||Over the past decade there have been 8 new drugs approved for the treatment of epilepsy. Most of these have been approved initially as adjunctive therapy in highly refractory patients with partial seizures. Only two (felbamate and oxcarbazebine) received an indication for use as monotherapy at the time of approval. Subsequently, a third (lamotrigine) has received an indication for withdrawal to monotherapy in refractory patients.
The use of antiepileptic drugs in monotherapy is supported by data from numerous clinical studies. Refractory patients treated with two or more drugs have better seizure control and fewer side effects when converted to monotherapy. Conversely, when newly diagnosed or refractory patients go from monotherapy to polytherapy, only a small percentage have a substantial reduction in seizures, and most have an increase in side effects.