Lamotrigine or gabapentin was better tolerated than carbamazepine in new-onset geriatric epilepsy.

M e t h o d s Design: Randomized controlled trial. Allocation: Concealed.* Blinding: Blinded (clinicians and patients).* Follow-up period: 12 months. Setting: 18 Veterans Affairs Medical Centers in the United States. Patients: 593 patients ≥ 65 years of age (mean age 72 y, 96% men) with newly diagnosed epilepsy (≥ 1 seizure in the preceding 3 mo) who were untreated, treated only acutely (< 4 wk), or treated but at subtherapeutic levels. Exclusion criteria included life expectancy < 12 months, conditions that would affect the response to treatment, progressive neurologic disease, severe psychiatric disorders, current alcoholism, illicit drug use, and a history of noncompliance. Intervention: LTG titrated at 25 mg/d for 2 weeks, 50 mg/d for 2 weeks, 100 mg/d for 1 week, and then 150 mg/d (n = 200); GBP started at 300 mg/d and then increased by 300 mg/d every 3 days to 1500 mg/d (n = 195); or CBZ titrated by 200 mg every 2 weeks to 600 mg/d (n = 198). Outcomes: Tolerability and efficacy (retention in the trial) of GBP, LTG, and CBZ at 12 months. Patient follow-up: 99%.