Mono-Therapy versus Poly-Therapy: Ten Years Indian Experience on Various Seizure Disorders


Objectives: To find out prescription patterns and seizure freedom with different mono-, duo- and poly-therapies used in various seizure disorders in Indian setting. Material and Methods: Subjects with seizures, not responding to first antiepileptic drug, were evaluated prospectively for a period of 6 months. Patients on various dual antiepileptic drugs (AEDs) prescriptions were prospectively analyzed for 1) the pattern and frequency of different duo-therapies; 2) etiological profile of patients in duo-therapy prescription; and 3) frequency of seizure freedom on various duo-therapy groups. Results: Among 2542 patients, 293 (11.5%) lost in follow-up and thus, 2249 (88.5%) were followed. 1324 (58.9%) had seizure freedom on mono-therapy, 532 (23.7%) required duo-therapy and only 45 (2%) were better controlled on poly-therapy. Among the subjects, who were on mono-therapy, Carbamazepine/Oxcarbazepine was the most commonly prescribed in 1285 (50.55%) patients as first drug followed by Valproate compound and Phenytoin. The most common duo-therapy used was combination of Valproate with Lamotregine, followed by Phenytoin and Phenobarbitone. Other mono-therapy and combinations are given in this paper. Conclusions: Duo-therapy was required and found to be effective in 23.7% of Indian patients with epilepsy. Selection of appropriate two drug combination is based on individual approach and overall clinical profile of patient.

Share and Cite:

Goel, D. and Mittal, M. (2015) Mono-Therapy versus Poly-Therapy: Ten Years Indian Experience on Various Seizure Disorders. World Journal of Neuroscience, 5, 350-357. doi: 10.4236/wjns.2015.55034.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Sridharan, R. and Murthy, B.N. (1999) Prevalence and Pattern of Epilepsy in India. Epilepsia, 40, 631-636.
[2] Beghi, E. and Perucca, E. (1995) The Management of Epilepsy in the 1990s: Acquisitions, Uncertainties and Priorities for Future Research. Drugs, 49, 680-694.
[3] Perucca, E. (1996) Established Antiepileptic Drugs. Baillieres clin Neurol, 5, 693-722.
[4] Beghi, E., Di Mascio, R. and Tognoni, G. (1986) Drug Treatment of Epilepsy: Outlines, Criticism and Perspectives. Drugs, 31, 249-265.
[5] Schmidt, D. (1982) Two Antiepileptic Drugs for Intractable Epilepsy with Complex-Partial Seizures. Journal of Neurology, Neurosurgery & Psychiatry, 45, 1119-1124.
[6] Brodie, M.J. and Mumford, J.P. (1999) Double-Blind Substitution of Vigabatrin and Valproate in Carbamazepine-Resistant Partial Epilepsy. Epilepsy Research, 34, 199-205.
[7] Reynolds, E.H. and Shorvon, S.D. (1981) Monotherapy or Polytherapy for Epilepsy? Epilepsia, 22, 1-10.
[8] Reynolds, E.H. and Shorvon, S.D. (1981) Single Drug or Combination Therapy for Epilepsy? Drugs, 21, 474-482.
[9] Birbeck, G.L., Hays, R.D., Cui, X.P. and Vickrey, B.G. (2002) Seizure Reduction and Quality of Life Improvements in People with Epilepsy. Epilepsia, 43, 535-538.
[10] Collings, J.A. (1990) Epilepsy and Well Being. Social Science & Medicine, 31, 165-170.
[11] Leidy, N.K., Elixhauser, A., Vickrey, B., Means, E. and William, M.K. (1999) Seizure Frequency and Health Related Quality of Life of Adults with Epilepsy. Neurology, 53, 162-166.
[12] Elwes, R.D., Johnson, A.L., Shorvon, S.D., et al. (1984) The Prognosis for Seizure Control in Newly Diagnosed Epilepsy. The New England Journal of Medicine, 311, 944-947.
[13] Sillanpaa, M., Jalava, M., Kaleva, O., et al. (1998) Long-Term Prognosis of Seizures with Onset in Childhood. The New England Journal of Medicine, 338, 1715-1722.
[14] Collaborative Group for the Study of Epilepsy (1992) Prognosis of Epilepsy in Newly Referred Patients: A Multicenter Prospective Study of the Effects of Monotherapy on the Long-Term Course of Epilepsy. Epilepsia, 33, 45-51.
[15] Kwan, P. and Brodie, M.J. (2001) Effectiveness of First Antiepileptic Drug. Epilepsia, 42, 1255-1260.
[16] Lim, S.H., Tan, E.K. and Chen, C. (1997) Pattern of Anti-Epileptic Drug Usage in a Tertiary Referral Hospital in Singapore. Neurological Journal of South East Asia, 2, 77-85.
[17] Kwan, P. and Brodie, M.J. (2000) Epilepsy after First Drug Fails: Substitution or Add-On? Seizure, 9, 464-468.
[18] Stephen, L.J. and Brodie, M.J. (2012) Antiepileptic Drugs Monotherapy versus Polytherapy: Pursuing Seizure Freedom and Tolerability in Adults. Current Opinion in Neurology, 25, 164-172.
[19] Shorvon, S.D. and Reynolds, E.H. (1979) Reduction in Polytherapy for Epilepsy. BMJ, 2, 1023-1025.
[20] Brodie, M.J. and Graeme, J.S. (2011) Combining Antiepileptic Drugs—Rationale Polytherapy? Seizure, 20, 369-375.
[21] Hakkarainen, H. (1980) Carbamazepine vs. Diphenylhydantoin vs. Their Combination in Adult Epilepsy. Neurology, 30, 354.
[22] Stringer, J.L. and Hinggins, M.G. (1994) Interaction of Phenobarbital and Phenytoin in an Experimental Model of Seizures in Rats. Epilepsia, 35, 216-220.
[23] Smith, D.B., Mattson, R.H., Cramer, J.A., Collins, J.F., Novelly, R.A. and Craft, B. (1987) Results of a Nationwide Veterans Administration Co-Operative Study Comparing the Efficacy and Toxicity of Carbamazepine, Phenobarbital, Phenytoin & Primidone. Epilepsia, 28, 550-558.
[24] Kanner, A.M. and Frey, M. (2000) Adding Valproate to Lamotrigine: A Study of Their Pharmacokinetic Interaction. Neurology, 55, 588-591.
[25] Ghaffapour, M., Hejazie, S.S., Harirchian, M.H. and Pourmahmoodian, H. (2005) Phenytoin, Carbamazepine, Sodium Valproate and Lamotrigine Induced Cutaneous Reactions. Acta Medica Iranica, 43, 37-42.
[26] Mirelesh, R. and Leppik, E. (2007) Valproate and Clonazepam Comedication in Patients with Intractable Epilepsy. Epilepsia, 26, 122-126.
[27] Nicolson, A., Appleton, R.E., Chadwick, D.W. and Smith, D.F. (2004) The Relationship between Treatment with Valproate, Lamotrigine, and Topiramate and the Prognosis of the Idiopathic Generalised Epilepsies. Journal of Neurology, Neurosurgery & Psychiatry, 75, 75-79.
[28] Arif, H., Nahm, E.A., Resor Jr., S.R. and Hirsch, L.J. (2008) Efficacy of Clobazam as Add-On Therapy for Refractory Epilepsy: Experience at a US Epilepsy Center. Clinical Neuropharmacology, 31, 333-338.
[29] Blaise, F.D. (1986) Bourgeois. Antiepileptic Drug Combinations and Experimental Background: The Case of Phenobarbital and Phenytoin. Archives of Pharmacology, 333, 406-411.
[30] Karas, C.A. (1986) Effects of Phenobarbital in Combination with Phenytoin or Valproic Acid on the Delayed-Matching-to-Sample Performance of Pigeons. Pharmacology Biochemistry and Behavior, 25, 929-932.
[31] Kostadinova, I., Millusheva, M., Krustev, A. and Toreva, D. (1992) Effects of Phenobarbital, Carbamazepine and a Combination of Both on Corazol-Induced Changes in the Bioelectric Activity of Rat Brains. Folia Medica, 34, 20-23.
[32] Thomson, A.H. and Brodie, M.J. (1992) Pharmacokinetic Optimization of Anticonvulsant Therapy. Clinical Pharmacokinetics, 23, 216-230.
[33] Bourgeois, B.F. (1988) Anticonvulsant Potency and Neurotoxicity of Valproate Alone and in Combination with Carbamazepine or Phenobarbital. Clinical Neuropharmacology, 11, 348-359.
[34] Cereghino, J.J., Brock, J.T., Van Meter, J.C., Penry, J.K., Smith, L.D. and White, B.G. (1975) The Efficacy of Carbamazepine Combinations in Epilepsy. Clinical Pharmacology & Therapeutics, 18, 733-741.
[35] Morris, J.C., Dodson, W.E., Hatlelid, J.M. and Ferrendelli, J.A. (1987) Phenytoin and Carbamazepine, Alone and in Combination Anticonvulsant and Neurotoxic Effects. Neurology, 37, 1111.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.