Abstract
Seizure freedom is one of the main goals of therapy in epilepsy patients as it is associated with significant quality of life improvement. There is still no consensual definition of seizure remission regarding the period of its duration.
For patients, long-life remission is definitely the most acceptable. The way how to reach seizure freedom starts with initial monotherapy with adequately chosen antiepileptic drug.
Most of the patients but not all are responding to moderate or even modest dosing, in some higher or maximal dosing is necessary to reach the full benefit. In initial monotherapy failure the further step is alternative monotherapy or polytherapy.
Though monotherapy is tradionally viewed as a gold standard, both approaches should be considered in individual patient. In certain cases adding another drug may be less risky than the trial of converting from one monotherapy to another, mainly in patients with frequent or severe seizures.
Monitoring and assessment of adverse effects of therapy is an inevitable part of epilepsy treatment as these can strongly influence the quality of life. Polytherapy seems to carry a higher risk of adverse effects however with new mechanism of action of modern drugs and with individual tailoring of drug dosing the adverse effects are comparable to monotherapy.