Monotherapy and polypharmacy

The availability of many new antiepileptic drugs (AEDs) with novel mechanisms of action has made polypharmacy, using combinations of AEDs with differing mechanisms, a viable alternative. The concept of monotherapy in epilepsy is relatively new, having attained widespread use only during the past few decades, and replacing irrational use of combinations of AEDs. In intractable epilepsy, however, monotherapy is often unsuccessful in achieving complete control, and skilled use of AEDs with differing mechanisms may provide better results. Monotherapy remains the treatment method of choice for new-onset epilepsy, but if control is not achieved, rational combinations should be considered. Most critical to successful treatment of epilepsy is the correct identification of the epileptic syndrome.