Failure of a first regimen of monotherapy to control the newly diagnosed epilepsies. What to do next?

• Authors: José Pimentel
• Languages of publication: EN

Abstracts

EN

Background. Monotherapy is the choice regimen to treat newly diagnosed epilepsies. However, if it fails, several strategies may be followed.Aim. To discuss the treatment options when an initial monotherapy regimen fails.Methods. We reviewed the relevant literature on the topic by using PubMed.Review and Discussion. Approximately 64% of people with epilepsy (PWE) de novo are free of seizures with the first appropriate antiepileptic drug (AED) in monotherapy. The type (first versus second generation) of the first AED to use depends on the physician's personal choice provided that it is a first-line AED. There is a tendency to prefer a substitution rather than a combination of a failed first AED when it was produced associated with an idiosyncratic reaction, was poorly tolerated at a moderate dose, or produced no improvement in seizure control. In contrast, there is some evidence to prefer secondary polytherapy whenever the PWE tolerate its first AED but with a suboptimal response. In this case, and particularly mainly if a first generation AED was used as a first-line treatment, I prefer to choose a new generation AED given their more favourable pharmacokinetic and pharmacodynamic profiles. A very often used strategy is transitional polytherapy between two regimens of monotherapy.Conclusion. Any therapeutic decision should take into account factors such as seizure type or syndrome, possibility of drug side effects, comorbidities, comedications, age, teratogenic potential, and compliance. Whatever the option to be taken, the PWE, his family or the caregivers should take part in the decision making.

Keywords

EN

antiepileptic drugs; drug therapy combination; epilepsy

• Publisher: De Gruyter Open
• Journal: Journal of Epileptology
• Year: 2014
• Volume: 22
• Issue: 2
• Pages: 109-112

Dates

published

1 - 12 - 2014

online

1 - 3 - 2015

received

10 - 10 - 2014

accepted

16 - 12 - 2014

Contributors

author

José Pimentel

• Epilepsy Clinic, Department of Neurology, Hospital de Santa Maria (CHLN), Lisbon Faculty of Medicine, Instituto de Medicina Molecular, Lisbon, Portugal

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Identifiers

DOI

10.1515/joepi-2015-0018