[Value of sodium valproate in the treatment of partial epilepsy]

There seems no doubt, in reviewing the literature from controlled randomized studies, that valproate is effective in the treatment of partial epilepsy. There is unanimity amongst a number of large comparative studies that valproate seems as effective as carbamazepine in suppressing secondarily generalized seizures. Controlled studies that have used minimum doses of carbamazepine or valproate in previously untreated patients with partial epilepsy have not suggested that the outcomes with the two drugs are significantly different; however, a Veterans Administrations Study which included over 200 patients who had been previously treated with other antiepileptic drugs suggested the possibility that carbamazepine might be somewhat more effective in suppressing complex partial seizures than valproate. In practice the choice between the two current first-line antiepileptic drugs (carbamazepine and valproate) would seem to be determined by their different adverse effect profiles. Valproate is better tolerated in the shorter term because of the absence of idiosyncratic skin reactions, whilst those patients who tolerate carbamazepine initially may have fewer long-ferm problems and seem less prone to develop weight gain than patients treated with sodium valproate. For patients presenting with seizures that cannot easily be classified, valproate would seem to be the drug of choice because of its broader spectrum of antiepileptic drug activity.