Topiramate compared with placebo for juvenile myoclonic epilepsy

Patient or population: people with juvenile myoclonic epilepsy

Settings: 18 centers in the USA; 10 centers in Europe; 1 center in Costa Rica

Intervention: topiramate

Comparison: placebo

Proportion of responders (at least 50% seizure frequency reduction in PGTCS)

RR 4.00 (1.08 to 14.75)

22

(1 study)

⊕⊝⊝⊝
Very low^{1, 2}

More participants taking topiramate responded with a 50% or greater reduction in PGTCS compared with placebo (P = 0.04)

Proportion of participants who experienced at least one AE and individual AEs

N/A

22

(1 study)

⊕⊝⊝⊝
Very low^{1, 2}

The number of participants experiencing at least one AE was not reported.

Individual AEs: no significant differences were found in nausea, URTI, abnormal vision, or diarrhea between topiramate and placebo

Number of participants who were seizure‐free

N/A

*The basis for the assumed risk was the event rate in the control group. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
AE: adverse event;CI: confidence interval; PGTCS: primarily generalized tonic‐clonic seizures; RR: risk ratio; URTI: upper respiratory tract infection

GRADE Working Group grades of evidence
 

High certainty: we are very confident that the true effect lies close to that of the estimate of the effect

Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different

Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect

Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect
 

Topiramate compared with valproate for juvenile myoclonic epilepsy

Patient or population: people with juvenile myoclonic epilepsy

Settings: Cincinnati Children’s Hospital Medical Center, Cincinnati, USA; Haeundae Paik Hospital, Busan, Republic of Korea

Intervention: topiramate

Comparison: valproate

Proportion of responders (at least 50% seizure frequency reduction in myoclonic seizures)

RR 0.88 (0.67 to 1.15)

23
(1 study)

⊕⊝⊝⊝
Very low^{1, 2}

No significant difference was found.

Proportion of responders (at least 50% seizure frequency reduction in PGTCS)

RR 1.22 (0.68 to 2.21)

16

(1 study)

⊕⊝⊝⊝
Very low^{1, 2}

No significant difference was found.

Proportion of participants who experienced at least one AE and individual AEs

NA

61
(2 studies)

⊕⊝⊝⊝
Very low^{1, 2}

The number of participants experiencing at least one AE was not reported.

We found significantly more events of paresthesia with topiramate, and more events of weight gain and tremor with valproate. There was no significant difference between groups for headache, concentration difficulty, fatigue, alopecia, dizziness, weight loss, psychomotor slowing, somnolence, nausea, appetite increase, insomnia, abnormal vision, rash, anorexia, hallucination or diarrhea.

Number of participants who were seizure‐free

RR 1.13 (0.61 to 2.11)

27
(1 study)

⊕⊝⊝⊝
Very low^{1, 2}

No significant difference was found.

*The basis for the assumed risk was the event rate in the control group. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
AE: adverse event; CI: confidence interval; PGTCS: primarily generalized tonic‐clonic seizures; RR: risk Ratio

GRADE Working Group grades of evidence
 

High certainty: we are very confident that the true effect lies close to that of the estimate of the effect

Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different

Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect

Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect