A Long-term Experience of Monotherapy in a Tertiary Epilepsy Center: Comparison between Oxcarbazepine and Levetiracetam

Abstract

Introduction: To evaluate and compare the long-term efficacy and safety of oxcarbazepine (OCB) and levetiracetam (LEV) based on a large population of patients at a tertiary epilepsy center. Methods: All patients who were using OCB or LEV at the Seoul National University Hospital between January 2007 and March 2009 were recruited. Patients who had received brain surgery for seizure control or who had associated progressive disease were excluded from this study. The electronic medical records of these patients were reviewed retrospectively. Results: A total of 307 patients were recruited. One hundred fifty-eight of the 177 patients treated with OCB and 58 of the 130 patients treated with LEV had localization-related epilepsy (LRE). The mean duration of follow-up of the OCB group was longer than that of the LEV group. In the LRE subgroup, 86 patients (54.4%) with OCB and 36 patients (52.9%) with LEV remained seizure free during the follow-up period (P = 0.837). LEV was also effective for juvenile myoclonic epilepsy (57.1% seizure-free rate) and epilepsy with generalized tonic–clonic seizure (62.5% seizure-free rate). In the LRE subgroup, the baseline seizure frequency was inversely correlated with seizure-free outcome. The 3-year retention rates in patients treated with OCB and LEV were not significantly different (81.4% vs 72.1%

P = 0.781). General weakness (11.9% vs 4.6%

P = 0.027) and skin rash (4.0% vs 0%

P = 0.022) were more frequent in the OCB group, whereas irritability (0.6% vs 33.8%

P < 0.001) was more frequent in the LEV group. The baseline seizure frequency, dose of medication, and dose-escalation rate to the maximum dosage were not associated with any adverse events. Conclusions: OCB and LEV were effective and safe as a monotherapy for partial epilepsy. LEV was also effective for the treatment of generalized epilepsy. The retention rate of each drug was well maintained up to 3 years. Skin rash was more frequent in the OCB group and irritability was more frequent in the LEV group.