Intervention Review

Carbamazepine versus valproate monotherapy for epilepsy

  1. Anthony G Marson1,*,
  2. Paula R Williamson2,
  3. Jane L Hutton3,
  4. Helen E Clough4,
  5. David W Chadwick1

Editorial Group: Cochrane Epilepsy Group

Published Online: 24 JUL 2000

Assessed as up-to-date: 26 JUL 2007

DOI: 10.1002/14651858.CD001030

How to Cite

Marson AG, Williamson PR, Hutton JL, Clough HE, Chadwick DW. Carbamazepine versus valproate monotherapy for epilepsy. Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD001030. DOI: 10.1002/14651858.CD001030.

Author Information

  1. 1

    Clinical Sciences Centre for Research & Education, University Department of Neurological Science, Liverpool, Merseyside, UK

  2. 2

    University of Liverpool, Centre for Medical Statistics and Health Evaluation, Liverpool, Merseyside, UK

  3. 3

    University of Warwick, Department of Statistics, Coventry, UK

  4. 4

    University of Liverpool, Department of Veterinary Clinical Sciences, Neston, South Wirral, UK

*Anthony G Marson, University Department of Neurological Science, Clinical Sciences Centre for Research & Education, Lower Lane, Fazakerley, Liverpool, Merseyside, L9 7LJ, UK. a.g.marson@liverpool.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 24 JUL 2000

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Carbamazepine and valproate are drugs of first choice for epilepsy. Despite the lack of hard evidence from individual randomized controlled trials, there is strong clinical belief that valproate is the drug of choice for generalized epilepsies and carbamazepine for partial epilepsies.

Objectives

To overview the best evidence comparing carbamazepine and valproate monotherapy

Search methods

We searched the Cochrane Epilepsy Group's Specialized Register (27 July 2007), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2007), and MEDLINE (1966 to July 2007). No language restrictions were imposed. We also contacted pharmaceutical companies and researchers in the field.

Selection criteria

Randomized controlled trials comparing carbamazepine and valproate monotherapy for epilepsy.

Data collection and analysis

This was an individual patient data review. Outcome measures were time to withdrawal of allocated treatment, time to 12-month remission, and time to first seizure post randomization. Data were analysed using the stratified logrank test with results expressed as hazard ratios (HR) with 95% confidence intervals (CIs), where HR > 1 indicates an event is more likely on valproate. A test for an interaction between treatment and epilepsy type (partial versus generalized) was also undertaken.

Main results

Results data were available for 1265 participants from five trials, representing 85% of the participants recruited into the eight trials that met our inclusion criteria. The main overall results (HR) were: time to treatment withdrawal 0.97 (95% CI 0.79 to 1.18); 12 month remission 0.87 (95% CI 0.74 to 1.02); first seizure 1.09 (95% CI 0.96 to 1.25) suggesting no overall difference for these outcomes. The test for an interaction between treatment and epilepsy type was non significant for time to treatment withdrawal and 12-month remission, but significant for time to first seizure. The age distribution of adults classified as having a generalized epilepsy indicate that significant numbers of individuals may have had their epilepsy misclassified.

Authors' conclusions

We have found some evidence to support the policy of using carbamazepine as the first treatment of choice in partial epilepsies, but no evidence to support the choice of valproate in generalized epilepsies, but confidence intervals are too wide to confirm equivalence. Misclassification of people with epilepsy may have confounded our results, and has important implications for the design and conduct of future trials.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Carbamazepine versus valproate monotherapy for epilepsy

No reliable evidence to distinguish between carbamazepine and valproate for partial onset seizures and generalized onset tonic-clonic seizures.

Epilepsy is a disorder where recurrent seizures are caused by abnormal discharges from the brain. Carbamazepine is commonly used to treat partial seizures while valproate is used for generalized seizures. The review of trials found no evidence to support the belief that valproate is superior to carbamazepine for generalized tonic-clonic seizures. While it was found that younger people fared better on valproate and older people on carbamazepine, this may be because generalized epilepsy is more common in childhood and adolescence.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以Carbamazepine或Valproate作為癲癇的單一藥物治療之比較

Carbamazepine和Valproate是治療癲癇的第一線選擇。儘管缺乏獨立的隨機對照試驗提供證據,但是臨床上堅信Valproate是治療全盤發作型癲癇症的首選,而Carbamazepine則是治療局部發作型癲癇症的首選。

目標

這裏回顧了比較使用Carbamazepine和Valproate作為單一藥物治療癲癇的最佳證據。

搜尋策略

我們搜尋了Cochrane Epilepsy Group's Specialized Register (2007年7月27日)以及Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library,2007年第3期), MEDLINE (1966年2007年7月)。沒有設定任何語言限制。 我們也聯繫了醫藥公司和該領域的研究人員。

選擇標準

選擇比較Carbamazepine和Phenytoin作為單一藥物治療癲癇的隨機對照試驗

資料收集與分析

本研究是取自臨床試驗中個別病人資料的回顧。治療成果的收集包括開始治療後至停止試驗用藥的時間,開始治療後至達成連續12個月緩解的時間,開始隨機分配治療後至首次癲癇發作的時間等。我們使用tratified logrank test來分析資料,將結果呈現為hazard ratios (HR) 和95% confidence intervals (CIs),其中HR>1表示該事件較可能發生在使用valproate時。我們也檢驗了治療藥物和發作類型(局部發作型癲癇症對比全盤發作型癲癇症)之間的相互影響。

主要結論

我們從5個試驗中取得其中1265位受試者的相關資料,佔所有8個符合我們選擇條件的試驗中所有病患的85%。各項治療成果的HR如下:開始治療後至停止試驗用藥的時間為0.97 (95% CI 0.79 – 1.18);開始治療後至達成連續12個月緩解的時間為0.87 (95% CI 0.741.02); 開始隨機分配治療後至首次癲癇發作的時間為1.09 (95% CI 0.96−1.25),以上皆顯示兩種藥物治療間沒有明顯差異。至於治療藥物和發作類型之間的相互影響方面,在開始治療後至停止試驗用藥的時間和開始治療後至達成連續12個月緩解的時間等治療成果上無顯著差異,但於開始隨機分配治療後至首次癲癇發作的時間上則明顯有別。然而因有許多成人病患被歸類在全盤發作型癲癇症,這代表可能有相當數目的病患其癲癇分類並不正確。�

作者結論

我們找到了部份證據支持使用Carbamazepine作為治療局部發作型癲癇症的首選治療,而沒有證據支持將Valproate作為全盤發作型癲癇症的首選治療,但因分析得出的信賴區間太寬,無法認定兩種藥物的療效相等。雖然本研究可能因臨床試驗對癲癇病患類型的錯誤劃分而導致結果的混淆,這個狀況將給未來臨床試驗的設計和實行時提供一個重要的啟示。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

目前尚無可靠的證據能夠區分Carbamazepine和Valproate在治療局部發作型癲癇症和全盤發作型癲癇症時存在差異。癲癇是一種由於大腦放電異常引起的反覆發作的疾病。Carbamazepine常用於治療局部發作型癲癇症,而Valproate常用於治療全盤發作型癲癇症。本回顧研究發現,沒有證據支持使用Valproate治療全盤發作型癲癇症優於Carbamazepine。同時也發現,年輕癲癇患者使用Valproate治療成果較好而年齡較大的癲癇患者則使用Carbamazepine較好,這種差異可能因為全盤發作型癲癇症在兒童和青少年當中較為普遍。