Monotherapy versus polytherapy in epilepsy : experimental and clinical studies

Abstract

Antiepiletic drugs are about equally efficacious in suppressing epileptic seizures,however they do differ in type and severity of their adverse effects. The main hypothesis of this was that, contrary to what is commonly assumed, giving more than one antiepileptic drug does not lead to more adverse effects and may even offer advantages. In a unique collaboration with neurologists from Northern Limburg, Noord-Brabant, Utrecht and Gelderland a multicentre trial was carried out, in which patients who were to receive antiepileptic drugs for the first time, were given either one drug at its normal dosage or two drugs both at half of their normal dosage. No differences were found concerning seizure control or adverse effects in patients who completed the trial, however more patients on only one drug than on two drugs tended to withdraw from treatment due to adverse effects. Similarly, in experiments with rats who spontaneously develop epilepsy, the animals who received combination therapy were less passive (which can be seen as a measure for sedation) than the animals on one drug. These encouraging findings open the way for more extensive evaluation of combination therapy, and especially into which of these combinations offer advantages