Comparison of carbamazepine, phenobarbital, phenytoin, and primidone in partial and secondarily generalized tonic-clonic seizures.
Journal Article (Clinical Trial;Journal Article)
We conducted a 10-center, double-blind trial to compare the efficacy and toxicity of four antiepileptic drugs in the treatment of partial and secondarily generalized tonic-clonic seizures in 622 adults. Patients were randomly assigned to treatment with carbamazepine, phenobarbital, phenytoin, or primidone and were followed for two years or until the drug failed to control seizures or caused unacceptable side effects. Overall treatment success was highest with carbamazepine or phenytoin, intermediate with phenobarbital, and lowest with primidone (P less than 0.002). Differences in failure rates of the drugs were explained primarily by the fact that primidone caused more intolerable acute toxic effects, such as nausea, vomiting, dizziness, and sedation. Decreased libido and impotence were more common in patients given primidone. Phenytoin caused more dysmorphic effects and hypersensitivity. Control of tonic-clonic seizures did not differ significantly with the various drugs. Carbamazepine provided complete control of partial seizures more often than primidone or phenobarbital (P less than 0.03). Overall, carbamazepine and phenytoin are recommended drugs of first choice for single-drug therapy of adults with partial or generalized tonic-clonic seizures or with both.
Full Text
Duke Authors
Cited Authors
- Mattson, RH; Cramer, JA; Collins, JF; Smith, DB; Delgado-Escueta, AV; Browne, TR; Williamson, PD; Treiman, DM; McNamara, JO; McCutchen, CB
Published Date
- July 18, 1985
Published In
Volume / Issue
- 313 / 3
Start / End Page
- 145 - 151
PubMed ID
- 3925335
International Standard Serial Number (ISSN)
- 0028-4793
Digital Object Identifier (DOI)
- 10.1056/NEJM198507183130303
Language
- eng
Conference Location
- United States