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The Limitations of Antiepileptic Drug Monotherapy
Author(s) -
Krämer G.
Publication year - 1997
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1157.1997.tb04599.x
Subject(s) - carbamazepine , medicine , refractory (planetary science) , combination therapy , epilepsy , partial seizures , complex partial seizures , anticonvulsant , antiepileptic drug , drug , anesthesia , pediatrics , pharmacology , psychiatry , temporal lobe , physics , astrobiology
Summary The success rate for antiepileptic drug (AED) monotherapy varies among seizure types and epilepsy syndromes, although monotherapy has been shown to be suitable for the majority of patients. Certain groups of patients, e.g., patients with partial seizures, with or without secondarily generalizing, are less satisfactorily controlled with monotherapy. Prospective studies have shown that 33–50% of patients with refractory partial epilepsies and symptomatic generalized epilepsies whose seizures are not satisfactorily controlled by monotherapy respond well to a combination of AEDs. Current consensus is that all patients should initially receive monotherapy [e.g., valproate (VPA) or carbamazepine (CBZ)] and, if unsuccessful, an alternative AED should be administered as monotherapy. Only if seizures are still not satisfactorily controlled should combination therapy be instituted. Studies have shown that combination therapy with VPA and CBZ brings seizures of many previously nonresponsive patients with refractory complex partial and secondary generalized epilepsies under control. However, to establish the limitations of monotherapy in an individual, the maximal tolerated dosage must have been administered. Full seizure control may occur in some patients only when the plasma concentration exceeds the therapeutic range.