A Cochrane review [Abstract] 1 included 11 studies with a total of 424 subjects with drug-resistant epilepsy. Flunarizine was studied in one parallel and seven cross-over trials, nimodipine in two cross-over and nifedipine in one cross-over trial. A 50% or greater reduction in seizure frequency was selected as a specified outcome. For the parallel trial with flunarizine (n=93), the odds ratio (OR) for 50% or greater reduction in seizure frequency was 1.64 (95% CI 0.55 to 4.94), indicating a non-significant advantage of flunarizine. The data for this outcome were not obtainable from the 7 cross-over trials. Flunarizine was significantly more likely to be withdrawn than placebo (OR 5.83, 95% CI 2.06 to 16.45). No adverse effects were statistically associated with flunarizine. For nimodipine, there were data only from the first treatment period from one of the two cross-over trials (17 participants). The ORs for a 50% or greater reduction in seizure frequency was 11.34 (95% CI 1.00 to 128.03) and for treatment withdrawal 2.46 (95% CI 0.22 to 27.75).
Comment: The quality of the evidence is downgraded by study quality (unclear allocation concealment), imprecise results (few patients and wide confidence intervals) and indirectness of evidence (differences in outcomes).
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