Comparative Efficacy Of Lamotrigine, Valproate Sodium, And Levetiracetam For Managing Idiopathic Generalised Tonic-Clonic Seizures In Adults

BACKGROUND: Idiopathic generalized tonic-clonic seizures (IGTCS) constitute a
common type of epilepsy, that is, the spontaneous, generalized convulsions, and may
seriously affect the quality of life of patients. The long-term seizure control is important to
minimize morbidity, eliminate injuries, and enhance psychosocial outcomes. Some of the
antiepileptic medications (AEDs) that are frequently prescribed include Lamotrigine,
Valproate Sodium and Levetiracetam as the first-line treatment. Although each of them
showed effectiveness on a one-on-one basis, there is still a lack of comparative data on their
effectiveness, safety, and tolerability in adult IGTCS populations, and head-to-head
comparisons are required.
PURPOSE: The aim of the present study was to comparatively evaluate the efficacy, safety,
and tolerability of Lamotrigine, Valproate Sodium, and Levetiracetam in adults with IGTCS,
in terms of reducing the frequency of seizures, reaching seizure freedom, adverse effects
profile and patient-reported quality of life.
METHODS: It was a prospective, randomized, comparative interventional study that was
carried out among adult patients presenting with IGTCS. Included participants were
selected into three categories to be treated with monotherapy of either Lamotrigine,
Valproate Sodium, or Levetiracetam over a period of six months. Patient diaries and clinical
follow ups were used to monitor the frequency of seizures. Main outcomes were percentage
change in the frequency of seizures, and the fraction of patients without any seizures.
Secondary endpoints measured adverse drug reaction, tolerability and quality of life (QOL)
with validated scales. Statistical tests were ANOVA (in the case of continuous variables) and
Chi-square (in case of categorical results), and the p-values below 0.05 were regarded as
statistically significant.
FINDINGS: The three AEDs proved to be effective to a great extent in the management of
IGTCS. The highest percentage of reductions in the frequency of seizures was observed with
Valproate Sodium (82%), then Levetiracetam (78%), and Lamotrigine (74%). Valproate,
Levetiracetam and Lamotrigine showed complete freedom of seizures in 68, 63 and 58
percent respectively. There were some adverse effects, which differed among groups:
Valproate users complained of weight gain, tremor, and gastrointestinal discomfort;
Lamotrigine was also associated with mild rash in some patients; and Levetiracetam wasleast affected with its side effects being mild behavioral changes. All groups had a high
quality of life (p<0.05) as Levetiracetam users expressed the greatest satisfaction and
compliance.
CONCLUSION: Lamotrigine, Valproate Sodium, and Levetiracetam can all be
monotherapies used successfully to help adults with IGTCS. Valproate was shown to be
better in terms of seizure control, but Levetiracetam had a better tolerability and patient
compliance. Lamotrigine is also a safe and effective alternative, especially in women with
potential to bear children because it has a good safety profile. These results favor
personalized AED choice on the basis of effectiveness, tolerability and patient-specific
criterion.
KEYWORD: Lamotrigine, Valproate Sodium, Levetiracetam, Idiopathic Generalized Tonic-Clonic Seizures,
Epilepsy, Seizure Control, Antiepileptic Drugs, Quality of Life.