Adverse effects in epilepsy therapy. Wait and see or go for it?

Attention for adverse effects (AEs) is important for optimizing epilepsy treatment. However, a uniform strategy is lacking. In particular there appears to be a dichotomy between those who "wait and see" and those who "go for it", i.e. routinely check a list of AEs. Our intention is to identify the effects of different approaches.

Trial reports on carbamazepine or valproate monotherapy (Medline-search), and data from the Nijmegen Epilepsy Research Group were analyzed.

Analysis suggests that for certain AEs, such as diplopia, dysarthria, affect and mood disturbances, headache, dizziness, gastro-intestinal disturbances, dermatological disturbances and idiosyncratic reactions, it does not matter which approach is chosen. However, sedation, cognitive impairments, sexual dysfunction, hair changes, nystagmus, gait disturbances, tremor and weight changes are reported more frequently when routinely checked. The value of routine laboratory monitoring is, however, questioned.

Use of different strategies to detect AEs obstructs estimation of risks of AEDs. Baseline measurements and regular checking for those AEs, which are reported more frequently by authors who actively search for AEs, is advisable.