Tang L, et al. – This meta–analysis assessed the safety and efficacy of lamotrigine (LTG) on generalized epilepsies (GE) seizure in comparison with valproic acid (VPA). The clinicians proposed that following GE, VPA appeared to be a better choice in controlling seizure. However, if an adequate trial of VPA monotherapy was not effective and intolerable, therapy had to be switched to alternative monotherapy, especially in young women.

• Up to February 2017, the clinicians conducted a search based on the databases from Pubmed, Embase and the Cochran database.
• They determined the relative risk odds ratios (ORs) and the relevant 95% confidence intervals (CI).

• The clinicians included 5 randomized controlled trials and 4 observational cohort studies involving 1,732 cases.
• The outcomes demonstrated that for the outcome rate to treatment withdrawal for any reason and seizure freedom, VPA was significantly superior to LTG.
• For withdrawal after 12- and 24-month treatment, the ORs and 95% CI of VPA vs. LTG were 0.39(0.27, 0.56) and 0.50(0.14, 1.75), respectively, and were 3.51(2.68, 4.59) and 8.58(5.40, 13.63) for 12- and 24- month seizure free intervals, respectively.
• Furthermore, between the two groups, the risk of adverse effects (OR (95%CI); 1.11(0.61–2.01)) was not significantly different.
• However, the treatment withdrawal because of lack of seizure control were in the LTG group (OR (95%CI); 0.15(0.10-0.23)), while the treatment withdrawal because of intolerable side effects were in the VPA group (OR (95%CI); (1.75(1.10-2.80)).