***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: This prospect i ve , open-label study evaluated the efficacy and safety of adjunctive levetiracetam ( LEV ) in Korean adults with uncontrolled partial epilepsy . Study patients had to have an average of at least 1 and not more than 14 partial seizures per month ( averaged over a 3-month historical baseline ) despite the use of one or two AEDs . Patients initially received LEV 1000 mg/day ( administered bid ) and could increase to 2000 mg/day after 2 weeks , and to 3000 mg/day after another 2 weeks , to obtain adequate seizure control . During the 12-week maintenance period , the dose of LEV could be increased or decreased once if seizure control was insufficient or tolerability warranted , respectively . Seizure count and adverse events ( AEs ) were recorded by patients . Global evaluation scale ( GES ) and quality of life ( QOLIE-31 ) were also evaluated . A total of 100 patients were enrolled and 92 patients completed the study . The median percent reduction in weekly seizure frequency over the treatment period was 43.2 % . The > or=50 % and > or=75 % responder rates were 45.4 % and 36.1 % , respectively . Seizure freedom throughout the 16-week treatment period was observed in 17 patients . On investigator 's GES , 81 patients were considered improved , with 41 patients showing marked improvement . Most QOLIE-31 scales improved significantly . Treatment-emergent AEs were reported in 59 patients . Three most common AEs were somnolence ( 36 % ) , dizziness ( 12 % ) , and headache ( 8 % ) . Adjunctive LEV therapy was effective and well-tolerated in Korean adults with refractory partial epilepsy CONTEXT Despite reported success , surgery for pharmacoresistant seizures is often seen as a last resort . Patients are typically referred for surgery after 20 years of seizures , often too late to avoid significant disability and premature death . OBJECTIVE We sought to determine whether surgery soon after failure of 2 antiepileptic drug ( AED ) trials is superior to continued medical management in controlling seizures and improving quality of life ( QOL ) . DESIGN , SETTING , AND PARTICIPANTS The Early R and omized Surgical Epilepsy Trial ( ERSET ) is a multicenter , controlled , parallel-group clinical trial performed at 16 US epilepsy surgery centers . The 38 participants ( 18 men and 20 women ; aged ≥12 years ) had mesial temporal lobe epilepsy ( MTLE ) and disabling seizues for no more than 2 consecutive years following adequate trials of 2 br and -name AEDs . Eligibility for anteromesial temporal resection ( AMTR ) was based on a st and ardized presurgical evaluation protocol . Participants were r and omized to continued AED treatment or AMTR 2003 - 2007 , and observed for 2 years . Planned enrollment was 200 , but the trial was halted prematurely due to slow accrual . INTERVENTION Receipt of continued AED treatment ( n = 23 ) or a st and ardized AMTR plus AED treatment ( n = 15 ) . In the medical group , 7 participants underwent AMTR prior to the end of follow-up and 1 participant in the surgical group never received surgery . MAIN OUTCOME MEASURES The primary outcome variable was freedom from disabling seizures during year 2 of follow-up . Secondary outcome variables were health-related QOL ( measured primarily by the 2-year change in the Quality of Life in Epilepsy 89 [ QOLIE-89 ] overall T-score ) , cognitive function , and social adaptation . RESULTS Zero of 23 participants in the medical group and 11 of 15 in the surgical group were seizure free during year 2 of follow-up ( odds ratio = ∞ ; 95 % CI , 11.8 to ∞ ; P < .001 ) . In an intention-to-treat analysis , the mean improvement in QOLIE-89 overall T-score was higher in the surgical group than in the medical group but this difference was not statistically significant ( 12.6 vs 4.0 points ; treatment effect = 8.5 ; 95 % CI , -1.0 to 18.1 ; P = .08 ) . When data obtained after surgery from participants in the medical group were excluded , the effect of surgery on QOL was significant ( 12.8 vs 2.8 points ; treatment effect = 9.9 ; 95 % CI , 2.2 to 17.7 ; P = .01 ) . Memory decline ( assessed using the Rey Auditory Verbal Learning Test ) occurred in 4 participants ( 36 % ) after surgery , consistent with rates seen in the literature ; but the sample was too small to permit definitive conclusions about treatment group differences in cognitive outcomes . Adverse events included a transient neurologic deficit attributed to a magnetic resonance imaging-identified postoperative stroke in a participant who had surgery and 3 cases of status epilepticus in the medical group . CONCLUSIONS Among patients with newly intractable disabling MTLE , resective surgery plus AED treatment result ed in a lower probability of seizures during year 2 of follow-up than continued AED treatment alone . Given the premature termination of the trial , the results should be interpreted with appropriate caution . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00040326 The objective of this study was to compare the relative cost-effectiveness of two AEDs by a prospect i ve clinical audit . Patients starting on the adjunctive therapies lamotrigine and topiramate were recruited from the out-patient epilepsy clinics at Queen Square . Three interview were scheduled : baseline ; three months follow-up and six months from baseline . Of the 81 patients recruited , a total of 73 patients completed all three interviews . An intention to treat analysis was performed on the data . Seizure severity and frequency were assessed using the National Hospital Seizure Severity Scale . Side-effects , adverse events and reasons for stopping medication were also recorded . At the third interview , a total of 47/73 ( 64 % ) were still on the prescribed adjunctive drug . Outcome was assessed by two methods : the > 50 % seizure reduction cited in the literature and a more stringent assessment of patient ' satisfaction ' which we defined operationally on clinical criteria . Using this definition , a total of 10/73 ( 14 % ) patients were ' satisfied ' . The relative costs of starting patients on each of the two AEDs were calculated , both drug costs and the costs of adverse events ( the latter were defined as events requiring urgent medical attention ) . The costs of the two drugs were compared . A number of method ological issues relating to cost comparison are discussed . Outcome and pharmaco-economic studies need to assess more than reduction in number of seizures . They should take into account variables important for quality of life including side-effects and adverse events 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 Twenty-four patients with refractory epilepsy on one or more antiepileptic drugs were given additional vigabatrin ( 1 g twice daily for six weeks , followed by 1.5 g twice daily for a further six weeks ) and matched placebo in a double blind , r and omised , crossover study . A battery of neuropsychological tests was administered at baseline and at weeks two , six and 12 of both treatment periods . No significant differences were found between vigabatrin and placebo at any time point for any of the objective tests of cognitive function . Patients , however , reported a greater degree of sedation after two and six weeks on vigabatrin than during the equivalent placebo phase ( p < 0.01 ) , although no such difference was apparent at 12 weeks . Follow up over a mean of 14.75 months in 12 responders , who continued on vigabatrin , revealed a significant improvement ( all p < 0.01 ) on each of three composite scales ( three psychomotor tests , four memory tests , three self rating scales ) compared with their scores during the double blind trial . Vigabatrin did not cause cognitive impairment either acutely or in the long term . Phased introduction , however , seems a prudent policy to allow tolerance to early subjective sedation Lamotrigine is a broad-spectrum antiepileptic drug that blocks sodium channels , thereby inhibiting the pre-synaptic release of excitatory neurotransmitters . The primary aim of the study was to evaluate lamotrigine add-on therapy and consecutive monotherapy in patients with epilepsy whose seizures were not controlled by carbamazepine or valproate . One hundred and twenty six epilepsy patients at 18 centres in Pol and were recruited into a lamotrigine substitution study .  In all patients , existing seizures were poorly controlled with valproate ( n= 63 ) or carbamazepine ( n= 63 ) monotherapy . The study consisted of four phases : ( 1 ) a 4-week lamotrigine dose-escalation phase , ( 2 ) an 8-week lamotrigine add-on phase , ( 3 ) an 8-week carbamazepine/valproate withdrawal phase , and ( 4 ) an 8-week lamotrigine monotherapy phase . Of 126 patients recruited into the study , 107 ( 85 % ) completed dose-escalation and add-on therapy with lamotrigine and 85 ( 68 % ) completed lamotrigine monotherapy . Fifty percent of patients during add-on therapy and 53 % during lamotrigine monotherapy experienced at least 50 % reduction in total seizures ( responders ) compared to the pre- study period . Approximately 20 % of patients during add-on therapy and 27 % during lamotrigine monotherapy were seizure free . Total well-being was assessed using a Visual Analogue Scale with 62 % of patients during add-on therapy and 60 % in lamotrigine monotherapy reporting improvement in scores . Lamotrigine was generally well tolerated . Treatment was discontinued in 7 % because of adverse events . In conclusion , lamotrigine is an effective AED in add-on therapy and monotherapy , it is safe and well tolerated , and successful conversion from add-on to monotherapy can be achieved in many cases . An additive effect between lamotrigine and valproate was observed Several specific and general measures are available for the assessment of overall health related quality of life in epilepsy . Few of the commonly used measures provide utility weights for use in cost-utility analyses . This study compares four methods for measuring utility weights : time trade-off ( TTO ) , st and ard gamble ( SG ) , 15D , end the EuroQol visual analog scale .  All patients aged 18 - 67 years with a diagnosis of epilepsy , who had been admitted to or attended the outpatient clinic at a large county hospital 1987 - 1994 , received a comprehensive question naire . From 397 respondents , 82 patients were r and omly selected . Most of the 57 patients completing the study generally had well-controlled epilepsy , but were still on anti-epileptic medication . Mean age was 44 years . Fourty-one percent were male and 59 % female . The result ing utility weights differed considerably between the measures , both with regard to central tendency and dispersion . Median utility scores : EuroQol visual analog scale 0.75 , 15D 0.90 , TTO 0.98 , SG 0.99 . There was a good association between the EuroQol rating scale and the 15D , and a moderate association between SG and TTO . These preference instruments measure different aspects 
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Javed noted that patients with ID were less likely to report side effects than patients without ID , especially in regard to cognitive adverse events [ 5 ] .
A recent Cochrane review concluded that side effects in the ID population are similar to the