***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: Objective To examine the prevalence of outcome reporting bias — the selection for publication of a subset of the original recorded outcome variables on the basis of the results — and its impact on Cochrane review s. Design A nine point classification system for missing outcome data in r and omised trials was developed and applied to the trials assessed in a large , unselected cohort of Cochrane systematic review s. Research ers who conducted the trials were contacted and the reason sought for the non-reporting of data . A sensitivity analysis was undertaken to assess the impact of outcome reporting bias on review s that included a single meta- analysis of the review primary outcome . Results More than half ( 157/283 ( 55 % ) ) the review s did not include full data for the review primary outcome of interest from all eligible trials . The median amount of review outcome data missing for any reason was 10 % , whereas 50 % or more of the potential data were missing in 70 ( 25 % ) review s. It was clear from the publications for 155 ( 6 % ) of the 2486 assessable trials that the research ers had measured and analysed the review primary outcome but did not report or only partially reported the results . For reports that did not mention the review primary outcome , our classification regarding the presence of outcome reporting bias was shown to have a sensitivity of 88 % ( 95 % CI 65 % to 100 % ) and specificity of 80 % ( 95 % CI 69 % to 90 % ) on the basis of responses from 62 trialists . A third of Cochrane review s ( 96/283 ( 34 % ) ) contained at least one trial with high suspicion of outcome reporting bias for the review primary outcome . In a sensitivity analysis undertaken for 81 review s with a single meta- analysis of the primary outcome of interest , the treatment effect estimate was reduced by 20 % or more in 19 ( 23 % ) . Of the 42 meta-analyses with a statistically significant result only , eight ( 19 % ) became non-significant after adjustment for outcome reporting bias and 11 ( 26 % ) would have overestimated the treatment effect by 20 % or more . Conclusions Outcome reporting bias is an under-recognised problem that affects the conclusions in a substantial proportion of Cochrane review s. Individuals conducting systematic review s need to address explicitly the issue of missing outcome data for their review to be considered a reliable source of evidence . Extra care is required during data extraction , review ers should identify when a trial reports that an outcome was measured but no results were reported or events observed , and contact with trialists should be encouraged PURPOSE To describe our experience with levetiracetam ( LEV ) as initial or conversion monotherapy treatment for juvenile myoclonic epilepsy ( JME ) .  Valproate , the usual first line agent for JME , has chronic adverse effects , particularly for women of childbearing potential . Since JME requires lifetime treatment , chronic adverse effects of therapy are important consideration . METHODS We review ed the medical records of patients with JME treated with LEV in the first 4 years after marketing . We recorded demographic data , results of  EEG and imaging studies , antiepileptic drug ( AED ) history , LEV initial dose and final dose , side effects related to LEV , and  therapeutic response  to treatment . We classified JME into definite and probable based on clinical and EEG criteria . The minimum duration of follow up was 1 year . RESULTS LEV was the first therapy in 12 patients and the initial appropriate agent in 16 . Fourteen patients had been treated with another appropriate AED . Eighty percent ( 24/30 ) of patients became seizure free with LEV monotherapy and two additional patients showed improved seizure control . Final therapeutic doses of LEV ranged from 12 to 50mg/(kgday ) . Complete seizure control using LEV was not predicted by previous AED use . Treatment failure with valproate also did not predict failure of LEV . Patients with definite JME responded best within the study group ( 11 of 11 seizure free , p<0.05 ) . CONCLUSIONS This study supports consideration of LEV for first line treatment of JME and suggests the need for a large prospect i ve trial OBJECTIVE The aim of this study was to evaluate the efficacy and tolerability of topiramate ( TPM ) in juvenile myoclonic epilepsy ( JME ) . METHOD We assessed seizure control and adverse effects of TPM in 22 patients ( 18 females ) aged 13 to 53 years . Target TPM dosage was up to 200 mg/day . The patients were subdivided into 3 groups : those treated with seizure control plus side effects ( n=4 ) ; treated with non-controlled seizures ( n=15 ) and with JME newly diagnosed ( n=3 ) . RESULTS Sixteen patients completed the first year of the follow-up . Generalized tonic-clonic seizures were completely controlled in 10 ( 62.5 % ) ; more than 50 % of reduction in 4 ( 25.0 % ) and less than 50 % in 2 ( 12.5 % ) . Myoclonia were controlled in 11 ( 68.8 % ) and persisted in 5 ( 31.2 % ) patients . Absence seizures were present in 5 ( 22.7 % ) of whom 2 ( 9.0 % ) showed more than 50 % of seizure reduction while 3 ( 13.6 % ) presented worsening . Discontinuations were due to inadequate seizure control and adverse events ( N=4 ) , low compliance and loss of follow-up ( N=2 ) and subject choice ( N=1 ) . CONCLUSION TPM showed to be an effective and well-tolerated drug in the treatment of JME . Although frequently observed , TPM side effects were tolerable and the drug could be maintained in the majority of patients BACKGROUND Topiramate is a broad-spectrum agent effective against primarily generalized tonic-clonic seizures ( PGTCS ) as well as partial-onset seizures .  Juvenile myoclonic epilepsy is one of the most common idiopathic generalized epilepsies , with most patients experiencing PGTCS . OBJECTIVE To evaluate topiramate as add-on therapy in patients with juvenile myoclonic epilepsy . DESIGN Post-hoc analysis of a patient subset from 2 multicenter , double-blind , r and omized , placebo-controlled , parallel-group trials . SETTING Eighteen centers in the United States ; 10 centers in Europe ; 1 center in Costa Rica ( primary trials ) . PATIENTS A total of 22 patients with juvenile myoclonic epilepsy participating in placebo-controlled trials assessing topiramate ( target dose , 400 mg/d in adults ) in inadequately controlled PGTCS . MAIN OUTCOME MEASURE Reduction of PGTCS . RESULTS A 50 % or more reduction of PGTCS in 8 of 11 topiramate-treated patients ( 73 % ) and 2 of 11 placebo-treated patients ( 18 % ) ( P = .03 ) . Reductions in myoclonic , absence , and total generalized seizures were also observed , although topiramate vs placebo differences did not achieve statistical significance . CONCLUSION As a broad-spectrum agent , topiramate is an effective option for patients with juvenile myoclonic epilepsy Juvenile myoclonic epilepsy ( JME ) is managed with valproate in most patients ; however , valproate is an antiepileptic drug that has relatively severe adverse effects , especially in women . We performed a prospect i ve , open-label , r and omized observational study for comparison of efficacy and tolerability between topiramate and valproate in patients with JME . The inclusion criteria were patients with newly diagnosed JME or previously diagnosed JME with a history of a poor response or adverse effects to other antiepileptic drugs . The primary endpoint of this study was percentage of patients who were free of myoclonic seizures for 24 weeks in the two groups . The frequency and severity of adverse effects were also assessed . Sixteen patients were r and omized to topiramate and 17 to valproate . In the topiramate arm , 11 of 16 patients ( 68.9 % ) completed 24-week maintenance therapy and seven of the 11 ( 64 % ) were seizure-free . In the valproate arm , 16 of 17 patients ( 94.1 % ) completed 24-week follow-up and nine of 16 ( 56 % ) were seizure-free . The difference ( 64 % topiramate versus 56 % valproate ) did not reach statistical significance in this study group ( p = 0.08 , Fisher 's exact test ) . However , the severity of adverse effects was significantly different . Only 1 of 10 adverse effects from topiramate was ranked moderate-to-severe ( 10 % ) , in comparison with severe rankings for 10 of 17 adverse effects from valproate ( 59 % ) ( p = 0.018 , Fisher 's exact test ) . In summary , the efficacy of topiramate and valproate was not different , but the severity of adverse effects was favourable for topiramate . Our findings suggest that valproate may be replaced with topiramate , especially for the patients with JME who do not tolerate valproate Objectives – Based on dose predictions from animal and human volunteer studies , most patients enrolled in initial r and omized controlled trials of topiramate as adjunctive therapy in adults with partial‐onset seizures were r and omized to ≥ 600 mg/day topiramate . Subsequent experience suggests that dosage needs were overestimated . This double‐blind , placebo‐controlled study evaluated 200 mg/day topiramate in adults with treatment‐resistant partial‐onset seizures receiving a concurrent enzyme‐inducing antiepileptic agent ( carbamazepine ) . Material and methods – After a 4‐week baseline , 263 adults receiving carbamazepine who had at least three partial‐onset seizures during the baseline period were r and omized  to placebo or one of two topiramate 200 mg/day treatment arms : topiramate escalated weekly 25 mg/day(8‐week escalation ) or 50 mg/day(4‐week escalation ) . Therapy was then maintained for the remainder of the 12‐week double‐blind study . Results – Median percent reduction in seizure frequency from baseline to study end was 44 % with topiramate and 20 % with placebo ( P ≤ 0.001 ) . A significant therapeutic effect was present at 2 weeks with a dose of 100 mg/day . The most common adverse events ( ≥10 % incidence in topiramate‐treated patients ) were somnolence , fatigue , paresthesia , nervousness and anorexia ; 8 % of topiramate‐treated patients and 2 % of placebo‐treated patients discontinued because of adverse events . As a result of the low incidence of adverse events , differences between titration rates in terms of tolerability were not detected . Conclusion – Topiramate 200 mg/day is an appropriate target dose as adjunctive therapy in adults with treatment‐resistant partial‐onset seizures , even when receiving an enzyme‐inducing agent ; 100 mg/day also appears to be effective . A significant therapeutic effect may be seen in the second week of treatment with a dose of 100 mg/day Few r and omized , controlled trials evaluating antiepileptic drug ( AED ) efficacy and tolerability have focused solely on patients with juvenile myoclonic epilepsy ( JME ) . We conducted a pilot , r and omized controlled trial comparing  topiramate ( N=19 ) and valproate ( N=9 ) in adolescents/adults with JME to evaluate clinical response when these broad-spectrum agents are titrated to optimal effect . Rating scales were used to systematic ally assess tolerability . Among patients completing 26 weeks of treatment , 8 of 12 ( 67 % ) in the topiramate group and 4 of 7 ( 57 % ) in the valproate group were seizure-free during the 12-week maintenance period . Median daily dose was 250 mg topiramate or 750 mg valproate . Two ( 11 % ) topiramate-treated patients and one ( 11 % ) valproate-treated patient discontinued due to adverse events . Systemic toxicity scores , but not neurotoxicity scores , differed substantially between the two groups ; greater systemic toxicity was associated with valproate . Our preliminary findings that topiramate may be an effective , well-tolerated alternative to valproate warrant validation in a double-blind trial 
    Output:
    
This review does not provide sufficient evidence to support topiramate for the treatment of people with JME .
Based on the current limited available data , topiramate seems to be better tolerated than valproate , but there were no more benefits of efficacy in topiramate compared with valproate .