Efficacy and tolerability of anti‐epileptic drugs—an internet study

Objective To ascertain efficacy and tolerability of carbamazepine ( CBZ ), sodium valproate ( VPA ), lamotrigine ( LTG ) and levetiracetam ( LEV ) using the UKAED register ( www.ukaed.info ). Methods Patients on CBZ (n=91), VPA (n=61), LTG (n=105), LEV (n=72) and healthy control subjects ( CTR ) on no medication (n=51) were extracted. All patients had anonymously provided information on seizure type and frequency and completed the Liverpool Adverse Event Profile ( LAEP ). Results The number of seizure‐free patients in the last 4 weeks was overall CBZ / VPA / LTG / LEV =60%/79%/67%/67%, for generalized epilepsy was CBZ / VPA / LTG / LEV =67%/89%/65%/94%, and for localization‐related epilepsy was CBZ / VPA / LTG / LEV =59%/71%/67%/57%. Mean LAEP scores were CBZ / VPA / LTG / LEV / CTR =42.21/39.66/39.86/43.01/29.69. The mean LAEP was significantly higher in patients reporting depression and in patients with active epilepsy than in patients without depression and remission. Central nervous system ( CNS ) adverse effects including memory problems, difficulty concentrating, depression, unsteadiness, restlessness, feelings of anger, shaky hands and dizziness were significantly more frequent in CBZ , VPA , LTG and LEV than in CTR . The feeling of anger was significantly more frequent in LEV , and depression was significantly more frequent in CBZ compared to the other drugs. Conclusion In this Internet‐based register of self‐reported efficacy and tolerability, CBZ , VPA , LTG and LEV were similar. Self‐reported CNS adverse effects were significantly more frequent than in controls. In addition, anger was associated with LEV and depression with CBZ . Confounding factors were depression and uncontrolled epilepsy.