***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The long-term efficacy and safety of sodium valproate and carbamazepine in adult out patients with newly diagnosed primary generalised or partial and secondarily generalised seizures were compared in a r and omised , open , multicentre study at 22 neurology outpatient clinics . Patients were r and omised to oral sodium valproate ( Epilim EC enteric coated 200 mg tablets twice daily , n = 149 ) or oral carbamazepine ( 100 mg twice daily increasing to 200 mg twice daily in week 2 , n = 151 ) and followed up for three years . If clinical ly necessary , dosages were regularly increased until seizures were controlled or toxicity developed . Sodium valproate and carbamazepine controlled both primary generalised and partial seizures equally effectively overall . Significantly more patients on sodium valproate than carbamazepine ( 126/140 ( 90 % ) v 105/141 ( 75 % ) , p = 0.001 ) remained on r and omised treatment for at least six months . Skin rashes occurred significantly more often in carbamazepine recipients than in sodium valproate recipients ( 11.2 % v 1.7 % , p < 0.05 ) and carbamazepine was associated with a higher withdrawal rate because of adverse events ( 15 % v 5 % on sodium valproate ) in the first six months of treatment . There was no difference between the drugs in the rate of withdrawal because of poor seizure control at any stage , regardless of seizure type . At the end of the three year trial period , over 70 % of the available patients were still on r and omised treatment or had recently stopped treatment after achieving full seizure control . Sodium valproate and carbamazepine were both associated with a high degree of overall seizure control regardless of seizure type and both have good long-term tolerability in adult patients with newly diagnosed epilepsy . Recommendations are made for a higher initial dosage regime for sodium valproate in partial seizures Background The choice of antiepileptic drug for an individual should be based upon the highest quality evidence regarding potential benefits and harms of the available treatments . Systematic review s and meta- analysis of r and omised controlled trials should be a major source of evidence supporting this decision making process . We summarise all available individual patient data evidence from r and omised controlled trials that compared at least two out of eight antiepileptic drugs given as monotherapy . Methods Multiple treatment comparisons from epilepsy monotherapy trials were synthesized in a single stratified Cox regression model adjusted for treatment by epilepsy type interactions and making use of direct and indirect evidence . Primary outcomes were time to treatment failure and time to 12 month remission from seizures . A secondary outcome was time to first seizure . Results Individual patient data for 6418 patients from 20 r and omised trials comparing eight antiepileptic drugs were synthesized . For partial onset seizures ( 4628 ( 72 % ) patients ) , lamotrigine , carbamazepine and oxcarbazepine provide the best combination of seizure control and treatment failure .  Lamotrigine is clinical ly superior to all other drugs for treatment failure but estimates suggest a disadvantage compared to carbamazepine for time to 12 month remission [ Hazard Ratio ( 95 % Confidence Interval ) = 0.87(0.73 to 1.04 ) ] and time to first seizure [ 1.29(1.13 to 1.48 ) ] . Phenobarbitone may delay time to first seizure [ 0.77(0.61 to 0.96 ) ] but at the expense of increased treatment failure [ 1.60(1.22 to 2.10 ) ] . For generalized onset tonic clonic seizures ( 1790 ( 28 % ) patients ) estimates suggest valproate or phenytoin may provide the best combination of seizure control and treatment failure but some uncertainty remains about the relative effectiveness of other drugs . Conclusion For patients with partial onset seizures , results favour carbamazepine , oxcarbazepine and lamotrigine . For generalized onset tonic clonic seizures , results favour valproate and phenytoin PURPOSE In this prospect i ve study , we compared the long-term cognitive and behavioral effects of lamotrigine ( LTG ) and carbamazepine ( CBZ ) in patients with newly diagnosed or untreated partial epilepsy . METHODS This was a multicenter , open-label , r and omized study that compared monotherapy with LTG and CBZ in newly diagnosed or untreated patients with partial epilepsy . We employed an 8-week titration period and a 40-week maintenance period . Neuropsychological tests , Symptom Check List-90 , and QOLIE-31 were assessed at baseline , 16 weeks , and 48 weeks after drug treatment . A group-by-time interaction was the primary outcome measure and was analyzed by use of the linear mixed model . RESULTS A total of 110 patients were eligible and 73 completed the 48-week study  ( LTG , n=39 ; CBZ , n=34 ) . Among the cognitive tests , significant group-by-time interaction was identified only in phonemic fluency of Controlled Oral Word Association Task ( p=0.0032 ) and Stroop Color-Word Interference ( p=0.0283 ) , with a significant better performance for LTG group . All other neuropsychological tests included did not show significant group-by-time interactions . Among the subscales of Symptom Check List-90 , significant group-by-time interactions were identified in Obsessive-Compulsive ( p=0.0005 ) , Paranoid Ideation ( p=0.0454 ) , Global Severity Index ( p=0.0194 ) , and Positive Symptom Total ( p=0.0197 ) , with a significant improvement for CBZ group . QOLIE-31 did not show significant group-by-time interactions . CONCLUSION Our data suggest that epilepsy patients on LTG have better performance on phonemic fluency and the task of Stroop Color-Word Interference than do patients on CBZ , whereas patients on CBZ had more favorable behavioral effects on two subscales and two global scores of Symptom Check List-90 than did patients on LTG Using a r and omized parallel group study design , we compared the cognit i ve effects of carbamazepine ( CBZ ) , phenobarbital ( PB ) , and valproate ( VPA ) in children with epilepsy . Seventy-three children with newly diagnosed epilepsy were tested with the Wechsler Intelligence Scale for Children-Revised ( WISC-R ) , Bender-Gestalt test , and auditory event-related potentials ( P 300 ) before and 6 and 12 months after antiepileptic drug ( AED ) treatment . There were no significant differences in WISC-R IQs and Bender-Gestalt scores for children in any group at any of the three sessions . P 300 latencies were increased in the children receiving PB but not in children receiving CBZ and VPA . P 300 amplitudes were significantly reduced in treated children in all three groups , but amplitudes were not significantly different among the three groups . These findings suggest that PB may affect cognitive function of epileptic children and that the P 300 may be a sensitive additional procedure that can be used to assess the cognitive effect of AEDs Abstract Background and Objectives Sudden unexplained/unexpected death ( SUDEP ) is related to high mortality in patients with epilepsy . The prolongation of QT interval , involved in cardiac arrhythmia-related SUDEP , may be precipitated by antiepileptic dru gs ( AEDs ) . In this study , we evaluated the effects of phenobarbital and levetiracetam on PR – QTc intervals in patients with post-stroke seizures . Methods We performed an open-label , parallel group , prospect i ve , multicenter study between June 2009 and December 2013 in patients older than 18 years of age with a clinical diagnosis of post-stroke seizure and treated with phenobarbital or levetiracetam .  In order to exclude a role of cerebral post-stroke injury on modulation of PR and QTc intervals , patients with cerebral post-stroke injury and without seizures were also enrolled as controls . Results Interictal electrocardiography analysis revealed no significant difference in PR interval between patients treated with an AED ( n = 49 ) and control patients ( n = 50 ) ( 181.25 ± 12.05 vs. 182.4 ± 10.3 ms ; p > 0.05 ) . In contrast , a significantly longer QTc interval was recorded in patients treated with an AED compared with control patients ( 441.2 ± 56.6 vs. 396.8 ± 49.3 ms ; p < 0.01 ) . Patients treated with phenobarbital showed a significantly longer QTc interval than patients treated with levetiracetam ( 460.0 ± 57.2 vs. 421.5 ± 50.1 ms ; p < 0.05 ) . Conclusions The study reported that in patients with late post-stroke seizures  , phenobarbital  prolonged QTc interval more so than levetiracetam Objective To compare the effectiveness of levetiracetam ( LEV ) with extended-release sodium valproate ( VPA-ER ) and controlled-release carbamazepine ( CBZ-CR ) as monotherapy in patients with newly diagnosed epilepsy . Methods This unblinded , r and omised , 52-week superiority trial ( NCT00175903 ) recruited patients ( ≥16 years of age ) with ≥2 unprovoked seizures in the previous 2 years and ≥1 in the previous 6 months . The physician chose VPA or CBZ as preferred st and ard treatment ; each patient was r and omised to st and ard treatment or LEV . The primary outcome was time to treatment withdrawal ( LEV vs st and ard antiepileptic drugs ( AEDs ) ) . Analyses also compared LEV with VPA-ER , and LEV with CBZ-CR . Findings 1688 patients ( mean age 41 years ; 44 % female ) were r and omised to LEV ( n=841 ) or st and ard AEDs ( n=847 ) . Time to treatment withdrawal was not significantly different between LEV and st and ard AEDs : HR ( 95 % CI ) 0.90 ( 0.74 to 1.08 ) . Time to treatment withdrawal ( HR ( 95 % CI ) ) was 1.02 ( 0.74 to 1.41 ) for LEV/VPA-ER and 0.84 ( 0.66 to 1.07 ) for LEV/CBZ-CR . Time to first seizure ( HR , 95 % CI ) was significantly longer for st and ard AEDs , 1.20 ( 1.03 to 1.39 ) , being 1.19 ( 0.93 to 1.54 ) for LEV/VPA-ER and 1.20 ( 0.99 to 1.46 ) for LEV/CBZ-CR . Estimated 12-month seizure freedom rates from r and omisation : 58.7 % LEV versus 64.5 % VPA-ER ; 50.5 % LEV versus 56.7 % CBZ-CR . Similar proportions of patients within each stratum reported at least one adverse event : 66.1 % LEV versus 62.0 % VPA-ER ; 73.4 % LEV versus 72.5 % CBZ-CR . Conclusions LEV monotherapy was not superior to st and ard AEDs for the global outcome , namely time to treatment withdrawal , in patients with newly diagnosed focal or generalised seizures BACKGROUND Carbamazepine is widely accepted as a drug of first choice for patients with partial onset seizures . Several newer drugs possess efficacy against these seizure types but previous r and omised controlled trials have failed to inform a choice between these drugs . We aim ed to assess efficacy with regards to longer-term outcomes , quality of life , and health economic outcomes . METHODS SANAD was an unblinded r and omised controlled trial in hospital-based outpatient clinics in the UK . Arm A recruited 1721 patients for whom carbamazepine was deemed to be st and ard treatment , and they were r and omly assigned to receive carbamazepine , gabapentin , lamotrigine , oxcarbazepine , or topiramate . Primary outcomes were time to treatment failure , and time to 12-months remission , and assessment was by both intention to treat and per protocol . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N38354748 . FINDINGS For time to treatment failure , lamotrigine was significantly better than carbamazepine ( hazard ratio [ HR ] 0.78 [ 95 % CI 0.63 - 0.97 ] ) , gabapentin ( 0.65 [ 0.52 - 0.80 ] ) , and topiramate ( 0.64 [ 0.52 - 0.79 ] ) , and had a non-significant advantage compared with oxcarbazepine ( 1.15 [ 0.86 - 1.54 ] ) . For time to 12-month remission carbamazepine was significantly better than gabapentin ( 0.75 [ 0.63 - 0.90 ] ) , and estimates suggest a non 
    Output:
    
Clobazam , levetiracetam , lamotrigine , oxcarbazepine , sulthiame , topiramate , and valproate had the best efficacy profiles and demonstrated no evidence of superiority or inferiority compared with CBZ .
The newer AEDs-levetiracetam , lamotrigine , oxcarbazepine , sulthiame , and topiramate-should be considered for monotherapy of focal epilepsy because they were demonstrated to be as effective as the older ones ( CBZ , clobazam , and valproate ) for the treatment of focal epilepsy and were more tolerable .
Lamotrigine was the AED with the best tolerability profile , suggesting that it may be the best option for the treatment of focal epilepsy in children and adults