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Licensed Unlicensed Requires Authentication Published by De Gruyter January 11, 2020

Overview of therapeutic changes in antiepileptic drugs in adult patients

  • Dinda M.N. Ratri ORCID logo EMAIL logo , Mahardian Rahmadi , Wardah R. Islamiyah and Nur Faridah Harum



Previous studies suggest a highly variable response of antiepileptic drugs (AEDs). This may be because the response to AEDs has been changed to sustained period of freedom from seizures. This study was conducted to determine whether therapeutic changes of AEDs in the treatment of seizure would be observable in an Indonesian population.


The study was conducted at the outpatient neurology polyclinic at the Universitas Airlangga Hospital, Surabaya, Indonesia. This was an observational retrospective cohort study, examining the outcomes of 41 cases of switching AEDs (increase or decrease of the dose, switch to branded or generic, or added or reduced type of AEDs).


After treatment with the switched AED, seizure did not show any significant improvement. However, the incidence of seizure during and after the therapeutic change showed a downward trend (from 44% to 32%).


According to the present study, mere optimization of antiepileptic therapy may not result in a steep decrease in seizure events, particularly in polytherapy with AEDs. On the other hand, monotherapy with AEDs evidences to decreasing tendency of seizures.


The author thanks to Universitas Airlangga Hospital Surabaya and Faculty of Pharmacy Universitas Airlangga that support this study.

  1. Research funding: This research was supported with financial assistance of the Tahir Professorship.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by the authors’ institutional review board Universitas Airlangga Hospital.


[1] World Health Organization. Epilepsy. Fact Sheets Detail 2019. Available at: Accessed: 26 Aug 2019.Search in Google Scholar

[2] Panayotopoulus CP. Principles of therapy in epilepsies. The epilepsies: seizures, syndromes and management. Oxfordshire (UK): Bladon Medical Publishing, 2005.Search in Google Scholar

[3] Lindsten H, Stenlund H, Forsgren L. Remission of seizures in a population-based adult cohort with a newly diagnosed unprovoked epileptic seizure. Epilepsia 2001;42:1025–30.10.1046/j.1528-1157.2001.0420081025.xSearch in Google Scholar PubMed

[4] Schiller Y. Seizure relapse and development of drug resistance following long-term seizure remission. Arch Neurol 2009;66:1233–9.10.1001/archneurol.2009.211Search in Google Scholar PubMed

[5] Hauser WA, Rich SS, Lee JR, Annegers JF, Anderson VE. Risk of recurrent seizures after two unprovoked seizure. N Engl J Med 1998;338:429–34.10.1056/NEJM199802123380704Search in Google Scholar PubMed

[6] Cheng JY, French JA. Intelligent use of antiepileptic drugs is beneficial to patients. Curr Opin Neurol 2018;31:169–75.10.1097/WCO.0000000000000532Search in Google Scholar PubMed

[7] Hixson JD. Stopping antiepileptic drugs: when and why ? Curr Treat Option Neurol 2010;12:434–42.10.1007/s11940-010-0083-8Search in Google Scholar PubMed PubMed Central

[8] Conway JM, Henry TR. Antiepilepsy drugs: pharmacodynamics and principles of drug selection antiepilepsy drugs: pharmacodynamics and principles of drug selection. Epilepsy 2012;1.Search in Google Scholar

[9] Ghaffarpour M, Ghelichnia HA, Harrichian MH, Ghabaee M, Tehrani MM, Bahrami P. Strategies of starting and stopping antiepileptic drugs in patients with seizure or epilepsy  – A comprehensive review. Arch Neurosci 2014;1:1–8.10.5812/archneurosci.14182Search in Google Scholar

[10] Finamore JM, Sperling MR, Zhan T, Nei M, Skidmore CT, Mintzer S. Seizure outcome after switching antiepileptic drugs: A matched, prospective study. Epilepsia 2016;57:1294–300.10.1111/epi.13435Search in Google Scholar PubMed

[11] Tang X, Yu P, Ding D, Ge Y, Shi Y, Wang P, et al. Risk factors for seizure reoccurrence after withdrawal from antiepileptic drugs in individuals who have been seizure-free for over 2 years. PLoS One 2017;12:1–11.10.1371/journal.pone.0181710Search in Google Scholar PubMed PubMed Central

[12] Kwan P, Brodie MJ. Epilepsy after the first drug fails: substitution or add-on? Seizure 2000;9:464–8.10.1053/seiz.2000.0442Search in Google Scholar PubMed

[13] Kwan P, Palmini A. Epilepsy and behavior association between switching antiepileptic drug products and healthcare utilization: a systematic review. Epilepsy Behav 2017;73:166–72.10.1016/j.yebeh.2017.05.010Search in Google Scholar PubMed

[14] Brodie MJ, Elder AT, Kwan P. Epilepsy in later life. Lancet Neurol 2009;8:1019–30.10.1016/S1474-4422(09)70240-6Search in Google Scholar

[15] Meinardi H, Scott RA, Reis R, Sander JW. The treatment gap in epilepsy: the current situation and ways forward. Epilepsia 2001;42:136–49.10.1046/j.1528-1157.2001.32800.xSearch in Google Scholar PubMed

[16] Perucca P, Scheffer IE, Kiley M. The management of epilepsy in children and adults. Med J Aust 2018;208:226–33.10.5694/mja17.00951Search in Google Scholar PubMed

[17] Löscher W. Basic pharmacology of valproate a review after 35 years of clinical use for the treatment of epilepsy. CNS Drugs 2002;16:669–94.Search in Google Scholar

[18] Joshi R, Tripathi M, Gupta P, Gupta YK. Effect of clobazam as add-on antiepileptic drug in patients with epilepsy. Indian J Med Res 2014;140:209–15.Search in Google Scholar

[19] Lee JW, Dworetzky B. Rational polytherapy with antiepileptic drugs. Pharmaceuticals (Basel) 2010:2362–79.10.3390/ph3082362Search in Google Scholar PubMed PubMed Central

[20] Sarhan EM, Walker MC, Selai C. Evidence for efficacy of combination of antiepileptic drugs in treatment of epilepsy Sarhan. J Neurol Res 2015;5:267–76.10.14740/jnr356wSearch in Google Scholar

[21] Angelopoulou C, Veletza S, Heliopoulos I, Vadikolias K, Tripsianis G, Stathi C, et al. Association of SCN1A gene polymorphism with antiepileptic drug responsiveness in the population of Thrace, Greece. Arch Med Sci 2017;13:138–47.10.5114/aoms.2016.59737Search in Google Scholar PubMed PubMed Central

[22] Tate SK, Depondt C, Sisodiya SM, Cavalleri GL, Schorge S, Soranzo N, et al. Genetic predictors of the maximum doses patients receive during clinical use of the anti-epileptic drugs carbamazepine and phenytoin. Proc Natl Acad Sci U S A 2005;102:5507–12.10.1073/pnas.0407346102Search in Google Scholar PubMed PubMed Central

[23] Baghel R, Grover S, Kaur H, Jajodia A, Rawat C, Srivastava A, et al. Evaluating the role of genetic variants on first-line antiepileptic drug response in North India: significance of SCN1A and GABRA1 gene variants in phenytoin monotherapy and its serum drug levels. CNS Neurosci Ther 2016;22:740–57.10.1111/cns.12570Search in Google Scholar PubMed PubMed Central

[24] Zaccara G, Perucca E. Interactions between antiepileptic drugs, and between antiepileptic drugs and other drugs. Epileptic Disord 2014;16:409–31.10.1684/epd.2014.0714Search in Google Scholar PubMed

[25] Beyenburg S, Bauer J, Reuber M. New drug for the treatment of epilepsy: a practical approach. Postgr Med J 2004;80:581–7.10.1136/pgmj.2004.019976Search in Google Scholar PubMed PubMed Central

Received: 2019-11-15
Accepted: 2019-11-22
Published Online: 2020-01-11

© 2019 Walter de Gruyter GmbH, Berlin/Boston

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