Results of a Nationwide Veterans Administration Cooperative Study Comparing the Efficacy and Toxicity of Carbamazepine, Phenobarbital, Phenytoin, and Primidone
Epilepsin, 28(Suppl. 3):SSO-S58, 1987 Raven Press, Ltd., New York 0 International League Against Epilepsy Results of a Nationwide Veterans Administration Cooperative Study Comparing the Efficacy and Toxicity of Carbamazepine, Phenobarbital, Phenytoin, and Primidone Dennis B. Smith, "Richard H. Mattson, ?Joyce A. Cramer, $Joseph F. Collins, §Robert A. Novelly, [[BruceCraft, and the Weterans Administration Epilepsy Cooperative Study Group Good Samaritan Hospital & Medical Center, Portland Oregon; *Yale University School of Medicine, New Haven, Connecticut; $Veterans Administration Cooperative Studies Program, Perry Point, Maryland; *f§Veterans Administration Hospital, West Haven, Connecticut; and llNeurology Service, Veterans Administration Medical Center, Augusta, Georgia, U.S.A. Summary: In 1985 a 5-year multicenter Veterans Admin- sociated with significantly lower incidences of intolerable istration Cooperative Study was completed that com- side effects than were primidone or phenobarbital. A be- pared the efficacy and toxicity of phenobarbital, car- havioral toxicity battery was performed whenever pos- bamazepine, phenytoin, and primidone in a double-blind sible prior to administration of any antiepileptic drug and prospective study design. A total of 622 patients, either at 1, 3, 6, and 12 months after initiation of monotherapy. previously untreated or undertreated, were entered into Significant differences in performance on all subtests of the study. Strict exclusion criteria limited confounding the battery were found between patients with epilepsy factors such as drug or alcohol abuse. Results showed and a control group matched by age, sex, and education. that each of the four drugs used as monotherapy were When the differential effects of all four drugs on behav- similarly effective in the treatment of generalized tonic- ioral toxicity were compared, few statistically significant clonic seizures, but carbamazepine was significantly differences emerged.
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