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Study flow diagram (results refer only to the updated version of the review).
Figuras y tablas -
Figure 1

Study flow diagram (results refer only to the updated version of the review).

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'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Ethosuximide versus valproate, Outcome 1 Seizure free.
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Analysis 1.1

Comparison 1 Ethosuximide versus valproate, Outcome 1 Seizure free.

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Comparison 1 Ethosuximide versus valproate, Outcome 2 80% or greater reduction in seizure frequency.
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Analysis 1.2

Comparison 1 Ethosuximide versus valproate, Outcome 2 80% or greater reduction in seizure frequency.

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Comparison 1 Ethosuximide versus valproate, Outcome 3 50% or greater reduction in seizure frequency.
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Analysis 1.3

Comparison 1 Ethosuximide versus valproate, Outcome 3 50% or greater reduction in seizure frequency.

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Comparison 2 Lamotrigine versus valproate, Outcome 1 Seizure free.
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Analysis 2.1

Comparison 2 Lamotrigine versus valproate, Outcome 1 Seizure free.

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Comparison 2 Lamotrigine versus valproate, Outcome 2 Normalization fo the EEG.
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Analysis 2.2

Comparison 2 Lamotrigine versus valproate, Outcome 2 Normalization fo the EEG.

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Comparison 3 Ethosuximide versus lamotrigine, Outcome 1 Seizure free at 12 months.
Figuras y tablas -
Analysis 3.1

Comparison 3 Ethosuximide versus lamotrigine, Outcome 1 Seizure free at 12 months.

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Table 1. Adverse effects on valproate: number of participants experiencing each event

Event

Callaghan 1982

Sato 1982

Martinovic 1983

Coppola 2004

Huang 2009

Glauser 2013

Acute pancreatitis

1

Obesity/Weight gain

1

1

14

Drowsiness

4

Nausea

5

3

12*

Vomiting

1

2

12*

Decreased platelet numbers

2

4

Increased appetite

15

Poor appetite

1

8

Diarrhoea

1

7

Dizziness

1

2

Hyperactivity

23

Attention problems

24

Hostility

22

Concentration decreased

18

Personality change

17

Sleep problem

17

Depression

11

Slow process speed

11

Memory problem

10

Apathy

9

Fatigue

27

Headache

1

18

Leukopenia

2

Elevated liver function tests

1

7

Elevated LDH

1

Rash

2

* Nausea, vomiting, or both
LDH: lactate dehydrogenase

Numbers of individuals within each study undertaking valproate: 14 (Callaghan 1982), 22 (Sato 1982), 10 (Martinovic 1983), 19 (Coppola 2004), 23 (Huang 2009), 146 (Glauser 2013a).

Figuras y tablas -
Table 1. Adverse effects on valproate: number of participants experiencing each event
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Table 2. Adverse effects on ethosuximide: number of participants experiencing each event

Event

Callaghan 1982

Sato 1982

Martinovic 1983

Glauser 2013

Drowsiness

1

5

Tiredness

2

Nausea

3

2

29*

Vomiting

3

29*

Increased appetite

6

Poor appetite

1

10

Diarrhoea

9

Dizziness

1

10

Headache

2

23

Leukopenia

3

Hiccups

1

Moodiness

1

Hyperactivity

13

Attention problems

8

Hostility

4

Concentration decreased

6

Personality change

6

Sleep problem

11

Depression

4

Slow process speed

3

Memory problem

0

Apathy

4

Fatigue

26

Rash

6

* Nausea, vomiting, or both

Numbers of individuals within each study undertaking ethosuximide: 14 (Callaghan 1982), 23 (Sato 1982), 10 (Martinovic 1983), 154 (Glauser 2013a).

Figuras y tablas -
Table 2. Adverse effects on ethosuximide: number of participants experiencing each event
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Table 3. Adverse effects on lamotrigine: number of participants experiencing each event

Event

Frank 1999

Coppola 2004

Huang 2009

Glauser 2013

Abdominal pain

5

Headache

2

2

14

Nausea

3

2*

Vomiting

2*

Poor appetite

2

9

Increased appetite

1

10

Diarrhoea

2

Dizziness

3

5

5

Hyperkinesia

2

Hyperactivity

12

Attention problems

11

Hostility

11

Concentration decreased

9

Personality change

10

Sleep problem

5

Depression

11

Slow process speed

7

Memory problem

8

Apathy

3

Fatigue

1

18

Rash

10

1

2

6

Nervousness

1

Diplopia

1

* Nausea, vomiting, or both

Numbers of individuals within each study undertaking lamotrigine: 15 (Frank 1999), 19 (Coppola 2004), 24 (Huang 2009), 146 (Glauser 2013a).

Figuras y tablas -
Table 3. Adverse effects on lamotrigine: number of participants experiencing each event
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Comparison 1. Ethosuximide versus valproate

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Seizure free Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 Drug naive

4

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 80% or greater reduction in seizure frequency Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Previously treated

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 50% or greater reduction in seizure frequency Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 1. Ethosuximide versus valproate
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Comparison 2. Lamotrigine versus valproate

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Seizure free Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 Seizure free at 1 month

2

Risk Ratio (M‐H, Fixed, 95% CI)

8.42 [2.77, 25.59]

1.2 Seizure free at 3 months

3

Risk Ratio (M‐H, Fixed, 95% CI)

1.64 [1.16, 2.31]

1.3 Seizure freedom at 6 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

1.42 [0.88, 2.28]

1.4 Seizure free at 12 months

4

Risk Ratio (M‐H, Fixed, 95% CI)

1.67 [1.32, 2.11]

2 Normalization fo the EEG Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 2. Lamotrigine versus valproate
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Comparison 3. Ethosuximide versus lamotrigine

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Seizure free at 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 3. Ethosuximide versus lamotrigine
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