title: Systematic testing of medical intractability for carbamazepine, phenytoin, and phenobarbital or primidone in monotherapy for patients considered for epilepsy surgery.
abstract: OBJECTIVE
  To assess medical intractability in patients considered for restrictive epilepsy surgery.
  
  
  METHODS
  Seventy-four patients received single drug treatment with carbamazepine (CBZ), phenytoin (PHT), and either phenobarbital (PB) or primidone (PRM). Medical intractability was established if seizure control was not obtained despite maximum tolerable doses of the drug. In all, 120 single drug treatments were administered with the drugs that has not been administered at maximal doses in monotherapy before the study.
  
  
  RESULTS
  Complete seizure control was not achieved in any patient. However, 7 patients (9.5%) had significant seizure reduction of at least 80%. In 4 patients, only the third antiepileptic drug (AED) proved effective.
  
  
  CONCLUSIONS
  The poor result of AED monotherapy in our patients may be attributed to the patients' long-standing chronic epilepsies and high seizure frequencies. Our findings suggest that despite the failure of one or two major AEDs in controlling seizures completely, further single drug treatment may still improve the quality of life in some patients who are candidates for epilepsy surgery.
authors.affiliation: Bethel Epilepsy Centre, Bielefeld, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Hermanns
authors.forename: S
authors.initials: S
authors.lastname: Noachtar
authors.forename: I
authors.initials: I
authors.lastname: Tuxhorn
authors.forename: H
authors.initials: H
authors.lastname: Holthausen
authors.forename: A
authors.initials: A
authors.lastname: Ebner
authors.forename: P
authors.initials: P
authors.lastname: Wolf
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D002220:Carbamazepine / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004351:Drug Resistance; D004827:Epilepsy / Q000145:classification / Q000188:drug therapy* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008875:Middle Aged; D018579:Patient Selection; D010634:Phenobarbital / Q000627:therapeutic use*; D010672:Phenytoin / Q000627:therapeutic use*; D011324:Primidone / Q000627:therapeutic use*; D011788:Quality of Life; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D011324:Primidone; D002220:Carbamazepine; D010672:Phenytoin; D010634:Phenobarbital