Introduction

Antiepileptic drugs (AED) are instituted in first unprovoked seizure withwell-defined risk factors for seizure recurrence. Monotherapy  is preferred; however, 39percent of patients may eventually require polytherapy, as seizure recurrence is associated with risk of adverse neurocognitive outcome.

Objective

The study aims to determine prevalence of risk factors associated with need of polytherapy for control of seizures.

Methodology

Risk factors for polytherapy were identified based on literature search. Children between 1-12years with epilepsy, and >12 months of AED were included in study. Patients with febrile seizures, syndromic epilepsy and progressive neurodegenerative diseases were excluded.

Results

Eighty children (monotherapy=48; polytherapy=32) were included andprevalence of individual risk factor was calculated in each group. The polytherapy group (mean (SD)= 6.97 (2.25))  had a significantly higher prevalence of risk factors as compared to monotherapy group (4.50 (2.12); p=0.001). Risk of polytherapy was significantly higher with following risk factors:abnormal neurological examination (OR=6.61; 95%CI=2.29, 19.08);developmental delay (Odds ratio (OR)= 5.57; 95% CI=1.94, 16.00); presentation with status epilepticus (OR=5.00; 95%CI=1.79, 13.97); seizure onset during infancy (OR=4.49, 95% CI=1.72, 11.69;neonatal seizures (OR=4.2; 95%CI=1.38, 12.81); neonatal hyperbilirubinaemia (OR=3.18; 95%CI=1.02, 9.91); abnormal neuroimaging (OR=3.09; 95% CI=1.08, 8.91) and history of seizure during sleep (OR=2.49; 95%CI=1.00, 6.28).

Conclusion

We demonstrate that abovementioned 8risk factors are significantly associated with the  need for polytherapy in children with epilepsy. In others, clinicians need tooptimize monotherapy aggressively for seizure control.