What do systematic reviews say?

Lamotrigine vs placebo

Summary of findings: lamotrigine showed no clear difference in treatment withdrawal compared with placebo (moderate certainty).

• Lamotrigine add‐on therapy for drug‐resistant focal epilepsy 2023 · Cochrane Headline outcomes only
  RR 1.11 [0.91, 1.37]
  14 studies · 1806 participants
  Moderate

Add‐on felbamate vs placebo

• Felbamate add‐on therapy for drug‐resistant focal epilepsy 2022 · Cochrane Headline outcomes only
  no estimate extracted
  4 studies · 236 participants
  Very low

Brivaracetam vs placebo

Brivaracetam showed no clear difference in treatment withdrawal compared with placebo (low certainty).

• Brivaracetam add‐on therapy for drug‐resistant epilepsy 2022 · Cochrane Headline outcomes only
  RR 1.27 [0.94, 1.74]
  6 studies · 2411 participants
  Low

Ketogenic diet (KD) vs usual care

It is very uncertain whether ketogenic diet (KD) changes treatment withdrawal compared with usual care (very low certainty).

• Ketogenic diets for drug‐resistant epilepsy 2020 · Cochrane Headline outcomes only
  RR 5.38 [0.42, 69.53]
  2 studies · 141 participants
  Very low

Ketogenic diet (KD) vs usual care

Ketogenic diet (KD) showed no clear difference in treatment withdrawal compared with usual care (low certainty).

• Ketogenic diets for drug‐resistant epilepsy 2020 · Cochrane Headline outcomes only
  RR 1.08 [0.74, 1.57]
  5 studies · 425 participants
  Low

Add‐on lamotrigine vs placebo

It is very uncertain whether add‐on lamotrigine changes treatment withdrawal compared with placebo (very low certainty).

• Lamotrigine add‐on therapy for drug‐resistant generalised tonic‐clonic seizures 2020 · Cochrane Headline outcomes only
  RR 1.2 [0.72, 1.99]
  2 studies · 270 participants
  Very low

Rufinamide vs placebo

Rufinamide probably leads to higher treatment withdrawal compared with placebo (moderate certainty).

• Rufinamide add‐on therapy for drug‐resistant epilepsy 2020 · Cochrane Headline outcomes only
  RR 1.83 [1.45, 2.31]
  6 studies · 1759 participants
  Moderate

Oxcarbazepine vs control

Oxcarbazepine probably leads to higher treatment withdrawal compared with control (moderate certainty).

• Oxcarbazepine add‐on for drug‐resistant focal epilepsy 2020 · Cochrane Headline outcomes only
  RR 1.75 [1.44, 2.13]
  6 studies · 1593 participants
  Moderate

Topiramate vs placebo

Topiramate leads to higher treatment withdrawal compared with placebo (high certainty).

• Topiramate add‐on therapy for drug‐resistant focal epilepsy 2019 · Cochrane Headline outcomes only
  RR 2.37 [1.66, 3.37]
  12 studies · 1650 participants
  High

Tiagabine vs placebo control

Tiagabine probably leads to higher treatment withdrawal compared with placebo control (moderate certainty).

• Tiagabine add‐on therapy for drug‐resistant focal epilepsy 2019 · Cochrane Headline outcomes only
  RR 1.81 [1.25, 2.62]
  3 studies · 769 participants
  Moderate

Clobazam vs placebo

• Clobazam add‐on therapy for drug‐resistant epilepsy 2019 · Cochrane Headline outcomes only
  no estimate extracted
  4 studies · 197 participants
  Very low

Gabapentin vs placebo

Gabapentin showed no clear difference in treatment withdrawalNumber of participants withdrawn for any reason compared with placebo (moderate certainty).

• Gabapentin add‐on treatment for drug‐resistant focal epilepsy 2021 · Cochrane Headline outcomes only
  RR 1.05 [0.74, 1.49]
  6 studies · 1206 participants
  Moderate

Levetiracetam vs placebo

Levetiracetam showed no clear difference in treatment withdrawal– all doses compared with placebo (high certainty).

• Levetiracetam add‐on for drug‐resistant focal epilepsy 2020 · Cochrane Headline outcomes only
  RR 1.11 [0.89, 1.4]
  13 studies · 2428 participants
  High

Intervention not reported

The intervention showed no clear difference in treatment withdrawal (any reason) (moderate certainty).

• Eslicarbazepine acetate add‐on therapy for drug‐resistant focal epilepsy 2021 · Cochrane Headline outcomes only
  RR 1.25 [0.93, 1.7]
  7 studies · 2185 participants
  Moderate

Pregabalin vs active comparators

Pregabalin showed no clear difference in treatment withdrawal for any reason compared with active comparators (low certainty).

• Pregabalin add‐on for drug‐resistant focal epilepsy 2022 · Cochrane Headline outcomes only
  RR 0.93 [0.76, 1.13]
  3 studies · 1286 participants
  Low

Pregabalin vs placebo

Pregabalin probably leads to higher treatment withdrawal for any reason compared with placebo (moderate certainty).

• Pregabalin add‐on for drug‐resistant focal epilepsy 2022 · Cochrane Headline outcomes only
  RR 1.33 [1.1, 1.6]
  9 studies · 2663 participants
  Moderate

Carisbamate vs placebo

It is very uncertain whether carisbamate changes treatment withdrawal for any reason compared with placebo (very low certainty).

• Carisbamate add‐on therapy for drug‐resistant focal epilepsy 2021 · Cochrane Headline outcomes only
  RR 1.32 [0.82, 2.12]
  4 studies · 2211 participants
  Very low

Intervention not reported

The intervention probably leads to higher treatment withdrawal (adverse effect) (moderate certainty).

• Eslicarbazepine acetate add‐on therapy for drug‐resistant focal epilepsy 2021 · Cochrane Headline outcomes only
  RR 2.72 [1.66, 4.46]
  7 studies · 2185 participants
  Moderate

Perampanel add‐on vs placebo

Perampanel add‐on may leads to higher treatment withdrawal due to any reason compared with placebo (low certainty).

• Perampanel add‐on for drug‐resistant focal epilepsy 2023 · Cochrane Headline outcomes only
  RR 1.3 [1.03, 1.63]
  7 studies · 2524 participants
  Low

Pregabalin vs active comparators

• Pregabalin add‐on for drug‐resistant focal epilepsy 2022 · Cochrane Headline outcomes only
  1.04 [0.73, 1.48]
  3 studies · 1286 participants
  Low