae-bf1e-44b733ef5e44,
  abstract     = {{Objectives<br/>To describe the process and results of the updated Swedish practice guidelines for monotherapy in epilepsy.<br/><br/>Materials and Methods<br/>The Swedish Medical Products Agency led the process together with medical experts. Evidence rating in accordance with the International League Against Epilepsy (ILAE) template was linked to the Cochrane group's GRADE system. Evidence from recently published trials and meta‐analyses was added. A national expert panel participated in the project and contributed their clinical experience.<br/><br/>Results<br/>In seizures with focal onset, carbamazepine, lamotrigine, or levetiracetam is recommended for children and adults (ILAE level A‐C for adults/Cochrane level strong for children and adults). Oxcarbazepine is an alternative for children, although its level A evidence, in a single class I trial, could relate to poor phenytoin tolerability. Eslicarbazepine acetate, lacosamide, and zonisamide are alternatives for adults and gabapentin for the elderly (ILAE level A). Carbamazepine is not a first choice for the elderly due to its high potential for interactions. In generalized epilepsy with tonic‐clonic seizures (GTC), lamotrigine, levetiracetam, and sodium valproate are recommended for children and adults (ILAE level C‐D/Cochrane level moderate‐strong) although sodium valproate is contraindicated in girls and women of childbearing age unless special considerations are met. Ethosuximide is the first choice in absence epilepsy without GTC (ILAE level A).<br/><br/>Conclusions<br/>Lamotrigine and levetiracetam can be used as first choice for focal seizures and generalized epilepsy with GTC, suitable in all age‐groups and for both men and women. Recommendations for GTC seizures have lower evidence than those for focal seizures.}},
  author       = {{COMPAGNO STRANDBERG, MARIA and Söderberg-Löfdal, Karin and Kimland, Elin and Dahlin, Maria and Kallen, Kristina}},
  issn         = {{1600-0404}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{323--332}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Acta Neurologica Scandinavica}},
  title        = {{Evidence-based Anti-seizure Monotherapy in Newly Diagnosed Epilepsy: a New Approach}},
  url          = {{http://dx.doi.org/10.1111/ane.13312}},
  doi          = {{10.1111/ane.13312}},
  volume       = {{142}},
  year         = {{2020}},
}