Schneiderman J H
Division of Neurology, University of Toronto, Ontario, Canada.
Can J Neurol Sci. 1998 Nov;25(4):S9-13. doi: 10.1017/s0317167100034909.
The long-standing debate between proponents of monotherapy and those of polytherapy for treatment of epilepsy has been rekindled by the recent development of several new antiepileptic drugs. The likelihood of improved seizure control on polytherapy must be weighed against the risk of increased side effects, complex drug interactions and cost. Providing maximal seizure control while avoiding overtreatment is a challenge which requires an ongoing critical evaluation of each patient's management. This review provides a framework for decision-making by considering 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 controlled on polytherapy; 5) change in medical condition.
几种新型抗癫痫药物的近期研发重新引发了关于癫痫治疗采用单药治疗还是联合治疗的长期争论。联合治疗改善癫痫控制的可能性必须与副作用增加、复杂药物相互作用及成本风险相权衡。在避免过度治疗的同时实现最大程度的癫痫控制是一项挑战，这需要对每位患者的治疗进行持续严格评估。本综述通过考虑在五种临床情况下影响单药治疗和联合治疗选择的问题，提供了一个决策框架：1）新诊断的癫痫；2）单药治疗时发作；3）联合治疗时发作得到控制；4）联合治疗时未得到控制；5）病情变化。
