We read with interest the article by Kälviäinen et al1 comparing vigabatrin and carbamazepine monotherapy for newly diagnosed epilepsy, but we take issue with their assessment of the results.
Their conclusion begins "The overall success of vigabatrin and carbamazepine monotherapies in preventing seizures... was equal." The primary measure of treatment success that they used was 1 generalized or 1 to 4 partial seizures occurring during a treatment period of less than 1 year or freedom from seizures. In this group of patients with newly diagnosed epilepsy, anything less than freedom from seizures should be counted as treatment failure.2 When freedom from seizures is studied, carbamazepine seems to be much more efficacious than vigabatrin (52% of patients receiving carbamazepine were seizure free compared with 32% of patients receiving vigabatrin, P<.01).1 Indeed, this is one of the few comparative trials in such a group to show superiority of
Walker MC, Cockerell OC, Sander JWAS. Vigabatrin and Carbamazepine Monotherapy for Newly Diagnosed Epilepsy. Arch Neurol. 1996;53(6):477–478. doi:10.1001/archneur.1996.00550060019005
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