Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

125 questions · 128 findings · 12 reviews

No studies found 23 · 18%GRADE not reported 3 · 2.3%Very low 32 · 25%Low 41 · 32%Moderate 19 · 14.8%High 10 · 7.8%

Topiramate vs valproate

Proportion of responders (at least 50% seizure frequency reduction in myoclonic seizures) · people with juvenile myoclonic epilepsy

It is very uncertain whether topiramate changes proportion of responders (at least 50% seizure frequency reduction… compared with valproate (very low certainty).

1 finding from 1 review

Topiramate vs valproate

Proportion of responders (at least 50% seizure frequency reduction in PGTCS) · people with juvenile myoclonic epilepsy

It is very uncertain whether topiramate changes proportion of responders (at least 50% seizure frequency reduction… compared with valproate (very low certainty).

1 finding from 1 review

Topiramate vs valproate

Seizure freedom · people with juvenile myoclonic epilepsy

It is very uncertain whether topiramate changes number of participants who were seizure‐free compared with valproate (very low certainty).

1 finding from 1 review

Lithium vs valproate

Efficacy: remission (categorical) YMRS ≤ 12 and no increase in MADRS at end of study · acute mania

Lithium showed no clear difference in efficacy: remission (categorical) YMRS ≤ 12 and no increase in MADRS… compared with valproate (moderate certainty).

1 finding from 1 review
  • Lithium for acute mania 2019 · Cochrane Headline outcomes only
    OR 0.78 [0.46, 1.32]
    1 study · 257 participants
    Moderate

Lithium vs valproate

Acceptability: total withdrawals · acute mania

Lithium showed no clear difference in acceptability: total withdrawals compared with valproate (high certainty).

1 finding from 1 review
  • Lithium for acute mania 2019 · Cochrane Headline outcomes only
    OR 1.2 [0.86, 1.69]
    5 studies · 629 participants
    High

Lithium vs valproate

Adverse event: tremor · acute mania

Lithium leads to higher adverse event: tremor compared with valproate (high certainty).

1 finding from 1 review
  • Lithium for acute mania 2019 · Cochrane Headline outcomes only
    OR 10.51 [1.96, 56.48]
    2 studies · 449 participants
    High

Lithium vs valproate

Somnolence · acute mania

Lithium leads to lower adverse event: somnolence compared with valproate (high certainty).

1 finding from 1 review
  • Lithium for acute mania 2019 · Cochrane Headline outcomes only
    OR 0.47 [0.29, 0.76]
    4 studies · 575 participants
    High

Lithium vs valproate

Nausea · acute mania

Lithium showed no clear difference in adverse event: nausea compared with valproate (moderate certainty).

1 finding from 1 review
  • Lithium for acute mania 2019 · Cochrane Headline outcomes only
    OR 1.53 [0.97, 2.4]
    4 studies · 583 participants
    Moderate

Lithium vs valproate

Efficacy: response (categorical) YMRS/SADS‐C decrease ≥ 50% by end of study · acute mania

Lithium showed no clear difference in efficacy: response (categorical) YMRS/SADS‐C decrease ≥ 50% by end… compared with valproate (moderate certainty).

1 finding from 1 review
  • Lithium for acute mania 2019 · Cochrane Headline outcomes only
    OR 1.22 [0.87, 1.7]
    5 studies · 607 participants
    Moderate

Lithium vs valproate

Efficacy: response (continuous) Change in YMRS (ITT‐LOCF) from baseline to end of study · acute mania
1 finding from 1 review
  • Lithium for acute mania 2019 · Cochrane Headline outcomes only
    no estimate extracted
    5 studies · 398 participants
    Very low