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Treatment of newly diagnosed epilepsy with a single antiepileptic drug (AED) is now the favored approach for seizure management. The emergence of monotherapy as a mainstay treatment resulted from studies that demonstrated the effectiveness and advantages of a single AED in controlling seizures. Monotherapy is usually associated with fewer potential problems such as toxicity, teratogenicity, and drug-drug interactions, and is generally less expensive and easier to administer than polytherapy. Furthermore, the vast majority of patients can achieve adequate seizure control with the use of a single AED, and patients converted to monotherapy after having done poorly on polytherapy frequently show improved seizure control and experience fewer adverse effects. These findings and other advantages of monotherapy have contributed to the general failure of the concept of rational polytherapy and the acceptance of AED monotherapy as first-line treatment for most patients with epilepsy.
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