With so many antiepileptic drugs, who is the more ideal choice for drug-resistant focal epilepsy?

Epilepsy is a clinical syndrome of highly synchronized abnormal discharge of brain neurons caused by various reasons. It has the characteristics of seizure, transient, stereotyped and recurrent. According to statistics, 0.5% to 1% of people suffer from epilepsy, and about 10% of them may have a seizure in their lifetime; about 1/3 of patients with focal epilepsy may develop into chronic refractory epilepsy. By trying 2 kinds of AEDs treatment can not achieve epilepsy without seizure, but need AEDs combination treatment to effectively control epilepsy. Although more than 24 AEDs have been on the market in the past few decades, how to choose AEDs has become a problem faced by clinicians, especially after the launch of new AEDs because of the lack of direct comparative studies on the efficacy and safety of AEDs. An online meta-analysis compares the efficacy and safety of 17 AEDs This online meta-analysis aims to compare and analyze the efficacy and safety of multiple AEDs (including new AEDs) in the treatment of refractory focal epilepsy. This study (HuQ, etal.Efficacyandsafetyofantiepilepticdrugsforrefractorypartial-onsetepilepsy: anetworkmeta-analysis.JNeurol.2018Jan.265 (1): 1-11.) Is based on Pubmed, Embase, CochraneCentralRegisterofControlledTrials and other databases, and the search deadline is February 18, 2017. The standard RCTs included 76 RCTs, 20,711 patients with focal epilepsy, and 17 AEDs. Lacosamide (LCM), carbamide (CRS), eslicarbazepine (ESL), gabapentin (GBP), lamotrigine (LTG), levetiracetam (LEV), oxcarbazepine (OXC), pirenpanet (PER), pregabalin (PGB), retigabine (RTG), topiramate (TPM), aminohexenoic acid (VGB), valproic acid (VPA), rufinamide (RUF), Tigabin (TGB), Bovaracetam (BRV), Zonisamide (ZNS). This study compared the results of the efficacy and safety of epilepsy patients using AEDs. The main criterion for evaluating the efficacy is the seizure-free rate, which is defined as the proportion of patients with a 100% reduction in seizures during the maintenance period of the RCTs or the double-blind treatment period (titration period + maintenance period), hereinafter referred to as “seizure-free”; safety assessment The main criterion is the withdrawal rate, which is defined as the proportion of patients who withdraw due to adverse reactions during the treatment period. (Remarks: In the evaluation of efficacy and safety, if the same AED in RCTs is compared with placebo in multiple groups for analysis, it should be grouped into one group for evaluation.) Research results Rate is a commonly used index for evaluating the prognosis of patients with epilepsy, and it is also a common index for evaluating the efficacy of AEDs. The results of this network meta-analysis showed that 54 RCTs reported efficacy evaluation results, which included a total of 15,784 patients and 17 AEDs. The meta-analysis “No seizures” showed that all the effects of AEDs were better than placebo except CRS, GBP, LTG, ZNS, RUF and TGB. The cumulative probability ranking results of curative effect show that: TGB & gt.BRV & gt.VPA & gt.LEV & gt.TPM (Figure 1). ■ Safety evaluation results Withdrawal rate evaluation can be used to reflect the level of drug safety. A total of 66 RCTs in the network meta-analysis reported safety results, including a total of 18,989 patients and 17 AEDs. Meta-analysis of drug “tolerance” results showed that compared with LCM, ESL, OXC, PGB, RTG, LEV-treated epilepsy patients have a lower withdrawal rate. Probability analysis of “tolerance” ranking shows: placebo & gt.LEV & gt.BRV & gt.PER, so it shows LE among 17 AEDs