title: Does one more medication help? Effect of adding another anticonvulsant in childhood epilepsy.
abstract: OBJECTIVE
  To study adding an anticonvulsant in children with uncontrolled epilepsy on ≥ 1 appropriate anticonvulsants.
  
  
  METHODS
  Chart review, patients with intractable epilepsy in a neurology clinic July 1, 2004 to December 31, 2007. Inclusion: Children on ≥ 1 stable anticonvulsant who had a second, third, or fourth anticonvulsant added.
  
  
  METHODS
  Noncompliance, subtherapeutic doses, and/or serum anticonvulsant levels, inappropriate anticonvulsant for seizure type, inadequate documentation, infantile spasms, or significant dosage changes in the baseline anticonvulsant(s) over the follow-up period. Patients were followed until further therapeutic changes occurred or September 30, 2008, whichever came first.
  
  
  RESULTS
  ≥ 50% decrease in seizure frequency.
  
  
  RESULTS
  Charts reviewed: 1886. Patients who met criteria: 84. Time to assessment: 4 weeks to 42 months (median = 7 months). ≥ 50% reduction in seizure frequency: 35 of 52 patients with second agent added; 5 of 30 patients with third agent added (P = .0001).
  
  
  CONCLUSIONS
  Worthwhile seizure reduction is reasonably likely with the addition of a second anticonvulsant, but much less likely with the addition of third anticonvulsant.
authors.affiliation: Department of Pediatric Neurology, Childrens Hospital Los Angeles, Los Angeles, CA 90027, USA. jdesai@chla.usc.edu
authors.forename: Jay
authors.initials: J
authors.lastname: Desai
authors.forename: Wendy G
authors.initials: WG
authors.lastname: Mitchell
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000145:classification / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants