Levetiracetam versus Oxcarbazepine as monotherapy in newly diagnosed focal epilepsy: A systematic review and meta‐analysis

Abstract

Objective: To compare the efficacy and safety of Levetiracetam (LEV) and Oxcarbazepine (OXC) as monotherapy for the treatment of newly diagnosed focal epilepsy. Methods:We searched PubMed, Cochrane Library, EMBASE, and Google Scholar from January 1, 2000 to May 11, 2022, with no language restrictions along with The Clini-calTrials.gov website and the WHO International Controlled Trials Registry platforms.We pooled the risk ratio (RR) and corresponding 95% confidence interval (95% CI) for the efficacy and safety outcomes. The quality of included trials was assessed using the Cochrane Collaboration's tool.Results: Two RCTs included a total of 574 newly diagnosed focal epilepsy patients (the LEV group [282 patients] and the OXC group [292 patients]). LEV group when compared with the OXC group had no significant difference in the pooled estimate of seizure freedom at week 24. (RR: 0.81; 95% CI: 0.62-1.05, p = .11). Similarly, there was no significant difference in the pooled estimate of withdrawal due to adverse events (AEs) (RR: 0.87; 95% CI: 0.34-2.23, p = .77). The commonly reported AEs in both trials were dizziness, headache, rash, somnolence, and nasopharyngitis with zero medication-related death and few serious AEs. Conclusions:LEV is noninferior to OXC in terms of seizure freedom at week 24 and treatment withdrawal rate due to AEs among adults but long-term treatment data is still missing. Future multicentric double-blinded RCTs and real-world studies are of great need.

Risk factors of electrical status epilepticus during sleep in children with benign childhood epilepsy with centro-temporal spikes

“…Specifically, LEV is a relatively new second-generation AEDs, and it can bind selectively to proteins related to neurotransmitter release, which can work rapidly. 12 …”

“…Specifically, LEV is a relatively new second-generation AEDs, and it can bind selectively to proteins related to neurotransmitter release, which can work rapidly. 12 Moreover, OXC is a new-generation AEDs derived from traditional AEDs, with few side effects. It plays an anti-convulsive role mainly by blocking sodium channel and promoting potassium conduction, and has a good therapeutic effect on children.…”

Risk assessment of arrhythmias related to three antiseizure medications: a systematic review and single-arm meta-analysis

“…OXC is not recommended for elderly patients with a history of cardiac conduction abnormalities or ventricular arrhythmias ( 63 ). A meta-analysis of LEV and OXC as monotherapy showed that their adverse effects did not differ much, but LEV had better seizure control ( 64 ). A study showed that epileptic patients who took carboxamide derivatives (including OXC) had a higher risk of arrhythmia than epileptic patients without medication and those without epilepsy ( 3 ).…”

Efficacy of levetiracetam combined with oxcarbazepine in the treatment of adults with temporal lobe epilepsy and its impact on memory and cognitive function

“…The rationale behind this may lie in the fact that oxcarbazepine, as a second-generation antiepileptic drug, possesses favorable pharmacokinetics. It can block voltage-dependent calcium or sodium ion channels, inhibit hyperexcitability of neuronal membranes, reduce synaptic activity, stabilize emotions, and alleviate anxiety and depression [24,25].…”