Original Research

Treatment Outcomes of Topiramate and Levetiracetam for Generalized Tonic-Clonic Seizures Among Adults with Idiopathic Generalized Epilepsy

Faheem Saeed1
Sir Ganga Ram Hospital/Fatima Jinnah Medical University, Lahore
Zeeshan Rashid1
Sir Ganga Ram Hospital/Fatima Jinnah Medical University, Lahore
Mamoona Tanvir2
Akhtar Saeed Medical College, Lahore
Zaib Zahid2
Akhtar Saeed Medical College, Lahore
Muhammad Latif2
Akhtar Saeed Medical College, Lahore
Muhammad Adnan3
Health Research Institute, National Institute of Health, Islamabad

✉ Correspondence: Muhammad Adnan Email: adnanpmrc@gmail.com

DOI https://doi.org/10.70302/jpsim.v6i2.2531
Volume: 6, Issue 2 Pages: 165–169 Published: 05 Jun 2025
Received: 11 Nov 2024 Revised: 15 Jan 2025 Accepted: 25 Apr 2025 Published Online: 05 Jun 2025

Abstract

Objectives

To compare the safety and efficacy of Lrvetiracetam (LEV) versus Topiramate (TPM) as monotherapy for generalized Tonic-Clonic seizure (GTCS) alone in adults with idiopathic Generalized Epilepsy(IGE).

Methods

Out of 60 IGE patients with GTCS alone, 30 cases on oral topiramate (50 mg/day) were recruited in TPM group, and 30 cases taking oral levetiracetam (500 mg twice a day) in LEV group. Follow-up assessments, conducted for three months, aimed to evaluate reductions in seizure frequency and adverse events. Total 51 patients (25 in TPM group and 26 in LEV group) completed the study, and data subjected to final SPSS analysis.

Results

Mean age of 51 patients was 33.0 ± 13.0 years. Women proportion was little higher than men (54.9% vs. 44.1%). Two-third of them had >2 seizures at the time of enrollment. Baseline variables were similar among the two study groups (all p-values >0.05). At a 12-week follow-up visit, overall two-third of the total population became seizure-free. Seizure-free rate in TPM group was considerably greater than the LEV group (p-value 0.088). None of the patients in both groups reported headache, nausea, anxiety and vomiting. Incidence of adverse events in the TPM group was insignificantly higher than the LEV group (all p-values >0.05).

Conclusion

Topiramate was a more efficacious but less tolerated broad-spectrum anti-epileptic drug than levetiracetam for treating GTCS among adults with IGE.

Keywords
Epilepsy Levetiracetam Seizure Topiramate.

How to Cite This Article

Saeed F, Rashid Z, Tanvir M, Zahid Z, Latif M, Adnan M. Treatment Outcomes of Topiramate and Levetiracetam for Generalized Tonic-Clonic Seizures Among Adults with Idiopathic Generalized Epilepsy. J Pak Soc Intern Med. 2025;6(2):165–169. doi:10.70302/jpsim.v6i2.2531

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Conflict of Interest

All authors declare no competing interests.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

No specific funding was received for this research.

Funder information follows the Crossref Funder Registry standard.

References

  1. Devinsky O, Elder C, Sivathamboo S, Scheffer IE, Koepp MJ. Idiopathic generalized epilepsy: misunderstandings, challenges, and opportunities. Neurology. 2024; 102(3): e208076.
  2. Shahbaz NN, Hassan Y, Abdullah M. Adult onset idiopathic generalized epilepsy: A hospital-based study. Pak J Med Sci. 2011; 27(2): 256-60.
  3. Ullah S, Ali N, Khan A, Ali S, Nazish HR. The epidemiological characteristics of epilepsy in the province of Khyber Pakhtunkhwa, Pakistan. Front Neurol. 2018; 9: 845.
  4. Elmali AD, Auvin S, Bast T, Rubboli G, Koutroumanidis M. How to diagnose and classify idiopathic (genetic) generalized epilepsies. Epileptic Disord. 2020; 22(4): 399-420.
  5. Kim H, Kim DW, Lee ST, Byun JI, Seo JG, No YJ, et al. Antiepileptic drug selection according to seizure type in adult patients with epilepsy. J Clin Neurol. 2020; 16(4): 547-55.
  6. Kumar A, Maini K, Kadian R. Levetiracetam. [Updated 2023 Dec 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024; Available from: https://www.ncbi.nlm.nih.gov/books/NBK499890/
  7. Yi ZM, Wen C, Cai T, Xu L, Zhong XL, Zhan SY, et al. Levetiracetam for epilepsy: an evidence map of efficacy, safety and economic profiles. Neuropsychiatr Dis Treat. 2018; 15: 1-19.
  8. Fariba KA, Saadabadi A. Topiramate. [Updated 2024 Jun 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024; Available from: https://www.ncbi.nlm.nih.gov/books/NBK554530/
  9. Sarhan EM, Walker MC, Selai C. Evidence for efficacy of combination of antiepileptic drugs in treatment of epilepsy. J Neurol Res. 2016; 5(6): 267-76.
  10. Rathore C, Patel KY, Satishchandra P. Current concepts in the management of idiopathic generalized epilepsies. Ann Indian Acad Neurol. 2022; 25(1): 35-42.
  11. Jeon J, Oh J, Yu KS. A meta-analysis: efficacy and safety of anti-epileptic drugs prescribed in Korea as monotherapy and adjunctive treatment for patients with focal epilepsy. Transl Clin Pharmacol. 2021; 29(1): 6-20.
  12. Bootsma HP, Ricker L, Diepman L, Gehring J, Hulsman J, Lambrechts D, et al. Long-term effects of levetiracetam and topiramate in clinical practice: A head-to-head comparison. Seizure. 2008; 17(1): 19-26.
  13. Wang H, Wang H, Liu Y, Zhao J, Niu X, Zhu L, et al. Efficacy and safety of five broad-spectrum antiseizure medications for adjunctive treatment of refractory epilepsy: a systematic review and network meta-analysis. CNS Drugs. 2023;37(10):883-913.
  14. Bergey GK. Evidence-based treatment of idiopathic generalized epilepsies with new antiepileptic drugs. Epilepsia. 2005; 46(9): 161-8.
  15. Fariba KA, Saadabadi A. Topiramate. [Updated 2024 Jun 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025; Available from: https://www.ncbi.nlm.nih.gov/books/NBK554530/.
  16. Privitera M. Efficacy of levetiracetam: a review of three pivotal clinical trials. Epilepsia. 2001; 42(4): 31-5.
  17. Chappell B, Crawford P. An audit of lamotrigine, levetiracetam and topiramate usage for epilepsy in a district general hospital. Seizure. 2005; 14(6): 422-8.

Reference list indexed for Google Scholar and ResearchGate. DOI links resolve via doi.org.

CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2025 Journal of Pakistan Society of Internal Medicine.
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