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First-line therapy for newly diagnosed epilepsy (e.g. carbamazepine)is generally considered effective.However,in a significant proportion of patients (especially in the elderly),us-age may be limited by unwanted adverse events.To synthesize ev-idence regarding efficacy and tolerability of lamotrigine as first line, monotherapy or prophylactic antiepileptic. MEDLINE, PsycINFO,Scopus,EMBASE,and the Cochrane Central Register of Controlled Trials (CENTRAL)were searched from inception to June 2014.Randomised controlled trials (RCTs)comparing lam-otrigine with carbamazepine monotherapy for newly diagnosed epi-lepsy.Eligible studies were independently selected and methodo-logical quality was independently evaluated by two reviewers. Effects were summarized using standardized hazard ratio (HR)or odds ratio (OR)with suitable effect models.Pre-specified sensi-tivity analyses were performed to explain heterogeneity.Nine stud-ies involving 2793 participants met the inclusion criteria.The effects of lamotrigine compared with carbamazepine in patients with newly diagnosed seizures were investigated in all studies.We found that carbamazepine was inferior in comparison to lamotrigine when measuring the proportion of remaining seizure free in the elderly (hazard ratio (HR)1.71;95%confidence interval (CI) 1.27 to 2.29)but notthe children and the adult.There was strong evidence for the tolerability profile of lamotrigine compared with carbamazepine in the Retention rates (HR 1 .67;95%CI 1 . 43 to 1.94).Moreover,lamotrigine lead to less adverse events. Lamotrigine and carbamazepine showed similar efficacy on newly diagnosed epilepsy but better efficacy in the elderly than carbam-azepine.Furthermore,lamotrigine was better tolerated.