Pharmacologic Advantages of Antiepileptic Drug Monotherapy

Abstract

SummaryDespite recent trends in re‐evaluating the effects of antiepileptic drug (AED) combinations, monotherapy remains the mainstay for treatment of epilepsy. Most patients with newly diagnosed epilepsy can become seizure‐free with administration of an appropriately selected AED, and a significant proportion (20–40%) of those refractory to initial treatment may respond after changing to monotherapy with an alternative AED. Monotherapy is also superior to polytherapy in terms of safety and tolerability. The incidence and severity of side effects increase in proportion to the number of AEDs received by the patient. In patients receiving monotherapy, dosage can be more easily optimized because the effects of individual AEDs can be evaluated separately. Additional advantages of monotherapy include lower treatment costs, simpler dosing schedule (expected to maximize compliance), and avoidance of adverse AED interactions. Admittedly, there are patients who may respond better to AED combinations, but the number is relatively small and, in some cases, the improvement in seizure control produced by an added AED may be more than offset by an excessive burden of side effects.