Issue #66 Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data Clinical Case and Discussion Questions Created by William E Cayley, Jr Journal Club Editor Prevea Family Medicine Residency

Martha Martha is a 25 year old woman who has come to your practice to establish care now that she is in her first pregnancy. She has a history of generalised tonic-clonic seizures since age 15, and has been on phenytoin “for several years” without having any seizures during that time. Martha says she is concerned about her epilepsy and its effect on her life, and on her pregnancy.

Martha She says she knows anti-epilepsy medications can be harmful to a developing baby. However, she says she does not want to stop medications as she is concerned that having a seizure could both adversely affect her independence (if she is unable to drive) and her pregnancy.

Martha Martha also says she has heard that there are a number of newer medications available to treat epilepsy, but when she has tried reading about the options available, she has been overwhelmed with the variety of options and conflicting information on safety and effectiveness. Today, Martha asks you what the “latest scientific information” is for treating epilepsy to prevent seizures.

Martha In searching the medical literature, you find a recent Cochrane review titled: Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data

Questions for discussion What does it mean that this is a “network” meta- analysis? How will you use this evidence to assess the effectiveness of anti-epileptic options for Martha? How will you use this evidence to evaluate the potential risks of Martha’s treatment options? What questions remain after evaluating Martha’s case in light of this evidence? What will you tell Martha?

Further Information How to cite the Cochrane Review: Nevitt SJ, Sudell M, Weston J, Tudur Smith C, Marson AG. Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD011412. DOI: 10.1002/14651858.CD011412.pub2. Find out more about Cochrane Journal Club: http://www.cochranelibrary.com/more-resources/cochrane-journal-club-.html Share your thoughts about this Journal Club: Email: CochraneJournalClub@wiley.com This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.