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Reinvestigation and Reduction of Polytherapy in Children With Chronic Seizures

Department of Pediatrics, Veterans General Hospital-Kaohsiung, National Yang-Ming University, Taiwan, childdoctor{at}hotmail.com

Pao-Chin Chiu, MD

Department of Pediatrics, Veterans General Hospital-Kaohsiung, National Yang-Ming University, Taiwan

Mei-Tsen Chen, MD

Department of Pediatrics, Veterans General Hospital-Kaohsiung, National Yang-Ming University, Taiwan

From October 2001 to October 2003, the authors reviewed all patients with chronic seizures taking antiepileptic drugs for more than 2 years with follow-up at the pediatric neurological clinic. They identified 31 patients who were using 3 or more drugs. Twenty-nine patients agreed to undergo a drug reduction and readjustment. The authors spent a mean period of 14.1 months to either purely reduce the numbers of drugs or introduce a new drug (rational polytherapy) plus removal of some drugs to achieve the end goal of a maximum of 2 or 3 drugs (if necessary). Seizure control in 96.6% of patients (28 of 29 patients) did not worsen after the readjustment and reduction of the antiepileptic drugs. Instead, 65.5% (19 of 29 patients) got better, and 37.9% (11 of 29) were seizure free. The number of antiepileptic drugs before and after adjusting was 3.6 (range, 3-6) to 1.9 (4 monotherapy, 22 duotheray, and 2 triple drugs). The most common combined therapies were sodium valproate/lamotrigine (n = 10) and carbamazepine/ topiramate (n = 5). Although the results could be possibly attributed to the spontaneous remission of the seizures, it was still shown that those patients were overtreated. Serial addition to 3 or more antiepileptic drugs is less likely to lead to seizure freedom for patients with difficult-to-treat epilepsy. On the contrary, polytherapy and some antiepileptic drugs could aggravate seizures. Certain combinations of antiepileptic drugs (rational polytherapy) offer better efficacy to control seizures.

Key Words: refractory epilepsy • overtreatment • rational polytherapy

Journal of Child Neurology, Vol. 22, No. 1, 15-20 (2007)
DOI: 10.1177/0883073807299963


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