For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
3
views
143
references
 Top references
cited by
0
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      130
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      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

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Summary

          Background

          Adjunctive newer antiseizure medications (ASMs) are being used in patients with treatment-resistant focal-onset seizures (FOS). An updated network meta-analysis (NMA) was necessary to compile evidence in this critical area.

          Methods

          We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus from their inception until 17 January 2024, evaluating the efficacy, tolerability, and safety of rufinamide (RUF), brivaracetam (BRV), cenobamate (CNB), eslicarbazepine (ESL), lacosamide (LCM), retigabine (RTG), and perampanel (PER) as adjunctive treatments for FOS. Efficacy outcomes included seizure response and seizure freedom. Tolerability was assessed by discontinuation due to adverse events (AEs). Safety outcomes were evaluated based on the number of patients experiencing at least one AE and serious adverse events (SAEs). This review is registered with PROSPERO (CRD42023485130).

          Findings

          A total of 29 studies involving 11,750 participants were included. For seizure response, all ASMs were significantly superior to placebo, with RTG ranking highest, followed by CNB. Considering dosage, CNB 400 mg/d was top-ranked, followed by RTG 1200 mg/d. For seizure freedom, BRV was highest-ranked, followed by CNB, with BRV 100 mg/d leading, followed by CNB 400 mg/d. Regarding tolerability, LCM 600 mg/d had the lowest ranking, followed by CNB 400 mg/d. For the safety outcome of AEs, ESL 1200 mg/d was ranked lowest, followed by CNB 400 mg/d. Regarding SAEs, LCM 400 mg/d was ranked lowest, followed by RTG 1200 mg/d.

          Interpretation

          ASMs at different dosages have varying efficacy and tolerability profiles. We have provided hierarchical rankings of ASMs for efficacy and safety outcomes. Our findings offer the most comprehensive evidence available to inform patients, families, physicians, guideline developers, and policymakers about the choice of ASMs in patients with treatment-resistant FOS.

          Funding

          None.

          Related collections

          Most cited references143

          • Record: found
          • Abstract: found
          • Article: not found

          The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations.

          Brian Hutton, Georgia Salanti, Deborah M Caldwell … (2016)
          The PRISMA statement is a reporting guideline designed to improve the completeness of reporting of systematic reviews and meta-analyses. Authors have used this guideline worldwide to prepare their reviews for publication. In the past, these reports typically compared 2 treatment alternatives. With the evolution of systematic reviews that compare multiple treatments, some of them only indirectly, authors face novel challenges for conducting and reporting their reviews. This extension of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement was developed specifically to improve the reporting of systematic reviews incorporating network meta-analyses. A group of experts participated in a systematic review, Delphi survey, and face-to-face discussion and consensus meeting to establish new checklist items for this extension statement. Current PRISMA items were also clarified. A modified, 32-item PRISMA extension checklist was developed to address what the group considered to be immediately relevant to the reporting of network meta-analyses. This document presents the extension and provides examples of good reporting, as well as elaborations regarding the rationale for new checklist items and the modification of previously existing items from the PRISMA statement. It also highlights educational information related to key considerations in the practice of network meta-analysis. The target audience includes authors and readers of network meta-analyses, as well as journal editors and peer reviewers.
          Article 0 comments Cited 1922 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies.

            Patrick Kwan, Alexis Arzimanoglou, Anne T. Berg … (2010)
            To improve patient care and facilitate clinical research, the International League Against Epilepsy (ILAE) appointed a Task Force to formulate a consensus definition of drug resistant epilepsy. The overall framework of the definition has two "hierarchical" levels: Level 1 provides a general scheme to categorize response to each therapeutic intervention, including a minimum dataset of knowledge about the intervention that would be needed; Level 2 provides a core definition of drug resistant epilepsy using a set of essential criteria based on the categorization of response (from Level 1) to trials of antiepileptic drugs. It is proposed as a testable hypothesis that drug resistant epilepsy is defined as failure of adequate trials of two tolerated, appropriately chosen and used antiepileptic drug schedules (whether as monotherapies or in combination) to achieve sustained seizure freedom. This definition can be further refined when new evidence emerges. The rationale behind the definition and the principles governing its proper use are discussed, and examples to illustrate its application in clinical practice are provided.
            Article 0 comments Cited 654 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Early identification of refractory epilepsy.

              Patrick Kwan, Martin J. Brodie (2000)
              More than 30 percent of patients with epilepsy have inadequate control of seizures with drug therapy, but why this happens and whether it can be predicted are unknown. We studied the response to antiepileptic drugs in patients with newly diagnosed epilepsy to identify factors associated with subsequent poor control of seizures. We prospectively studied 525 patients (age, 9 to 93 years) who were given a diagnosis, treated, and followed up at a single center between 1984 and 1997. Epilepsy was classified as idiopathic (with a presumed genetic basis), symptomatic (resulting from a structural abnormality), or cryptogenic (resulting from an unknown underlying cause). Patients were considered to be seizure-free if they had not had any seizures for at least one year. Among the 525 patients, 333 (63 percent) remained seizure-free during antiepileptic-drug treatment or after treatment was stopped. The prevalence of persistent seizures was higher in patients with symptomatic or cryptogenic epilepsy than in those with idiopathic epilepsy (40 percent vs. 26 percent, P=0.004) and in patients who had had more than 20 seizures before starting treatment than in those who had had fewer (51 percent vs. 29 percent, P<0.001). The seizure-free rate was similar in patients who were treated with a single established drug (67 percent) and patients who were treated with a single new drug (69 percent). Among 470 previously untreated patients, 222 (47 percent) became seizure-free during treatment with their first antiepileptic drug and 67 (14 percent) became seizure-free during treatment with a second or third drug. In 12 patients (3 percent) epilepsy was controlled by treatment with two drugs. Among patients who had no response to the first drug, the percentage who subsequently became seizure-free was smaller (11 percent) when treatment failure was due to lack of efficacy than when it was due to intolerable side effects (41 percent) or an idiosyncratic reaction (55 percent). Patients who have many seizures before therapy or who have an inadequate response to initial treatment with antiepileptic drugs are likely to have refractory epilepsy.
              Article 0 comments Cited 459 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Contributors
                Dongdong Zhou
                Yangmei Chen
                Journal
                Journal ID (nlm-ta): eClinicalMedicine
                Journal ID (iso-abbrev): EClinicalMedicine
                Title: eClinicalMedicine
                Publisher: Elsevier
                ISSN (Electronic): 2589-5370
                Publication date PMC-release: 28 February 2024
                Publication date Collection: April 2024
                Publication date (Electronic): 28 February 2024
                Volume: 70
                Electronic Location Identifier: 102513
                Affiliations
                [a ]Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
                [b ]Department of Respiratory, The Ninth People's Hospital of Chongqing, Chongqing, 400700, China
                [c ]Department of Medical Records, Heze Municipal Hospital, Heze, 274000, China
                [d ]Department of Neurology, Heze Third People's Hospital, Heze, 274000, China
                [e ]Department of Neurology, Shandong Provincial Hospital Heze Branch, Heze, 274000, China
                [f ]Department of Neurology, Heze Mudan District People's Hospital, Heze, 274000, China
                [g ]Department of Neurology, Juancheng County People's Hospital, Juancheng, 274600, China
                [h ]Department of Neurology, Heze Municipal Hospital Brain Hospital, Heze, 274000, China
                [i ]Mental Health Center, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
                Author notes
                [∗ ]Corresponding author. Mental Health Centre, University-Town Hospital of Chongqing Medical University, No. 55, University-Town Middle Road, Shapingba District, Chongqing, 401331, China. zhoudongdong@ 123456cqmu.edu.cn
                [∗∗ ]Corresponding author. Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, No.74, Linjiang Road, Chongqing, 400010, China. chenym1997@ 123456cqmu.edu.cn
                Article
                Publisher Item ID: S2589-5370(24)00092-0 Publisher ID: 102513
                DOI: 10.1016/j.eclinm.2024.102513
                PMC ID: 10915785
                PubMed ID: 38449838
                SO-VID: b9f23eca-e2df-4bec-a3ce-156da60fbb46
                Copyright © © 2024 The Author(s)
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 3 December 2023
                Date revision received : 13 February 2024
                Date accepted : 16 February 2024
                Categories
                Subject: Articles

                Keywords: focal seizures,seizure,epilepsy,antiseizure medications,network meta-analysis
                Data availability:
                Keywords: focal seizures, seizure, epilepsy, antiseizure medications, network meta-analysis

                Comments

                Comment on this article