Comparative effectiveness-safety of conventional versus newer antiepileptics in epileptic patients in a tertiary care hospital, India

Meenu Thomas 1 * , Dinesh Kumar Badyal 2, Jeyaraj Durai Pandian 3
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1 Department of Pharmacology, Teerthanker Mahaveer Medical College & Research Center, Moradabad, Uttar Pradesh, India
2 Department of Pharmacology, Christian Medical College and Hospital , Ludhiana, Punjab, India
3 Department of Neurology, Christian Medical College and Hospital, Ludhiana, Punjab, India
* Corresponding Author
J CLIN MED KAZ, In press.
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Background: As initial monotherapy, individuals with epilepsy are treated with both conventional and newer antiepileptic drugs (AEDs). The differences in their relative effectiveness and safety as a group, however, have not been thoroughly studied.
Objective: To evaluate and compare the effectiveness and safety of conventional and newer anti-epileptic drugs in epileptic patients.
Material and methods: A prospective comparative study was done in 126 epileptic patients. Patients divided into two groups Group A and B of 63 each received conventional and newer antiepileptic drugs respectively. Patients were allocated the AED based on type of epilepsy, patient characteristics and drug characteristics by the treating physician. Patients maintained a seizure diary which they filled weekly and this seizure diary was evaluated at 6 weeks and 12 weeks of follow up. Patients were assessed for adverse drug reactions (ADRs) at 0, 6 and 12 weeks of follow up and also for spontaneous reported ADRs at any time during the study.
Results: In both group A and group B, our study demonstrated that seizure freedom, seizure severity, and time before first seizure did not differ significantly (p>0.5). Except for cognitive dysfunction, impaired memory, and swollen gums, which were more frequent in the conventional anti-epileptics group, the ADR profiles of both group of medications were similar. Phenytoin was found to cause gum swelling and cognitive impairment. No subject experienced a serious adverse event.
Conclusion: Newer Antiepileptics as monotherapy are equally efficacious as conventional antiepileptics but may offer a better safety profile to epileptic patients.


Thomas M, Badyal DK, Pandian JD. Comparative effectiveness-safety of conventional versus newer antiepileptics in epileptic patients in a tertiary care hospital, India. J Clin Med Kaz. 2023.


  • Beghi E. The Epidemiology of Epilepsy. Neuroepidemiology. 2020; 54:185-91.
  • Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon CS, Dykeman J, et al. Prevalence and incidence of epilepsy: A systematic review and meta-analysis of international studies. Neurology. 2017; 88:296–303.
  • Santhosh NS, Sinha S, Satishchandra P. Epilepsy: Indian perspective. Ann Indian Acad Neurol. 2014; 17:S3-S11.
  • Vidaurre J, Herbst J. Nuevos. fármacos antiepilépticos [New antiepileptic drugs]. Medicina (B Aires). 2019; 79:48-53.
  • Liu G, Slater N, Perkins A. Epilepsy: Treatment Options. Am Fam Physician. 2017; 96(2):87-96.
  • Hanaya R, Arita K. The New Antiepileptic Drugs: Their Neuropharmacology and Clinical Indications. Neurol Med Chir (Tokyo). 2016; 56:205-20.
  • Feyissa A.M., López C.A.S., Britton J.W. Antiepileptic drug therapy in patients with autoimmune epilepsy. Neurol. Neuroimmunol. Neuroinflamm. 2017; 4:e353.
  • Reindl C, Sprügel MI, Sembill JA, Mueller TM, Hagen M, Gerner ST, et al. Influence of new versus traditional antiepileptic drugs on course and outcome of status epilepticus. Seizure. 2020; 74:20-5.
  • Schachter SC. Quality of life for patients with epilepsy is determined by more than seizure control: the role of psychosocial factors. Expert Rev Neurother. 2006; 6:111-8.
  • Stafstrom CE, Carmant L. Seizures and epilepsy: an overview for neuroscientists. Cold Spring Harb Perspect Med. 2015; 5:a022426.
  • Jesso G, Kulkarni C, Sarma GRK. Antiepileptic drugs and quality of life in patients with epilepsy: a tertiary care hospital-based study. Value Health Reg Issues. 2015; 6:1-6.
  • Laue-Gizzi H. Discontinuation of antiepileptic drugs in adults with epilepsy. Aust Prescr. 2021; 44(2):53-6.
  • Zhao L, Wu YP, Qi JL, Liu YQ, Zhang K, Li WL. Efficacy of levetiracetam compared with phenytoin in prevention of seizures in brain injured patients: A meta-analysis. Medicine (Baltimore). 2018; 97:e13247.
  • Thangaratinam S, Marlin N, Newton S, Weckesser A, Bagary M, Greenhill L, et al. AntiEpileptic drug Monitoring in PREgnancy (EMPiRE): a double-blind randomised trial on effectiveness and acceptability of monitoring strategies. Health Technol Assess. 2018; 22:1-152.
  • Marson AG, Al-Kharusi AM, Alwaidh M, Appleton R, Baker GA, Chadwick DW, et al. The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial. Lancet. 2007; 369:1016-26.
  • Misra UK, Dubey D, Kalita J. Comparison of lacosamide versus sodium valproate in status epilepticus: A pilot study. Epilepsy Behav. 2017; 76:110-13.
  • Kaushik S, Chopra D, Sharma S, Aneja S. Adverse Drug Reactions of Anti-Epileptic Drugs in Children with Epilepsy: A Cross-Sectional Study. Curr Drug Saf. 2019; 14:217-24.
  • Maqbool M, Dugassa D, Fekadu G. Adverse Drug Reactions of Antiepileptic Drugs in the Neurology Department of a Tertiary Care Hospital, Srinagar, Jammu & Kashmir, India. Arch Neurosci. 2021; 8:e112364.
  • Verma T, Mallik SB, Ramalingayya GV, Nayak PG, Kishore A, Pai KSR, et al. Sodium valproate enhances doxorubicin-induced cognitive dysfunction in Wistar rats. Biomed Pharmacother. 2017; 96:736-41.
  • Besag FMC, Vasey MJ. Neurocognitive Effects of Antiseizure Medications in Children and Adolescents with Epilepsy. Paediatr Drugs. 2021; 23:253-86.
  • Nagib MM, Tadros MG, Rahmo RM, Sabri NA, Khalifa AE, Masoud SI. Ameliorative Effects of α-Tocopherol and/or Coenzyme Q10 on Phenytoin-Induced Cognitive Impairment in Rats: Role of VEGF and BDNF-TrkB-CREB Pathway. Neurotox Res. 2019; 35:451-62.
  • Braakman HM, Verhoeven JS, Erasmus CE, Haaxma CA, Willemsen MH, Schelhaas HJ. Phenytoin as a last-resort treatment in SCN8A encephalopathy. Epilepsia Open. 2017; 2:343-44.
  • Kumari A, Bansal MB, Asrani KH, Yadav A. Nonsyndromic with Recurrent Idiopathic Gingival Fibromatosis: A Rare Case Report. Int J Clin Pediatr Dent. 2021; 14:158-60.
  • Wiffen PJ, Derry S, Bell RF, Rice AS, Tölle TR, Phillips T, et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017; 6:CD007938.
  • Ayalew MB, Muche EA. Patient reported adverse events among epileptic patients taking antiepileptic drugs. SAGE Open Med. 2018; 6:2050312118772471.