Sulthiame add-on therapy for epilepsy

被引:6
|
作者
Bresnahan, Rebecca [1 ]
Martin-McGill, Kirsty J. [1 ,2 ]
Milburn-McNulty, Philip [3 ]
Powell, Graham [3 ]
Sills, Graeme J. [4 ]
Marson, Anthony G. [1 ,3 ,5 ]
机构
[1] Univ Liverpool, Inst Translat Med, Dept Mol & Clin Pharmacol, Lower Lane, Liverpool L9 7LJ, Merseyside, England
[2] Univ Chester, Dept Clin Sci & Nutr, Chester, Cheshire, England
[3] Walton Ctr NHS Fdn Trust, Liverpool, Merseyside, England
[4] Univ Glasgow, Sch Life Sci, Glasgow, Lanark, Scotland
[5] Liverpool Hlth Partners, Liverpool, Merseyside, England
来源
COCHRANE DATABASE OF SYSTEMATIC REVIEWS | 2019年 / 08期
关键词
Anticonvulsants [adverse effects; *therapeutic use; Epilepsy [drug therapy; Pyridoxine [therapeutic use; Randomized Controlled Trials as Topic; Spasms; Infantile [* drug therapy; Thiazines [adverse effects; Female; Humans; Infant; Male; BENIGN CHILDHOOD EPILEPSY; CENTROTEMPORAL SPIKES; ANTIEPILEPTIC DRUG; DOUBLE-BLIND; CHILDREN; TRIAL; POLYTHERAPY; MONOTHERAPY;
D O I
10.1002/14651858.CD009472.pub4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background This is an updated version of the Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2015, Issue 10. Epilepsy is a common neurological condition, characterised by recurrent seizures. Most people respond to conventional antiepileptic drugs, however, around 30% will continue to experience seizures, despite treatment with multiple antiepileptic drugs. Sulthiame, also known as sultiame, is a widely used antiepileptic drug in Europe and Israel. We present a summary of the evidence for the use of sulthiame as add-on therapy in epilepsy. Objectives To assess the efficacy and tolerability of sulthiame as add-on therapy for people with epilepsy of any aetiology compared with placebo or another antiepileptic drug. Search methods For the latest update, we searched the Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group's Specialized Register and CENTRAL (17 January 2019), MEDLINE Ovid (1946 to January 16, 2019), ClinicalTrials.gov and the WHO ICTRP Search Portal (17 January 2019). We imposed no language restrictions. We contacted the manufacturers of sulthiame, and researchers in the field to seek any ongoing or unpublished studies. Selection criteria Randomised controlled trials of add-on sulthiame, with any level of blinding (single, double or unblinded) in people of any age, with epilepsy of any aetiology. Data collection and analysis Two review authors independently selected trials for inclusion, and extracted relevant data. We assessed these outcomes: (1) 50% or greater reduction in seizure frequency between baseline and end of follow-up; (2) complete cessation of seizures during follow-up; (3) mean seizure frequency; (4) time-to-treatment withdrawal; (5) adverse effects; and (6) quality of life. We used intention-to-treat for primary analyses. We presented results as risk ratios (RR) with 95% confidence intervals (CIs). However, due to the paucity of trials, we mainly conducted a narrative analysis. Main results We included one placebo-controlled trial that recruited 37 infants with newly diagnosed West syndrome. This trial was funded by DESITIN Pharma, Germany. During the study, sulthiame was given as an add-on therapy to pyridoxine. No data were reported for the outcomes: 50% or greater reduction in seizure frequency between baseline and end of follow-up; mean seizure frequency; or quality of life. For complete cessation of seizures during a nine-day follow-up period for add-on sulthiame versus placebo, the RR was 11.14 (95% CI 0.67 to 184.47; very low-certainty evidence), however, this difference was not shown to be statistically significant (P = 0.09). The number of infants experiencing one or more adverse events was not significantly different between the two treatment groups (RR 0.85, 95% CI 0.44 to 1.64; very low-certainty evidence; P = 0.63). Somnolence was more prevalent amongst infants randomised to add-on sulthiame compared to placebo, but again, the difference was not statistically significant (RR 3.40, 95% CI 0.42 to 27.59; very low-certainty evidence; P = 0.25). We were unable to conduct meaningful analysis of time-to-treatment withdrawal and adverse effects due to incomplete data. Authors' conclusions Sulthiame may lead to a cessation of seizures when used as an add-on therapy to pyridoxine in infants with West syndrome, however, we are very uncertain about the reliability of this finding. The included study was small and had a significant risk of bias, largely due to the lack of details regarding blinding and the incomplete reporting of outcomes. Both issues negatively impacted the certainty of the evidence. No conclusions can be drawn about the occurrence of adverse effects, change in quality of life, or mean reduction in seizure frequency. No evidence exists for the use of sulthiame as an add-on therapy in people with epilepsy outside West syndrome. Large, multi-centre randomised controlled trials are needed to inform clinical practice, if sulthiame is to be used as an add-on therapy for epilepsy.
引用
收藏
页数:28
相关论文
共 50 条
  • [1] Sulthiame add-on therapy for epilepsy
    Milburn-McNulty, P.
    Powell, G.
    Sills, G. J.
    Marson, A. G.
    COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2015, (10):
  • [2] Sulthiame add-on therapy for epilepsy
    Milburn-McNulty, Philip
    Powell, Graham
    Sills, Graeme J.
    Marson, Anthony G.
    COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2013, (03):
  • [3] Is sulthiame effective and tolerated as add-on therapy for infants with epilepsy? A Cochrane Review summary with commentary
    Liguori, Sara
    DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY, 2021, 63 (06): : 635 - 636
  • [4] Use of sulthiame as add-on therapy in children with myoclonic atonic epilepsy: A study of 35 patients
    Caraballo, Roberto H.
    Valenzuela, Gabriela Reyes
    Fortini, Sebastian
    Espeche, Alberto
    Gamboni, Beatriz
    Bautista, Claudia
    Cachia, Pedro
    Semprino, Marco
    Gallo, Adolfo
    Galicchio, Santiago
    EPILEPSY & BEHAVIOR, 2022, 131
  • [5] Epilepsy: A new add-on therapy for epilepsy
    Yates D.
    Nature Reviews Neurology, 2009, 5 (5) : 237 - 237
  • [6] Zonisamide add-on therapy for focal epilepsy
    Brigo, Francesco
    Lattanzi, Simona
    Igwe, Stanley C.
    Behzadifar, Masoud
    Bragazzi, Nicola Luigi
    COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2020, (07):
  • [7] Zonisamide add-on therapy for focal epilepsy
    Brigo, Francesco
    Lattanzi, Simona
    Igwe, Stanley C.
    Behzadifar, Masoud
    Bragazzi, Nicola Luigi
    COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2018, (10):
  • [8] Losigamone add-on therapy for focal epilepsy
    Chen, Hongchang
    He, Honghu
    Xiao, Yousheng
    Luo, Man
    Luo, Hongye
    Wang, Jin
    COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2019, (12):
  • [9] Losigamone add-on therapy for partial epilepsy
    Xiao, Y.
    Luo, M.
    Wang, J.
    Luo, H.
    COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2012, (06):
  • [10] Felbamate as an add-on therapy for refractory epilepsy
    Shi, Li Li
    Dong, JianCheng
    Ni, Hengjian
    Geng, JinSong
    Wu, Taixiang
    COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2014, (07):