Summary
Although the treatment of patients with epilepsy who are mentally retarded and have multiple handicaps has generally involved polypharmacy, there is an emerging trend towards simplified antiepileptic drug (AED) regimens. A prospective study of reduction in the number of AEDs was conducted in an institutionalised population of profoundly retarded patients with epilepsy and multiple handicaps. Of 44 patients with uncontrolled generalised seizures who were receiving 4 or 5 AEDs in our study, 28 (64%) achieved monotherapy and the remaining 16 (36%) achieved duotherapy, with significantly improved seizure control and reduced intensity of seizures (although seizure frequency increased transiently in some patients following withdrawal of primidone and phenobarbital). 14 patients (32%) became seizure-free: 13 received monotherapy and 1 received duotherapy. The remaining patients had ≥ 50% reduction in seizure frequency while receiving monotherapy (15 of 28) or duotherapy (15 of 16). The majority of patients who became seizure-free were receiving divalproex sodium or a combination of divalproex and Phenytoin. After dosage reduction to regimens with 1 or 2 drugs, most patients showed more positive behaviours and became more sociable. Overall treatment costs were also markedly reduced. We conclude that AED reduction to mono- or duotherapy is desirable in patients with multiple handicaps and refractory seizures who are receiving polypharmacy regimens.
Similar content being viewed by others
References
Albright P, Bruni J. Reduction of polypharmacy in epileptic patients. Archives of Neurology 42: 797–799, 1985
Armour DJ, Veitch GBA. Is valproate monotherapy a practical possibility in chronically uncontrolled epilepsy? Journal of Clinical Pharmacy and Therapeutics 13: 53–64, 1988
Beghi E, Bollini P, Di Mascio R, Cerisola N, Merloni T, et al. Effects of rationalizing drug treatment of patients with epilepsy and mental retardation. Developmental Medicine and Child Neurology 29: 363–369, 1987
Bourgeois B, Beaumanoir A, Blajev B, de la Cruz N, Despland PA, et al. Monotherapy with valproate in primary generalized epilepsies. Epilepsia 28 (Suppl. 2): 8–11, 1987
Chadwick D. Comparison of monotherapy with valproate and other antiepileptic drugs in the treatment of seizure disorders. American Journal of Medicine 84 (Suppl. 1A): 3–6, 1988
Collaborative Group for Epidemiology of Epilepsy. Adverse reactions to antiepileptic drugs: a multicenter survey of clinical practice. Epilepsia 27: 323–330, 1986
Committee on Drugs, American Academy of Pediatrics. Behavioral and cognitive effects of anticonvulsant therapy. Pediatrics 76: 644–647, 1985
Cornaggia C, Canevini MP, Giuccioli D, Pinelli P, Pruneri C, et al. Monotherapy and polytherapy for intractable epilepsies. Italian Journal of Neurological Sciences 6: 201–205, 1985
Covanis A, Gupta AK, Jeavons PM. Sodium valproate: monotherapy and polytherapy. Epilepsia 23: 693–720, 1982
Dean JC, Penry JK. Valproate monotherapy in 30 patients with partial seizures. Epilepsia 29: 140–144, 1988
Feuerstein J, Revol M, Roger J, Sallou C, et al. Monotherapy with sodium valproate in generalized primary epilepsy. Second phase: study of long-term efficacy and tolerance. Semaine des Hôpitaux 59: 1263–1274, 1983
Fischbacher E. Effect of reduction of anticonvulsants on wellbeing. British Medical Journal 285: 423–424, 1982
James DH. Monitoring drugs in hospitals for the mentally handicapped. British Journal of Psychiatry 142: 163–165, 1983
Mattson RH, Cramer JA. Crossover from polytherapy to monotherapy in primary generalized epilepsy. American Journal of Medicine 84 (Suppl. 1A): 23–28, 1988
Milano Collaborative Group for Studies on Epilepsy. Long-term intensive monitoring in the difficult patient: preliminary results of 16 months of observations — usefulness and limitations. In Gardner-Thorpe et al. (Eds) Antiepileptic drug monitoring, pp. 197–213, Pitman Press, Bath, 1977
O’Neill BP, Landon B, Harris LM, Riley HL III, Dreifuss FE. A comprehensive interdisciplinary approach to the care of the institutionalized person with epilepsy. Epilepsia 18: 243–250, 1977
Penry JK (Ed.) Epilepsy: diagnosis, management, quality of life, pp. 14–21, Raven Press, New York, 1986
Reynolds EH, Shorvon SD. Monotherapy or polytherapy for epilepsy? Epilepsia 22: 1–10, 1981
Schmidt D. Reduction of two-drug therapies in intractable epilepsy. Epilepsia 24: 368–376, 1983
Sheppard LC, Ballinger BR, Fenton GW. Anticonvulsant medication in mental handicap hospital: 1972–82. British Journal of Psychiatry 150: 513-517, 1987
Shorvon SD, Reynolds EH. Unnecessary polypharmacy for epilepsy. British Medical Journal 1: 1635–1637, 1977
Shorvon SD, Reynolds EH. Reduction in polypharmacy for epilepsy. British Medical Journal 2: 1023–1025, 1979
Thompson PJ, Trimble MR. Anticonvulsant drugs and cognitive functions. Epilepsia 23: 531–544, 1982
Vining EPG. Cognitive dysfunction associated with antiepileptic drug therapy. Epilepsia 28 (Suppl. 2): 18–22, 1987
Wilder BJ. Treatment considerations in anticonvulsant monotherapy. Epilepsia 28 (Suppl. 2): 1–7, 1987
Wilder BJ, Rangel RJ. Review of valproate monotherapy in the treatment of generalized tonic-clonic seizures. American Journal of Medicine 84 (Suppl. 1A): 7–13, 1988
Wilkinson IA, Murphy JV, Georgeson R, D’Souza BJ. On-site seizure clinic. Impact on the welfare of mentally retarded, institutionalized patients. Archives of Neurology 39: 41–43, 1982
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Mirza, W.U., Credeur, L.J. & Penry, J.K. Results of Antiepileptic Drug Reduction in Patients with Multiple Handicaps and Epilepsy. Drug Invest 5, 320–326 (1993). https://doi.org/10.1007/BF03259239
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03259239