Monotherapy or Combined therapy in non-responding Epilepsy, Which is best?

Abstract

Background: Epilepsy is one of the most prevalent chronic diseases (4/1000 children and 7/1000 adult worldwide). It is also associated with significant increased risk of psychiatric disorder and family distress. Treatment consists of anticonvulsants medications, lifestyle modification and psycho education. The compliance of the patient with treatment is very important for the management of epilepsy however, the subject has not been widely investigated.Subjects and methods: A convenient cross-sectional study was conducted among 113 patients (62 females and 51 males) with uncontrolled epileptic in a tertiary care center in AL Hussieny Teaching hospital in Kerbala and the Medical City in Baghdad / Iraq and the later represents the main center dealing with non-responding patients referred from all over the country. A special survey questionnaire form was prepared for this purpose including demographic information in addition to family history, type of epilepsy and treatment. In addition the results of investigations performed were assessed including: Video Electro-Encephalogram (EEG,) and Magnetic Resonance Imaging (MRI).Results: The mean age of the sample was 25.27±15.14 year and no significant gender difference was discovered. The monotherapy group of patients were younger than combined therapy group however the difference in age was not significant (p=.275). Most patients (71%, 80 patients) were in the monotherapy group, while only 29% (33 patients) were in the Combined therapy group. Video EEG was abnormal in 69.9% of (79 patients) of the total sample, while it was positive in 36% in combined therapy patients vs. 27% in monotherapy patients. Similarly, MRI was abnormality was encountered more in the combined therapy group (21% vs.14%). The main finding for this study was that monptherapy type of treatment was better in controlling epilepsy with highly significant difference (61% vs. 28%, p<.001). Additionally, the significant predictors of epileptic fit were positive family history and duration of disease.Conclusions: Monotherapy was found to be significantly better than combined therapy in controlling fit among patients with uncontrolled epileptic in tertiary care centers in Iraq.