SYSTEMATIC TESTING OF MEDICAL INTRACTABILITY FOR CARBAMAZEPINE, PHENYTOIN, AND PHENOBARBITAL OR PRIMIDONE IN MONOTHERAPY FOR PATIENTS CONSIDERED FOR EPILEPSY SURGERY

Purpose: To assess medical intractability in patients considered for r estrictive epilepsy surgery. Methods: Seventy-four patients received s ingle drug treatment with carbamazepine (CBZ), phenytoin (PHT), and ei ther phenobarbital (PB) or primidone (PRM). Medical intractability was established if seizure control was not obtained despite maximum toler able doses of the drug. In all, 120 single drug treatments were admini stered with the drugs that has not been administered at maximal doses in monotherapy before the study. Results: Complete seizure control was not achieved in any patient. However, 7 patients (9.5%) had significa nt seizure reduction of at least 80%. In 4 patients, only the third an tiepileptic drug (AED) proved effective. Conclusion: The poor result o f AED monotherapy in our patients may be attributed to the patients' l ong-standing chronic epilepsies and high seizure frequencies. Our find ings suggest that despite the failure of one or two major AEDs in cont rolling seizures completely, further single drug treatment may still i mprove the quality of life in some patients who are candidates for epi lepsy surgery.