Abstract
Objectives: To find out prescription patterns and seizure freedom with different mono-, duo- and poly-therapies used in various seizure disorders in Indian setting. Material and Methods: Subjects with seizures, not responding to first antiepileptic drug, were evaluated prospectively for a period of 6 months. Patients on various dual antiepileptic drugs (AEDs) prescriptions were prospectively analyzed for 1) the pattern and frequency of different duo-therapies; 2) etiological profile of patients in duo-therapy prescription; and 3) frequency of seizure freedom on various duo-therapy groups. Results: Among 2542 patients, 293 (11.5%) lost in follow-up and thus, 2249 (88.5%) were followed. 1324 (58.9%) had seizure freedom on mono-therapy, 532 (23.7%) required duo-therapy and only 45 (2%) were better controlled on poly-therapy. Among the subjects, who were on mono-therapy, Carbamazepine/Oxcarbazepine was the most commonly prescribed in 1285 (50.55%) patients as first drug followed by Valproate compound and Phenytoin. The most common duo-therapy used was combination of Valproate with Lamotregine, followed by Phenytoin and Phenobarbitone. Other mono-therapy and combinations are given in this paper. Conclusions: Duo-therapy was required and found to be effective in 23.7% of Indian patients with epilepsy. Selection of appropriate two drug combination is based on individual approach and overall clinical profile of patient.
Highlights
Epilepsy is defined as a chronic, neurological condition whose cardinal feature is a predisposition to recurrent, unprovoked seizures
We have developed a protocol at our center to prescribe various anti-epileptic drug (AED) in a step wise pattern
Findings of our study suggest that around 83% patients achieved seizure freedom on treatment and 59% had got the seizure freedom on mono-therapy
Summary
Epilepsy is defined as a chronic, neurological condition whose cardinal feature is a predisposition to recurrent, unprovoked seizures. How to cite this paper: Goel, D. and Mittal, M. (2015) Mono-Therapy versus Poly-Therapy: Ten Years Indian Experience on Various Seizure Disorders. The optimal goal of the therapy for patient with epilepsy is complete freedom from seizures on a single anti-epileptic drug (AED) which is affordable to the patient and does not have any adverse effect. Available evidences recommend AED mono-therapy as the initial step for new onset epilepsy cases [2] [3]. Medical treatment statistics suggest that around 50% patients can have seizures freedom from mono-therapy [4]. The failure of mono-therapy has evolved the concept of combining two or more AEDs (polytherapy) for better control of seizures [7]. The selection of first drug and types of drug combinations is largely based on clinician’s choice, experiences and available guidelines
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