In the December 14 issue of the journal, “Neurology”, Drs. Poolos and colleagues from the Fircrest Residential Habilitation Center in Shoreline, Washington and the Rainier Residential Habilitation Center in Buckley, Washington present an analysis of  adult individuals with epilepsy who are developmentally disabled  residing in two Washington state  institutions.  They specifically looked at which combination of antiepileptic drugs was potentially beneficial for individuals who have seizures.  They wanted to assess whether two drug therapy was superior to one drug in controlling seizures.  Specifically, the main measurement assessed how well the generalized tonic clonic seizures were prevented.  They specifically compared the following combination of drugs.  These included lamotrigine with valproic acid; carbamazepine with topiramate; lamotrigine, valproic acid, gabapentin; carbamazepine and phenytoin; and the drugs alone.

Of 148 individuals whose records were reviewed over a 30 year period of time, they found that only the combination of lamotrigine with valproic acid had superior benefit measured against other antiepileptic drug combinations.  They also found that the combination of these two drugs was better than using either drug by itself.  Moreover, the use of three medications at any one time provided no further benefit over a combination of two drugs.

The investigators concluded that valproic acid and lamotrigine in combination is better in preventing generalized convulsions than either drug by itself or to other drug combinations.  They also concluded that one should not use more than two antiepileptic drugs at any one time.

The problem with the study is that it was not controlled and had a relatively small number of patients.  Nevertheless, this study is important because it is the first time that any one drug combination has been reported to be beneficial than an individual drug.  Secondly, this is also a reminder that one needs to always validate whether all drugs are essential when treating individuals with epilepsy.  Oftentimes when patients with difficult to control epilepsy are seen by physicians, many times the neurologist is reluctant to eliminate any drug from their regimen and drugs keep getting added on.  It is important to try to maintain as few medications as possible, as this study clearly suggests that more than two drugs will not help the patient.  This is another important reminder of why we need to continue further work and research in identifying the best options for treating individuals with epilepsy.