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Monotherapy "may be best" for people with difficult to control epilepsy

15 Jan 2004

Patients with difficult
to control epilepsy who have been prescribed multiple anti-epileptic
drugs (AEDs) may benefit from a return to a single AED, even when seizure
control has not been achieved, according to a study presented to the
annual meeting of the American
Epilepsy Society

Researchers, led
by Dr Sarah Richardson of the University
of California-Davis
, studied the medical records of 35 people with
epilepsy whose seizures had been uncontrolled using two of the major
AEDs separately and who had then been prescribed multiple AEDs (polytherapy).
After polytherapy had failed to control their seizures, the patients
had been returned to taking only one AED (monotherapy).

None of the patients
experienced a worsening of seizure frequency after being switched back
to monotherapy and 80 per cent of those studied reported a reduction
in their seizure frequency of more than half. Most of the group also
reported also reported a better quality of life.

Dr Richardson commented:

"When patients
have failed polytherapy, it may be worthwhile to simplify the approach
and return to monotherapy. We know that there are certainly patients
who do better on one drug; and quality of life also becomes an issue
with polytherapy because of side effects.

"Our study suggests
that monotherapy might be a reasonable and possibly even preferable
approach with some patients, but because of the small sample size and
possible selection bias, a prospective randomised trial is needed to
confirm the findings."

She added that for
patients with a single seizure type, monotherapy is nearly always more
beneficial than polytherapy.