RATIONALIZED POLYTHERAPY FOR EPILEPSY

In the past, epilepsy was usually treated with polytherapy, but with l ittle knowledge as to the interactions and side-effects of the combina tions of the anti-epileptic drugs used. Adverse events and sparse clin ical knowledge led to monotherapy becoming the treatment regime of cho ice. A new generation of drugs, which are well-tolerated and have few or predictable interactions, have enabled the reassessment of polyther apy for the treatment of epilepsy. Extensive clinical trials of these drugs are allowing the emergence of a new, rationalized approach to po lytherapy. In our study, 19 patients with refractory partial epilepsy, and who were 'socially active and integrated into society), received vigabatrin as add-on therapy. Patients were taking a mean of 1.5 drugs , and five patients were taking small doses of drugs which lead to tol erance, such as barbiturates and benzodiazepines. With vigabatrin as a dd-on therapy, 14 patients (73%) had a greater than 50% reduction in s eizure frequency, and 10 (52%) had a greater than 70% reduction in sei zure frequency. In one patient, seizure frequency increased, and two p atients developed myoclonic jerks. Vigabatrin was not shown to have an y harmful effects in extensive laboratory EEG and cognitive function t ests. In fact, a minor improvement occurred in visual memory, which wa s probably related to the reduction in seizures. Addition of vigabatri n may, therefore, be of benefit to patients with partial epilepsy refr actory to monotherapy with standard anti-epilepsy drugs.