<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_joepi-2015-0018_s_001"><h3>Background</h3><p>Monotherapy is the choice regimen to treat newly diagnosed epilepsies. However, if it fails, several strategies may be followed.</p></sec><sec id="j_joepi-2015-0018_s_002"><h3>Aim</h3><p>To discuss the treatment options when an initial monotherapy regimen fails.</p></sec><sec id="j_joepi-2015-0018_s_003"><h3>Methods</h3><p>We reviewed the relevant literature on the topic by using PubMed.</p></sec><sec id="j_joepi-2015-0018_s_004"><h3>Review and Discussion</h3><p>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.</p></sec><sec id="j_joepi-2015-0018_s_005"><h3>Conclusion</h3><p>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.</p></sec></abstract>

BackgroundMonotherapy is the choice regimen to treat newly diagnosed epilepsies. However, if it fails, several strategies may be followed.AimTo discuss the treatment options when an initial monotherapy regimen fails.MethodsWe reviewed the relevant literature on the topic by using PubMed.Review and DiscussionApproximately 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.ConclusionAny 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.

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

Journal of Epileptology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

BackgroundMonotherapy is the choice regimen to treat newly diagnosed epilepsies. However, if it fails, several strategies may be followed.AimTo discuss the...

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

Published Online: Dec 18, 2014

Page range: 109 - 112

Received: Oct 10, 2014

Accepted: Dec 16, 2014

DOI: https://doi.org/10.21307/joepi-2015-0018

Keywords
antiepileptic drugs, drug therapy combination, epilepsy

© 2014 José Pimentel et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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

Published Online: Dec 18, 2014

Page range: 109 - 112

Received: Oct 10, 2014

Accepted: Dec 16, 2014

DOI: https://doi.org/10.21307/joepi-2015-0018

Keywordsantiepileptic drugs, drug therapy combination, epilepsy

© 2014 José Pimentel et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Keywords
antiepileptic drugs, drug therapy combination, epilepsy