Comparison of Efficacy & Safety of Levetiracetam Versus Topiramate in Treatment of Epilepsy


ABSTRACT:BACKGROUND:More than 14 antiepileptic drugs (AEDs) have been licensed for use in epilepsy over the last 20 years. Levetiracetam (LEV) & topiramate (TPM) are two of the most commonly prescribed new AEDs. The comparison between different AEDs is a crucial issue for decision making in epileptology.OBJECTIVE:To compare the efficacy & safety of LEV vs. TPM as monotherapy or add-on therapy in focal onset or generalised epilepsy.METHODS:The study carried on 75 epileptic patients (45 on LEV vs 30 on TPM). Data were taken regarding age, gender, type, dosage & duration of treatment, type & frequency of seizures six months before & after therapy, & drug-related adverse reactions (ARs). For data analysis each therapy group is divided into mono or add-on therapy. Further subdivision into generalised or focal seizure was done. Efficacy was assessed as a percentage of reduction of monthly seizure frequency after LEV or TPM initiation compared to baseline.RESULTS:In the total samples; although LEV was better than TPM in overall seizure control, the difference was not significant (p-value = 0.1). Seizure freedom was 57.8% with LEV vs. 43.8% with TPM. Reduction ≥50% was achieved in 100% LEV vs. 90% TPM patients. Both showed high efficacy in generalised & focal seizures in both add on & monotherapy groups. In the subgroup analysis of monotherapy; LEV showed a higher rate of seizure freedom (83.3%) vs. 55.6% with TPM for treatment of generalised seizure. While for focal seizure, LEV showed 100% responder rate vs. 50% for TPM. Despite the above observations none of the two AEDs showed significant superiority over the other. Both were equally effective in paediatric & adult patients in high & low doses. Drug ARs were less frequent with LEV than TPM although both of them had reasonable safety profile.CONCLUSION:The efficacies of LEV & TPM were almost equal in treating focal or generalised seizures as mono or add-on therapy. Both were equally effective in adults & paediatric patients, in high & low doses. The safety profile of LEV was more favourable than TPM.