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Meta-Analysis
. 2012 May 16;5(5):CD001908.
doi: 10.1002/14651858.CD001908.pub2.

Tiagabine add-on for drug-resistant partial epilepsy

Jennifer Pulman  1 , Anthony G Marson, Jane L Hutton
Affiliations
Meta-Analysis

Tiagabine add-on for drug-resistant partial epilepsy

Jennifer Pulman et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Epilepsy is a common neurological condition, affecting almost 0.5 to 1% of the population. Nearly 30% of people with epilepsy are resistant to currently available drugs. Tiagabine is one of the newer antiepileptic drugs and its effects as an adjunct (add-on) to standard drugs are assessed in this review.

Objectives: To evaluate the effects of add-on treatment with tiagabine upon seizures, adverse effects, cognition and quality of life for people with drug-resistant localisation related seizures.

Search methods: This is an updated version of the original Cochrane review published in issue 10, 2010. We searched the Cochrane Epilepsy Group's Specialised Register (December 2011), the Cochrane Central Register of Controlled Trials (CENTRAL, issue 4, 2011 of The Cochrane Library), and MEDLINE (1948 to November 2011). No language restrictions were imposed. We also contacted the manufacturers of tiagabine and experts in the field to seek any ongoing or unpublished studies.

Selection criteria: Randomised placebo controlled add-on trials of people of any age with localisation related seizures, in which an adequate method of concealment of randomisation was used were included. The studies could be double, single or unblinded and be of parallel or crossover design. They had to have a minimum treatment period of eight weeks. Trials using an active drug control group were also included.

Data collection and analysis: Two review authors independently selected trials for inclusion and extracted data. Any disagreements were resolved by discussion. Outcomes investigated included 50% or greater reduction in seizure frequency; treatment withdrawal; adverse effects; effects on cognition and quality of life. The primary analyses were by intention-to-treat. Worst case and best case analyses were also calculated for seizure outcomes. Dose response was evaluated in regression models.

Main results: Four parallel group and two crossover group trials were included. The overall relative risk (RR) with 95% confidence intervals (CIs) for a 50% or greater reduction in seizure frequency (tiagabine versus placebo) was 3.16 (95% CI 1.97 to 5.07). Due to differences in response rates among trials, regression models were unable to provide reliable estimates of responses to individual doses. The RR for treatment withdrawal was 1.81 (95% CI 1.25 to 2.62). The 99% CIs for the following adverse effects: dizziness; fatigue; nervousness and tremor did not include unity, indicating that they are significantly associated with tiagabine. For cognitive and quality of life outcomes the limited data available suggested that there were no significant effects on cognition and mood and adjustment.

Authors' conclusions: Tiagabine reduces seizure frequency but is associated with some adverse effects when used as an add-on for people with drug-resistant localisation-related seizures.

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Figures

Figure 1
Figure 1. Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies
Figure 2
Figure 2. Forest plot of comparison: 1 Tiagabine versus placebo control - 50% or greater reduction in seizure frequency, outcome: 1.1 Intention-to-treat analysis
See this image and copyright information in PMC

Update of

References

References to studies included in this review

    1. Crawford PM, Meinardi H, Brown S, Rentmeester TW, Pedersen PC, Lassen LC. Tiagabine: efficacy and safety in adjunctive treatment of partial seizures. Epilepsia. 2001;42(4):531–8. - PubMed
    1. Fritz N, Glogau S, Hoffmann J, Rademacher M, Elger CE, Helmstaedter C. Efficacy and cognitive side effects of tiagabine and topiramate in patients with epilepsy. Epilepsy & Behavior. 2005;6(3):373–81. - PubMed
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References to studies excluded from this review

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Additional references

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