[Monotherapy and polytherapy use of anti-epileptic drugs. Development of views]

The evolution of our approach to the treatment of epilepsy has occurred in three stages: at the turn of the century, when epilepsy was increasingly entering into the mainstream of Neurology, pharmacotherapy of epilepsy was limited to the bromides. Subsequently, phenobarbital used in 1912 and then phenytoin, discovered in 1932, remained, for many years, the only therapeutic options. To increase the chances of complete suppression of seizures, it appeared logical to use both medications together. This approach was used for many years despite the advent of carbamazepine and sodium valproate. In 1976, the first studies appeared indicating the advantages of using monotherapy from the start. Not only did this approach show itself to be effective, but there was a marked decrease in the incidence of side-effects engendered by polytherapy. Nevertheless, despite o carefully instituted monotherapy, between 20 and 30 p. cent of patients still had seizures refractory to treatment. A new era in antiepileptic drug development has created new hope in the management of epilepsy. Based on a better understanding of the disease process and scientific development in molecular biology, we are able to provide a more rational polypharmacy, taking into account their pharmacodynamic interactions and their relatively high cost.