INTRODUCTION
The evidence-based rationale formonotherapy in appropriate patientswith epilepsy
Treatment of newly diagnosed epilepsy with a
ing an appropriate, safe, and effective treatment
single antiepileptic drug (AED) is now the favored
strategy. For newly diagnosed partial seizures in
approach for seizure management. The emer-
adults and adolescents, the American Academy of
Address correspondence andreprint requests to Dr. Rajesh
gence of monotherapy as a mainstay treatment re-
Neurology (AAN) guidelines recommend mono-
sulted from studies that demonstrated the
therapy with oxcarbazepine, lamotrigine, gabap-
Neurology, UMDNJ RWJMedical School, Director
effectiveness and advantages of a single AED in
entin, or topiramate, or with an older “standard”
controlling seizures. Monotherapy is usually as-
AED such as carbamazepine, phenytoin, pheno-
University Medical Center, 1945State Route 33, Neptune, NJ
sociated with fewer potential problems such as
barbital, or valproate. The International League
toxicity, teratogenicity, and drug– drug interac-
Against Epilepsy (ILAE) guidelines recommend
tions, and is generally less expensive and easier to
carbamazepine and phenytoin as monotherapy
Neurology® 2007;69(Suppl 3):S1–S2
administer than polytherapy. Furthermore, the
and regard oxcarbazepine, gabapentin, lam-
vast majority of patients can achieve adequate sei-
otrigine, phenobarbital, topiramate, and vigaba-
zure control with the use of a single AED, and
trin as possibly efficacious. The AAN also
patients converted to monotherapy after having
recommends monotherapy with oxcarbazepine or
done poorly on polytherapy frequently show im-
topiramate for patients with refractory partial ep-
proved seizure control and experience fewer ad-
ilepsy. In view of the special health issues associ-
verse effects. These findings and other advantages
of monotherapy have contributed to the general
guidelines recommend AED monotherapy at the
failure of the concept of rational polytherapy and
lowest possible dose, with drug choice based on
the acceptance of AED monotherapy as first-line
seizure type, seizure control, and avoidance of
treatment for most patients with epilepsy.
The expanding assemblage of AEDs provides
Management of pediatric epilepsy requires
useful new pharmacologic tools with great potential
consideration of development-related issues in
for improving patients’ quality of life. However, the
addition to efficacy. An expert panel of physi-
selection of an appropriate AED for initiation of
cians treating pediatric epilepsy recently recom-
monotherapy requires careful assessment of the
mended oxcarbazepine and carbamazepine as
risk– benefit profiles of different agents, including
treatments of choice for initial monotherapy of
consideration of drug efficacy, tolerability, safety,
complex partial seizures and valproate as the
pharmacokinetics, ease of use, and cost. Moreover,
treatment of choice for symptomatic myoclonic
the pharmacologic management of epilepsy in spe-
and generalized tonic– clonic seizures (except in
cial patient populations presents unique challenges
the very young). The ILAE guidelines also recom-
and requires consideration of parameters specific to
mend oxcarbazepine as initial monotherapy for
each patient. Recently published treatment recom-
newly diagnosed or untreated partial-onset sei-
mendations provide guidance for the selection of
zures in children, based on level A evidence. The
monotherapy options for adults, the elderly, chil-
AAN guidelines recommend initial treatment of
dren, and women of reproductive age.
newly diagnosed partial epilepsy in children with
Guideline-based recommendations for the se-
standard drugs or with the newer drugs lam-
lection of AEDs can assist physicians in formulat-
otrigine, gabapentin, oxcarbazepine, or topira-
From the Department of Neurology, University of Medicine and Dentistry of New Jersey (UMDNJ), Epilepsy Program, Jersey Shore MedicalCenter, Neptune, New Jersey.
This supplement was supported by an educational grant from Novartis Pharmaceuticals Corporation. Disclosure: The author reports no conflicts of interest. Neurology® supplements are not peer-reviewed. Information contained in Neurology® supplements represents the opinions of the authors. These opinions are not endorsed by nor do they reflect the views of the American Academy of Neurology, Editor-in-Chief, or Associate Editorsof Neurology®.
Copyright 2007 by AAN Enterprises, Inc.
mate. In particular, lamotrigine is effective for
indicated as initial monotherapy in patients 10 years
children with newly diagnosed absence seizures,
or older with partial-onset or primary generalized
gabapentin is effective in the treatment of newly
diagnosed partial epilepsy, and lamotrigine, ox-
This supplement reviews the clinical applica-
carbazepine, and topiramate are effective in a
tion of AEDs approved for monotherapy and the
mixed population of newly diagnosed partial and
therapeutic benefits of their use in adults and in
generalized tonic– clonic seizures. Oxcarbazepine,
special patient populations. The latest recom-
topiramate, or lamotrigine are recommended as
mendations for use of new AEDs, strategies for
monotherapy in patients with refractory partial epi-
conversion from polytherapy to monotherapy, is-
lepsy. Of the new AEDs, oxcarbazepine is indicated
sues relating to the design of monotherapy clini-
by the US Food and Drug Administration for use as
cal trials, and animal models for the identification
monotherapy in the treatment of partial seizures in
of new AEDs and the use of AEDs in combination
children aged 4 years and older, and topiramate is
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INTRODUCTION
mate. In particular, lamotrigine is effective for
indicated as initial monotherapy in patients 10 years
children with newly diagnosed absence seizures,
or older with partial-onset or primary generalized
gabapentin is effective in the treatment of newly
diagnosed partial epilepsy, and lamotrigine, ox-
This supplement reviews the clinical applica-
carbazepine, and topiramate are effective in a
tion of AEDs approved for monotherapy and the
mixed population of newly diagnosed partial and
therapeutic benefits of their use in adults and in
generalized tonic– clonic seizures. Oxcarbazepine,
special patient populations. The latest recom-
topiramate, or lamotrigine are recommended as
mendations for use of new AEDs, strategies for
monotherapy in patients with refractory partial epi-
conversion from polytherapy to monotherapy, is-
lepsy. Of the new AEDs, oxcarbazepine is indicated
sues relating to the design of monotherapy clini-
by the US Food and Drug Administration for use as
cal trials, and animal models for the identification
monotherapy in the treatment of partial seizures in
of new AEDs and the use of AEDs in combination
children aged 4 years and older, and topiramate is