Topiramate, carbamazepine and valproate monotherapy: double-blind comparison in newly diagnosed epilepsy

Acta Neurol Scand. 2003 Mar;107(3):165-75. doi: 10.1034/j.1600-0404.2003.00093.x.


Objectives: To compare topiramate (TPM) with investigator's choice of carbamazepine (CBZ) or valproate (VPA) for initial treatment in patients with newly diagnosed epilepsy.

Material and methods: In patients with epilepsy diagnosed within previous 3 months, investigators selected CBZ (600 mg/day) or VPA (1250 mg/day) as preferred therapy based on the patient's clinical presentation. Based on investigators' treatment choice, patients (n=613) were assigned to the CBZ or VPA treatment branch. Within each branch, patients were randomized to double-blind treatment with the traditional antiepileptic drugs (CBZ or VPA), TPM 100 mg/day, or TPM 200 mg/day. Patients continued double-blind treatment until exiting the study or until 6 months after last patient randomized.

Results: No statistically significant differences between fixed doses of TPM and CBZ or VPA were observed in efficacy measures: time to exit, time to first seizure, and the proportion of patients seizure-free during the last 6 months of treatment. TPM 100 mg/day was associated with the fewest discontinuations due to adverse events.

Conclusion: In patients with newly diagnosed epilepsy, an initial target dose of TPM 100 mg/day is at least as effective as therapeutic doses of CBZ and VPA.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adolescent
  • Adult
  • Aged
  • Anticonvulsants / administration & dosage
  • Anticonvulsants / pharmacology*
  • Carbamazepine / administration & dosage
  • Carbamazepine / pharmacology*
  • Child
  • Double-Blind Method
  • Epilepsy / drug therapy*
  • Epilepsy / pathology
  • Female
  • Fructose / administration & dosage
  • Fructose / analogs & derivatives*
  • Fructose / pharmacology*
  • Humans
  • Male
  • Middle Aged
  • Seizures
  • Topiramate
  • Treatment Outcome
  • Valproic Acid / administration & dosage
  • Valproic Acid / pharmacology*


  • Anticonvulsants
  • Topiramate
  • Fructose
  • Carbamazepine
  • Valproic Acid