MONOTHERAPY VERSUS POLYTHERAPY IN EPILEPSY - A FRAMEWORK FOR PATIENT-MANAGEMENT

The long-standing debate between proponents of monotherapy and those o f polytherapy for treatment of epilepsy has been rekindled by the rece nt development of several new antiepileptic drugs. The likelihood of i mproved seizure control on polytherapy must be weighed against the ris k of increased side effects, complex drug interactions and cost. Provi ding maximal seizure control while avoiding overtreatment is a challen ge which requires an ongoing critical evaluation of each patient's man agement. This review provides a framework for decision-making by consi dering issues affecting the choice between monotherapy and polytherapy in five clinical situations: 1) newly diagnosed epilepsy; 2) seizures on monotherapy; 3) seizures controlled on polytherapy; 4) not control led on polytherapy; 5) change in medical condition.