I used to think that all antiseizure medications (ASMs) were equally effective.

This was a blind spot for me. It’s not that I didn’t know about trials like SANAD. I tended to minimize their significance. The rate of drug resistance hasn’t meaningfully changed, right? That was good enough for me.

The SANAD trial in 2007 showed lamotrigine was as good as the old stalwart carbamazepine and affirmed the supremacy of valproate for generalized epilepsy. [SANAD II][sanad2] in 2021 followed that up by finding superiority for lamotrigine yet again over levetiracetam and zonisamide. (And for valproate yet again over levetiracetam in generalized epilepsy).

[sanad2]: [komet]: https://journals.sagepub.com/doi/pdf/10.5698/1535-7597-14.5.255 [vpaetxltg]: [networkmeta3]: https://link.springer.com/article/10.1007/s40265-021-01661-4 [vacoop]: [mess]: