Lamotrigine was more effective than carbamazepine, gabapentin, and topiramate for treatment failure in partial epilepsy.

M e t h o d s Design: Randomized controlled trial (Standard and New Antiepileptic Drugs [SANAD] trial, Arm A) Allocation: Concealed.* Blinding: Unblinded.* Follow-up period: Up to 6 years. Setting: Hospital-based outpatient clinics in the United Kingdom. Patients: 1721 patients (mean age 38 y, 55% men) who had ≥ 2 clinically definite, unprovoked epileptic seizures in the past year and were recommended to take CBZ over valproate by the recruiting clinician. Exclusion criteria were age ≤ 4 years, acute symptomatic seizures (including febrile seizures), history of progressive neurologic disease, and contraindications to treatment. Intervention: CBZ (n = 378), GPT (n = 377), LTG (n = 378), OXC (n = 210), or TPM (n = 378). Outcomes: Treatment failure (i.e., stopping drug because of inadequate seizure control, intolerable side effects, or both or addition of other antiepileptic drugs) and 1-year remission. Secondary outcomes included 2-year remission and time to first seizure. Patient follow-up: 96% (intention-to-treat analysis). M a i n r e s u l t s For treatment failure, LTG was more effective than CBZ, GPT, and TPM; OXC was more effective than GPT (Table); LTG and OXC did not differ; CBZ did not differ from GPT, TPM, or OXC; TPM did not differ from GPT or OXC. For 1-year remission, CBZ was more effective than GPT; LTG was more effective than GPT; OXC was more effective than GPT (Table); CBZ did not differ from LTG, OXC, or TPM; TPM did not differ from GPT, LTG, or OXC; LTG and OXC did not differ. For 2-year remission, CBZ was more effective than GPT and TPM (Table); OXC and CBZ did not differ; LTG and TPM did not differ. The CBZ group had fewer first seizures than did the GPT and LTG groups (Table) but did not differ from the OXC or TPM groups.