Lamotrigine versus levetiracetam or zonisamide for focal epilepsy and valproate versus levetiracetam for generalised and unclassified epilepsy: two SANAD II non-inferiority RCTs
The results of the focal epilepsy RCT (n=990) do not support use of levetiracetam or zonisamide first-line. Results of the generalised and unclassified epilepsy RCT (n=520) do not support first-line use of levetiracetam in this setting.
Source:
National Institute for Health Research
SPS commentary:
The authors note that despite inadequate evidence, levetiracetam is increasingly prescribed as an alternative to valproate in the first-line treatment of idiopathic generalised epilepsy, due to the teratogenicity of valproate. For women of childbearing potential, these results inform discussions about the benefit (lower teratogenicity) and harm (worse seizure outcomes and higher treatment failure rate) of levetiracetam compared with valproate.