Epilepsy and paroxysmal conditions

Advanced search


Full Text:


Abstract: the article presents a discussion of the problem of rational polytherapy (RPT). RPT has become one of the main strategies of modern epilepsy treatment. Early using of the RPT is a tactic of choice for patients with high risk for pharmacoresistant epilepsy (EDF) and for patients with risk of problems that can occur while switching to alternative monotherapy. For early RPT a seizure control can be achieved more quick. That reduces the risks associated with seizures for patients with severe epilepsy. AEDs choice for the RPT should be based on the prevention of the pharmacodynamic and pharmacokinetic side effects. But efficacy data of AEDs in clinical practice should be taking into account.

About the Author

I. G. Rudakova
Moscows regional research clinical institute n.a. M.F. Vladimirskiy
Russian Federation


1. Karlov V.A. Epilepsy in children and adults, men and women [Epilepsiya u detei i vzroslykh zhenshchin i muzhchin]. Moscow. 2010; 720 s.

2. Mukhin K.Yu. Idiopathic generalized epilepsy [Idiopaticheskie generalizovannye epilepsii]. Moscow 2000.

3. Mukhin K.Yu. Epileptic encephalopathy [Epilepticheskie entsefalopatii]. Moscow. 2011.

4. Bardai A., Blum M. van Noord C. et al. Sudden cardiac death is associated both with epilepsy and with use of antiepileptic medications. Heart. 2014; 1-6.

5. Ben-Menachem E., Biton V., Jatuzis D., Abou-Khalil B., Doty P., Rudd G.D. Efficacy and safety of oral lacosamide as adjunctive therapy in adults with partial-onset seizures. Epilepsia. 2007; 48: 1308-1317.

6. Berg A.T., Shinnar S., Levy S.R. et al. Early development of intractable epilepsy in children. A prospective study. Neurology. 2001; 56: 1445-1452.

7. Beydoun A., Kutluay E. Conversion to monotherapy: clinical trials in patients with refractory partial seizures. Neurology. 2003. 60: 13-25

8. Brodie M.J., Leach J.P. Success or failure with antiepileptic drug therapy: beyond empiricism? Neurology. 2003; 60: 162-163.

9. Brodie M.J., Yuen A.W.C. and the 105 Study Group. Lamotrigine substitution study: synergism with sodium valproate? Epilepsy Res. 1997; 26: 423-432.

10. Brodie M.J. Medical therapy of epilepsy: When to initiate treatment and when to combine? J. Neurol. 2005; 252: 125-130.

11. Deckers C.L.P., Czuczwar S.J., Hekster Y.A. et al. Selection of antiepileptic drug polytherapy based on mechanisms of action: the evidence reviewed. Epilepsia. 2000; 41: 1364-1374.

12. Deckers C.L., Hekster Y.A., Keyser A. et all. Reappraisal of polytherapy in epilepsy: a critical review of drug load and adverse effects. Epilepsia. 1997; 38: 570-5.

13. Engel J., Coulter D.A. Hov to overcome drug resistence in epilepsy? Epilepsy Res. 2006. 69: 245-248

14. Ferrendelli J.A. Relating pharmacology to clinical practice: the pharmacologic basis of rational polypharmacy. Neurology. 1995; 45: 12-16.

15. French J.A. Definition of refractory seizures. Epilepsia. 2007; 48: 3-7.

16. French J.A., Faught E. Rational polytherapy. Epilepsia. 2009; 50 (8): 63-68.

17. Hitiris N., Mohanraj R., Norrie J., Sills G.J., Brodie M.J. Predictors of pharmacoresistant epilepsy. Epilepsy Res. 2007; 75: 192-196.

18. Johannessen S.I., Landmark C.J. Antiepileptic Drug Interactions – Principles and Clinical Implications. Current Neuropharmacology. 2010; 8: 254-267.

19. Kwan P., Arzimonoglou A., Berg A.T. et al. Definition of drug resistant epilepsy. Consensus proposal by the ad hoc Tasc force of the ILAE Comissijn on Therapeutic Strategies. Epilepsia. 2010; 51 (6): 1069-1077.

20. Kwan P., Brodie M.J. Early identification of refractory epilepsy. N Engl J Med. 2000; 341: 314-319.

21. Kwan P., Brodie M.J. Epilepsy after the first drug fails: substitution or add-on? Seizure. 2000; 9: 464-468.

22. MacDonald B.K., Johnson A.L., Goodridge D.M. et al. Factors predicting prognosis of epilepsy after presentation with seizures. Ann Neurol. 2000; 48: 8.

23. Mohanraj R., Brodie M.J. Measuring the efficacy of antiepileptic drugs. Seizure. 2003; 12: 413-443.

24. Neligan A et al. Treatment changes in a cohort of people with apparently drug-resistant epilepsy: an extended follow-up. J Neurol Neurosurg Psychiatry. 2012 Aug; 83 (8): 810-3.

25. Noack-Rink M et al. Lacosamide as Add-On to Monotherapy in Patients with Partial-Onset Seizures: Interim Results of the Post-Marketing VITOBA Study (VImpaT Added to One Baseline AED). American Academy of Neurology (AAN). Annual Meeting. 2012; P06.126.

26. Panayiotopoulos C.P. Rational polytherapy focal epilepsy. International neurological journal. 2007; 5 (15).

27. Panayotopoulos C.P. Principles of Therapy in Epilepsies. 2010.

28. Patsalos, P.N.; Perucca, E. Clinically important drug interactions in epilepsy: general features and interactions between antiepileptic drugs. Lancet Neurol. 2003; 2: 347-356.

29. Perucca E. Pharmacoresistance in epilepsy: how should it be defined? CNS Drugs. 1998; 10: 171-179.

30. Perucca E. Clinically relevant drug interactions with antiepileptic drugs.Br. J. Clin. Pharmacol. 2006; 61: 246-255.

31. Sake J.K., Hebert D., Isojärvi J. et al. A pooled analysis of lacosamide clinical trial data grouped by mechanism of action of concomitant antiepileptic drugs. CNS Drugs. 2010; 24: 1055-68.

32. Schiller Y., Najjar Y. Quantifying the response to antiepileptic drugs: effect of past treatment history. Neurology. 2008; 70 (1): 54-65.

33. Stephen L.J., Kwan P., Brodie M.J. Does the cause of localization-related epilepsy influence the response to antiepileptic drug treatment? Epilepsia. 2001; 42: 357-362.

34. Stephen L.J., Kelly K., Parker P., Brodie M.J. Adjunctive lacosamide in clinical practice: sodium blockadewith a difference? Epilepsy Behav. 2011; 22 (3): 499-504.

35. Trevathan E., Gilliam F. Lost years. Delayed referral for surgically treatable epilepsy. Neurology. 2003; 61: 432-433.

36. Villanueva V., López F.J., Serratosa J.M. et all. Control of seizures in different stages of partial epilepsy: LACO-EXP, a Spanish retrospective study of lacosamide. Epilepsy & Behavior. 2013; 29: 349-356.

37. Villanueva V., Serratosa JM., Guillamon E. et all. Long-term safety and efficacy of eslicarbazepine acetate in patients with focal seizures: Results of the 1-years ESLIBASE retrospective study. Epilepsy research. 2014; 108 (7).


For citations:

Rudakova I.G. RATIONAL APPROACH TO A COMBINATION THERAPY OF FOCAL EPILEPSY. Epilepsy and paroxysmal conditions. 2014;6(4):62-66. (In Russ.)

Views: 453

ISSN 2077-8333 (Print)
ISSN 2311-4088 (Online)