Abstract
The process of conversion between AED monotherapies is frequently necessary in epilepsy care, yet little practical guidance is available to practitioners. This article introduces an issue of Current Neuropharmacology devoted to the theme of AED conversions and related issues. In this series of articles, we reviewed the role of AED monotherapy in newly diagnosed epilepsy, the practice of transitional polytherapy during AED monotherapy conversions in patients experiencing breakthrough seizures or adverse effects, chronic maintenance polytherapy for refractory epilepsy, and the related topics of strategies for minimizing adverse effects, appropriate blood level monitoring, and patient-related factors in AED conversions. Successful conversion between AED monotherapies and polytherapy drug sequencing requires that practitioners possess and apply a thorough knowledge of epilepsy, AED pharmacology, and clinical reasoning, while being sensitive and reactive to patient reported adverse effects of treatment.
Highlights
The first antiepileptic drug (AED) monotherapy utilized successfully manages nearly half of epilepsy patients; conversion to a second monotherapy is necessary for those who fail to become seizure-free or who do not tolerate an initially chosen AED, and chronic polytherapy is necessary in many patients who develop refractory epilepsy [1]
While all newer AEDs were first approved in the United States for adjunctive treatment of partial-onset seizures—leading to their nearexclusive use as polytherapy initially—there is increasing use of newer AEDs as monotherapy paralleling expanding evidence basis for formal approval of monotherapy use, and adequate evidence to support off-label monotherapy use
Abundant evidence is available when initiating adjunctive AED therapy in refractory epilepsy, on practical grounds an important setting for use of newer AEDs since when a new AED becomes available, it is generally first limited to use in refractory patients having the greatest need for improved seizure control, until its safety and tolerability profile and expanded evidence for use in other settings is well established
Summary
The first antiepileptic drug (AED) monotherapy utilized successfully manages nearly half of epilepsy patients; conversion to a second monotherapy is necessary for those who fail to become seizure-free or who do not tolerate an initially chosen AED, and chronic polytherapy is necessary in many patients who develop refractory epilepsy [1]. Increasing generic availability may further encourage earlier use of newer AEDs in both monotherapy and adjunctive therapy situations.
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