Search tips
Search criteria 


Logo of jrsocmedLink to Publisher's site
J R Soc Med. 1991 March; 84(3): 159–162.
PMCID: PMC1293137

Modern treatment strategies for patients with epilepsy: a review.


Of patients who develop epilepsy 70-80% will become seizure free, the remaining 20% are the most difficult to treat satisfactorily. Eighty per cent of patients are best treated with a single drug. Stepwise treatment plans for the treatment of newly diagnosed patients and for the evaluation of patients with chronic epilepsy are suggested. There is a lack of consensus regarding the rate at which to taper antiepileptic drugs being discontinued in patients with active epilepsy. There are arguments for making drug changes rapidly; these arguments and strategies for managing the withdrawal of individual drugs are presented.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (753K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Duncan J, Shorvon S. Prognosis of epilepsy. Br J Hosp Med. 1986 Apr;35(4):254–259. [PubMed]
  • Reynolds EH, Shorvon SD. Monotherapy or polytherapy for epilepsy? Epilepsia. 1981 Feb;22(1):1–10. [PubMed]
  • Schmidt D. Two antiepileptic drugs for intractable epilepsy with complex-partial seizures. J Neurol Neurosurg Psychiatry. 1982 Dec;45(12):1119–1124. [PMC free article] [PubMed]
  • Thompson PJ, Trimble MR. Anticonvulsant drugs and cognitive functions. Epilepsia. 1982 Oct;23(5):531–544. [PubMed]
  • Chadwick D, Reynolds EH. When do epileptic patients need treatment? Starting and stopping medication. Br Med J (Clin Res Ed) 1985 Jun 22;290(6485):1885–1888. [PMC free article] [PubMed]
  • Duncan JS, Shorvon SD, Trimble MR. Discontinuation of phenytoin, carbamazepine, and valproate in patients with active epilepsy. Epilepsia. 1990 May-Jun;31(3):324–333. [PubMed]
  • Shorvon SD, Reynolds EH. Unnecessary polypharmacy for epilepsy. Br Med J. 1977 Jun 25;1(6077):1635–1637. [PMC free article] [PubMed]
  • Mattson RH, Cramer JA, Collins JF, Smith DB, Delgado-Escueta AV, Browne TR, Williamson PD, Treiman DM, McNamara JO, McCutchen CB, et al. Comparison of carbamazepine, phenobarbital, phenytoin, and primidone in partial and secondarily generalized tonic-clonic seizures. N Engl J Med. 1985 Jul 18;313(3):145–151. [PubMed]
  • Falconer MA, Taylor DC. Surgical treatment of drug-resistant epilepsy due to mesial temporal sclerosis. Etiology and significance. Arch Neurol. 1968 Oct;19(4):353–361. [PubMed]
  • Duncan JS, Sagar HJ. Seizure characteristics, pathology, and outcome after temporal lobectomy. Neurology. 1987 Mar;37(3):405–409. [PubMed]
  • Lesser RP, Modic MT, Weinstein MA, Duchesneau PM, Lüders H, Dinner DS, Morris HH, 3rd, Estes M, Chou SM, Hahn JF. Magnetic resonance imaging (1.5 tesla) in patients with intractable focal seizures. Arch Neurol. 1986 Apr;43(4):367–371. [PubMed]
  • Franceschi M, Triulzi F, Ferini-Strambi L, Giusti MC, Minicucci F, Fazio F, Smirne S, Del Maschio A. Focal cerebral lesions found by magnetic resonance imaging in cryptogenic nonrefractory temporal lobe epilepsy patients. Epilepsia. 1989 Sep-Oct;30(5):540–546. [PubMed]
  • Shorvon SD, Reynolds EH. Reduction in polypharmacy for epilepsy. Br Med J. 1979 Oct 27;2(6197):1023–1025. [PMC free article] [PubMed]
  • Theodore WH, Porter RJ. Removal of sedative-hypnotic antiepileptic drugs from the regimens of patients with intractable epilepsy. Ann Neurol. 1983 Mar;13(3):320–324. [PubMed]
  • Callaghan N, O'Dwyer R, Keating J. Unnecessary polypharmacy in patients with frequent seizures. Acta Neurol Scand. 1984 Jan;69(1):15–19. [PubMed]
  • Albright P, Bruni J. Reduction of polypharmacy in epileptic patients. Arch Neurol. 1985 Aug;42(8):797–799. [PubMed]
  • Jeavons PM, Clark JE, Maheshwari MC. Treatment of generalized epilepsies of childhood and adolescence with sodium valproate ("epilim"). Dev Med Child Neurol. 1977 Feb;19(1):9–25. [PubMed]
  • Callaghan N, O'Callaghan M, Duggan B, Feely M. Carbamazepine as a single drug in the treatment of epilepsy. A prospective study of serum levels and seizure control. J Neurol Neurosurg Psychiatry. 1978 Oct;41(10):907–912. [PMC free article] [PubMed]
  • Gannaway DJ, Mawer GE. Transfer from multiple to single antiepileptic drug therapy. Lancet. 1981 Jan 24;1(8213):217–217. [PubMed]
  • Covanis A, Gupta AK, Jeavons PM. Sodium valproate: monotherapy and polytherapy. Epilepsia. 1982 Dec;23(6):693–720. [PubMed]
  • Fischbacher E. Effect of reduction of anticonvulsants on wellbeing. Br Med J (Clin Res Ed) 1982 Aug 7;285(6339):423–424. [PMC free article] [PubMed]
  • Bennett HS, Dunlop T, Ziring P. Reduction of polypharmacy for epilepsy in an institution for the retarded. Dev Med Child Neurol. 1983 Dec;25(6):735–737. [PubMed]
  • Schmidt D. Reduction of two-drug therapy in intractable epilepsy. Epilepsia. 1983 Jun;24(3):368–376. [PubMed]
  • Roman EJ, Buchanan N, Lambert JB, Barrah N. Rationalisation of therapy in severe epilepsy. Aust N Z J Med. 1983 Dec;13(6):601–604. [PubMed]
  • Alvarez N, Hazlett J. Seizure management with minimal medications in institutionalized mentally retarded epileptics. A prospective study. First report after 4 1/2 years of follow up. Clin Electroencephalogr. 1983 Jul;14(3):164–172. [PubMed]
  • Schmidt D, Richter K. Alternative single anticonvulsant drug therapy for refractory epilepsy. Ann Neurol. 1986 Jan;19(1):85–87. [PubMed]
  • Duncan JS, Shorvon SD. Rates of antiepileptic drug reduction in active epilepsy--current practice. Epilepsy Res. 1987 Nov-Dec;1(6):357–364. [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press