Tiagabine add-on for drug-resistant partial epilepsy

Pereira J, Marson AG, Hutton JL

Published Online:

October 6, 2010

Tiagabine in combination with other antiepileptic drugs (add-on) can reduce seizures, but with some adverse effects.

Nearly a third of people with epilepsy become resistant to antiepileptic drugs (AEDs). Older AEDs do not prevent seizures for everyone and they have adverse effects. New AEDs have been developed as 'add-on' treatments to try and improve this. Tiagabine is one of these. The review of trials found that for people who have drug-resistant partial epilepsy, use of tiagabine in combination with other AEDs can decrease seizures further. There is also an increase in adverse effects such as dizziness, fatigue, nervousness and tremor. More research is needed to determine how this drug performs in comparison with other newer AEDs.

Abstract (click to read)

Background:

This is an updated version of the original Cochrane review published in issue 3, 2002.

Epilepsy is a common neurological condition, affecting almost 0.5 to 1% of the population. Nearly 30% of people with epilepsy are resistant to currently available drugs. Tiagabine is one of the newer antiepileptic drugs and its effects as an adjunct (add-on) to standard drugs is assessed in this review.

Objectives:

To evaluate the effects of add-on treatment with tiagabine upon seizures, adverse effects, cognition and quality of life for people with drug-resistant localization related seizures.

Search strategy:

We searched the Cochrane Epilepsy Group's Specialized Register (June 2010), the Cochrane Central Register of Controlled Trials (CENTRAL, issue 2 of 4 The Cochrane Library 2010), and MEDLINE (1950 to June 2010). No language restrictions were imposed. We also contacted the manufacturers of tiagabine and experts in the field to seek any ongoing or unpublished studies.

Selection criteria:

Randomized placebo controlled add-on trials of people of any age with localization related seizures, in which an adequate method of concealment of randomization was used. The studies could be double, single or unblinded and be of parallel or crossover design. They had to have a minimum treatment period of eight weeks.

Data collection and analysis:

Two review authors independently selected trials for inclusion and extracted data. Any disagreements were resolved by discussion. Outcomes investigated included 50% or greater reduction in seizure frequency; treatment withdrawal; adverse effects; effects on cognition and quality of life. The primary analyses were by intention-to-treat. Worst case and best case analyses were also calculated for seizure outcomes. Dose response was evaluated in regression models.

Main results:

Three parallel group and two crossover group trials were included. The overall relative risk (RR) with 95% confidence intervals (CIs) for a 50% or greater reduction in seizure frequency (tiagabine versus placebo) was 3.16 (95% CI 1.97 to 5.07). Due to differences in response rates among trials, regression models were unable to provide reliable estimates of responses to individual doses. The RR for treatment withdrawal was 1.81 (95% CI 1.25 to 2.62). The 99% confidence interval for the following adverse effects: dizziness; fatigue; nervousness and tremor did not include unity, indicating that they are significantly associated with tiagabine. For cognitive and quality of life outcomes the limited data available suggested that there were no significant effects on cognition and mood and adjustment.

Authors' conclusions:

Tiagabine reduces seizures frequency but is associated with some adverse effects when used as an add-on for people with drug-resistant localization related seizures.

This record should be cited as:

Pereira J, Marson AG, Hutton JL. Tiagabine add-on for drug-resistant partial epilepsy. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD001908. DOI: 10.1002/14651858.CD001908

Assessed as up to date:

September 8, 2010

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Primary Review Group:

Epilepsy Group

Health topics:

Neurology > Epilepsy > Drugs for broad populations

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Tiagabine add-on for drug-resistant partial epilepsy

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