What do systematic reviews say?

Perampanel add‐on vs placebo

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

• Perampanel add‐on for drug‐resistant focal epilepsy 2023 · Cochrane Headline outcomes only
  RR 2.36 [1.59, 3.51]
  7 studies · 2524 participants
  Low

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 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

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

Pregabalin vs placebo

Pregabalin probably leads to higher treatment withdrawal due to adverse effects compared with placebo (moderate certainty).

• Pregabalin add‐on for drug‐resistant focal epilepsy 2022 · Cochrane Headline outcomes only
  RR 2.6 [1.86, 3.64]
  9 studies · 2663 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

Brivaracetam vs placebo

Brivaracetam may leads to higher proportion of participants who experienced adverse events leading to… compared with placebo (low certainty).

• Brivaracetam add‐on therapy for drug‐resistant epilepsy 2022 · Cochrane Headline outcomes only
  RR 1.54 [1.02, 2.33]
  6 studies · 2411 participants
  Low

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

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

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

Carisbamate vs placebo

It is very uncertain whether carisbamate changes treatment withdrawal due to adverse events compared with placebo (very low certainty).

• Carisbamate add‐on therapy for drug‐resistant focal epilepsy 2021 · Cochrane Headline outcomes only
  RR 1.8 [0.78, 4.17]
  4 studies · 2211 participants
  Very low

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

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

Vigabatrin vs placebo

Vigabatrin may leads to higher ≥ 50% reduction in seizure frequency (ITT analysis) Duration of… compared with placebo (low certainty).

• Vigabatrin add‐on therapy for drug‐resistant focal epilepsy 2020 · Cochrane Headline outcomes only
  RR 2.6 [1.87, 3.63]
  4 studies · 513 participants
  Low

Vigabatrin vs placebo

It is very uncertain whether vigabatrin changes treatment withdrawal for any reason Duration of treatment (range):… compared with placebo (very low certainty).

• Vigabatrin add‐on therapy for drug‐resistant focal epilepsy 2020 · Cochrane Headline outcomes only
  RR 2.86 [1.25, 6.55]
  4 studies · 370 participants
  Very low

Vigabatrin vs placebo

It is very uncertain whether vigabatrin changes adverse effects: ataxia Duration of treatment (range): 7–36 weeks compared with placebo (very low certainty).

• Vigabatrin add‐on therapy for drug‐resistant focal epilepsy 2020 · Cochrane Headline outcomes only
  RR 2.76 [0.96, 7.94]
  7 studies · 481 participants
  Very low

Vigabatrin vs placebo

Vigabatrin may leads to higher adverse effects: dizziness/light‐headedness Duration of treatment… compared with placebo (low certainty).

• Vigabatrin add‐on therapy for drug‐resistant focal epilepsy 2020 · Cochrane Headline outcomes only
  RR 1.74 [1.05, 2.87]
  9 studies · 709 participants
  Low

Vigabatrin vs placebo

Vigabatrin may leads to higher adverse effects: fatigue Duration of treatment (range): 8–36 weeks compared with placebo (low certainty).

• Vigabatrin add‐on therapy for drug‐resistant focal epilepsy 2020 · Cochrane Headline outcomes only
  RR 1.65 [1.08, 2.51]
  9 studies · 709 participants
  Low