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Limitations of monotherapy trials in epilepsy

From the Department of Neurology, Washington University Epilepsy Program, Washington University, St. Louis, MO.

Address correspondence and reprint requests to Dr. Frank Gilliam, Department of Neurology, Washington University Epilepsy Program, Campus Box 8111, 660 South Euclid Avenue, St. Louis, MO 63110.

Monotherapy is considered optimal management for most patients with epilepsy, but designing monotherapy trials in epilepsy has proved to be a complex endeavor. Consideration of the validity of evidence for efficacy, potential risks to patients, clinical applicability of results, and effects of dosing and titration rates on efficacy and tolerability creates unique challenges. This article reviews pertinent aspects of trials of conversion to monotherapy in refractory patients and equivalence trials in newly diagnosed patients to better understand their limitations. Despite the inherent difficulties in designing monotherapy trials in epilepsy, previous monotherapy studies have provided important information for clinical management with new treatments.

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