Title

Second-Generation Antiepileptic Drugs' Impact on Balance: A Meta-Analysis

Department

neurology

Document Type

Article

Abstract

OBJECTIVE: To systematically review available evidence regarding whether second-generation antiepileptic drugs (AEDs) contribute to the risk of balance disorders. METHODS: We systematically evaluated data from randomized controlled trials that compared adjunctive therapy with a second-generation AED (gabapentin, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, tiagabine, toplramate, or zonisamide) vs placebo for partial epilepsy and that reported dose-specific rates of ataxia or imbalance for each group. Random-effects meta-analysis was used to pool ratios (risk ratio [RR]) and associated 95% confidence intervals to determine whether there was evidence of an overall AED class effect or a dose-response effect and whether there were differences between individual AEDs. RESULTS: Sixteen studies met inclusion criteria, representing 4279 individuals randomized to a second-generation AED and 1830 patients to placebo. Pooled analyses of all AEDs demonstrated that they increase imbalance risk at any dose (RR, 2.73; 95% confidence interval, 2.07-3.61) and at lowest dose (RR, 1.76; 95% confidence interval, 1.26-2.46). The highest dose analysis showed heterogeneity; evaluation of individual AEDs revealed that oxcarbamazepine and topiramate increased imbalance risk at all doses, whereas gabapentin and levetiracetam did not increase imbalance risk at any dose. A dose-response effect was observed for most AEDs. CONCLUSION. Second-generation AEDs at standard dosages, except for gabapentin and levetiracetam, increase the imbalance risk, and evidence exists for a dose-response effect. The mechanisms, risk factors, and consequences of this risk for individual AEDs warrant further study.

Medical Subject Headings

neurology

Publication Date

2007

Publication Title

Mayo Clinic Proceedings

ISSN

0025-6196

Volume

82

Issue

1

First Page

40

Last Page

47

Digital Object Identifier (DOI)

10.4065/82.1.40

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