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Carbamazepine versus phenobarbitone monotherapy for epilepsy
C Tudur Smith1, A G Marson, P R Williamson
1Division of Statistics and Operational Research, Department of Mathematical Sciences, University of Liverpool, Mathematics & Oceanography Building, Peach Street, Liverpool, UK, L69 7ZL. cat1@liverpool.ac.uk
The Cochrane Database of Systematic Reviews
|January 22, 2003
Summary
Carbamazepine shows improved tolerability over phenobarbitone, with similar efficacy for seizure control in epilepsy. Phenobarbitone withdrawal was significantly higher, indicating poorer tolerance.
Area of Science:
- Neurology
- Pharmacology
- Clinical Trials
Background:
- Phenobarbitone use is declining in Europe and the USA due to adverse effects, despite its common use in developing countries.
- Carbamazepine is a preferred treatment for partial onset seizures but may exacerbate generalized onset seizure types.
- This review compares carbamazepine and phenobarbitone using individual patient data.
Purpose of the Study:
- To compare the efficacy and tolerability of carbamazepine versus phenobarbitone monotherapy in patients with partial onset seizures or generalized onset tonic-clonic seizures.
- To evaluate time to treatment withdrawal, time to 12-month remission, and time to first seizure.
Main Methods:
- A systematic review of randomized or quasi-randomized controlled trials.
- Data from 684 participants across four trials were analyzed.
- Stratified logrank analysis was used to compare outcomes, expressed as hazard ratios (HR) with 95% confidence intervals (CIs).
Main Results:
- Carbamazepine demonstrated a significantly longer time to withdrawal compared to phenobarbitone (HR 1.63; 95% CI 1.23 to 2.15).
- No significant overall difference was found between the drugs for time to 12-month remission (HR 0.87; 95% CI 0.65 to 1.17) or time to first seizure (HR 0.85; 95% CI 0.68 to 1.05).
- A statistically significant interaction between treatment and seizure type was observed for time to first seizure, favoring phenobarbitone for partial onset seizures and carbamazepine for generalized onset tonic-clonic seizures.
Conclusions:
- Phenobarbitone is significantly more likely to be withdrawn, indicating poorer tolerability compared to carbamazepine.
- While no overall difference in seizure control was found, subgroup analysis suggests phenobarbitone may be more effective for partial onset seizures, and carbamazepine for generalized onset tonic-clonic seizures.