Oxcarbazepine add-on for drug-resistant partial epilepsy

Castillo SM, Schmidt DB, White S, Shukralla A

Published Online:

January 21, 2009

Oxcarbazepine is effective as a short-term combination treatment for partial epilepsy.

Epilepsy is a disorder where recurrent seizures are caused by abnormal electrical discharges from the brain. Oxcarbazepine is an antiepileptic drug which can be used as an add-on treatment for people with drug-resistant partial epilepsy who are resistant to other antiepileptic drugs. The review of trials found that oxcarbazepine used in this way can reduce seizure frequency in the short-term for adults and children. The review did not include people with generalized epilepsy or look at the long-term effects of oxcarbazepine.

Abstract (click to read)

Background:

Most people with epilepsy have a good prognosis and their seizures can be well controlled with the use of a single antiepileptic drug, but up to 30% develop refractory epilepsy, especially those with partial seizures. In this review we summarize the current evidence regarding oxcarbazepine when used as an add-on treatment for drug-resistant partial epilepsy.

Objectives:

To evaluate the effects of oxcarbazepine when used as an add-on treatment for drug-resistant partial epilepsy.

Search strategy:

We searched the Cochrane Epilepsy Group's Specialized Register (28 March 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2006), MEDLINE (1966 to March 2006). No language restrictions were imposed. We checked the reference lists of retrieved studies for additional reports of relevant studies. We also contacted Novartis (manufacturers of oxcarbazepine) and experts in the field.

Selection criteria:

Randomized, placebo-controlled, double-blinded, add-on trials of oxcarbazepine in patients with drug-resistant partial epilepsy.

Data collection and analysis:

Two review authors independently assessed trials for inclusion and extracted the relevant data. The following outcomes were assessed : (a) 50% or greater reduction in seizure frequency; (b) treatment withdrawal (any reason); (c) side effects. Primary analyses were intention-to-treat. Summary odds ratios were estimated for each outcome.

Main results:

Two trials were included representing 961 randomized patients.
Overall Odds Ratio (OR) (95% Confidence Interval (CIs)) for 50% or greater reduction in seizure frequency compared to placebo 2.96 (2.20, 4.00).
Treatment withdrawal OR (95% CIs) compared to placebo 2.17 (1.59, 2.97).
Side effects: OR (99% CIs) compared to placebo, ataxia 2.93 (1.72, 4.99); dizziness 3.05 (1.99, 4.67); fatigue 1.80 (1.02, 3.19); nausea 2.88 (1.77, 4.69); somnolence 2.55 (1.84, 3.55); diplopia 4.32 (2.65, 7.04), were significantly associated with oxcarbazepine.

Authors' conclusions:

Oxcarbazepine has efficacy as an add-on treatment in patients with drug-resistant partial epilepsy, both in adults and children. However, trials reviewed were of relatively short duration, and provide no evidence about the long-term effects of oxcarbazepine. Results cannot be extrapolated to monotherapy or to patients with other epilepsy types.

This record should be cited as:

Castillo SM, Schmidt DB, White S, Shukralla A. Oxcarbazepine add-on for drug-resistant partial epilepsy. Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD002028. DOI: 10.1002/14651858.CD002028

Assessed as up to date:

March 27, 2006

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Primary Review Group:

Epilepsy Group

Health topics:

Neurology > Epilepsy > Drugs for broad populations

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Independent high-quality evidence for health care decision making

Oxcarbazepine add-on for drug-resistant partial epilepsy

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