Indications for polytherapy
1. Multiple seizure type
2. Failure of adequate trial with monotherapy with AEDs
Principles of polytherapy
1. Use appropriate and *rational drug combinations (eg.) valporic acid (VPA), LTG, VPA & CLBZ have synergistic action. PB and PHT are enzyme inducers and reduce levels. PB and BZD increase side effects like drowsiness.
* Rational denotes using not more than 2 drugs at a time and avoiding drugs with similar mechanism of action. PB, BZDs, PHT and CBZ.
2. Exclude progressive/severe neurological disease.
Other Therapeutic modalities
a. Ketogenic diet
b. Vagal stimulation
Duration of therapy
The duration of AED therapy is for 2 years of seizure free period.
Gradual tapering AEDs over 6-12 weeks is adequate. Long duration tapering periods do not decrease the risk of seizures.
Patient follow up
Initially the patient visit should be 2 to 4 weekly depending on seizure frequency. Subsequently the patient is followed up every 3 to 6 monthly. Dosage adjustments
Long term remission
Relapse risk ranges from between 20-30% and is maximum (70-80%) in the first year of discontinuation of therapy.
Factors predicting the long term remission are as follows:
a. Normal intelligence
b. Normal neurologic examination,
c. Relatively small number of seizures at diagnosis
d. Shorter duration
e. Age at onset between 1 and 12 years.
f. Absence of a remote symptomatic etiology
Family and social awareness
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