Abstract: OBJECTIVE To systematically evaluate the efficacy and safety of oxcarbazepine(OXC) and carbamazepine(CBZ) in the treatment of vestibular paroxysmia(VP). METHODS Randomized controlled trials(RCTs) comparing OXC and CBZ in treating VP were searched in PubMed, Cochrane Library, Embase, Wanfang, CNKI, VIP, China Biomedical Literature Database(SinoMed), from the establishment of the database to April 2022. RevMan5.4 software was used to perform meta-analysis on outcomes including total effective rate, the dizziness handicap inventory(DHI) score, attack frequency, degree of vertigo, self-rating anxiety scale(SAS) score, self-rating depression scale(SDS) score and adverse reactions. The quality of evidence for each outcome was evaluated using GRADE standard. RESULTS A total of 6 RCTs were included with a total sample size of 425 cases, including 211 cases in the OXC group and 214 cases in the CBZ group. Meta analysis results showed that there was no significant difference in the total effective rate in treating VPRR=1.04, 95%CI(0.90, 1.20), P=0.57 and the degree of vertigoSMD=-0.80, 95%CI(-2.14, 0.54), P=0.24; OXC group was lower than CBZ group in DHI scoreMD=-8.81, 95%CI(-14.59, -3.03), P=0.003, attack frequencySMD=-1.86, 95%CI(-3.32, -0.41), P=0.01, SAS scoreMD=-7.77, 95%CI(-14.09, -1.46), P=0.02, SDS scoreMD=-10.45, 95%CI(-15.36,-5.54), P<0.000 1 and had fewer adverse reactionsRR=0.43, 95%CI(0.29, 0.63), P<0.000 1. GRADE evidence quality evaluation showed that the quality for the adverse reactions rate was low and the quality for the other index was very low. CONCLUSION Compared with CBZ, OXC has better effects on the frequency of vertigo attacks, quality of life, depression and anxiety and adverse reactions. However, the sample size of the current studies is small and the evidence is low-quality. Large-sample, high-quality RCTs are need to provide further evidence.