Objective  To assess the effectiveness and safety of anti-seizure medication (ASMs) for refractory partial-onset seizures.

Methods  The PubMed, Embase and The Cochrane Library were searched to collect randomized controlled trials (RCTs) related to ASMs for refractory partial-onset seizures from the inception of the database to November 1, 2024.

Results  56 literature were included, involving 57 RCTs and 15,667 patients. Network Meta-analysis showed that when compared with placebo, tiagabine [RR=3.43, 95%CI(1.91, 6.14)], topiramate [RR=2.61, 95%CI(2.11, 3.23)], levetiracetam [RR=2.28, 95%CI(1.84, 2.83)], zonisamide [RR=2.28, 95%CI(1.70, 3.08)], rufinamide [RR=2.28, 95%CI(1.24, 4.19)], oxcarbazepine [RR=2.10, 95%CI(1.61, 2.74)], vigabatrin [RR=2.06, 95%CI(1.28, 3.30)], gabapentin [RR=2.02, 95%CI(1.51, 2.70)], pregabalin [RR=2.00, 95%CI(1.60, 2.50)], cenobamate [RR=1.97, 95%CI(1.40, 2.76)], lamotrigine [RR=1.85, 95%CI(1.09, 3.12)], lacosamide [RR=1.78, 95%CI(1.51, 2.10)], eslicarbazepine acetate [RR=1.75, 95%CI(1.43, 2.14)] and brivaracetam [RR=1.74, 95%CI(1.37, 2.21)] showed statistically significant effectiveness in achieving a 50% response rate (P<0.05). According to the surface under the cumulative ranking curve, tiagabine had the optimal result of therapy, followed by topiramate, levetiracetam and zonisamide. The three ASMs exhibiting the poorest therapeutic were perampanel, eslicarbazepine acetate, and brivaracetam. In addition, the side effects of epilepsy medications such as eslicarbazepine acetate, perampanel and lamotrigine were more pronounced, particularly regarding dizziness.

Conclusion  This study recommended the use of tiagabine, topiramate, levetiracetam, and zonisamide for patients to treat refractory partial-onset seizures.

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