Drug-Level Monitoring on Admission for Presurgical Epilepsy Evaluation.

Abstract:

OBJECTIVE:Evaluation for surgical treatment is offered to patients who do not respond to antiepileptic drugs. Pseudo-pharmacoresistance (PPR) has been described in the context of impaired compliance, incorrect diagnosis of epilepsy or pharmacological interference resulting in too low blood levels. We were interested to determine the frequency and causes of PPR in patients admitted for presurgical evaluation. METHODS:We reviewed 553 drug levels in 199 patients and analyzed the relative frequency of drugs below reference range (10 and 20% below the range). RESULTS:Patients who had at least one serum level below the 10% cut-off amounted to 33% and 9% of patients had at least one serum level below the 20% cut-off. Only in 2 patients (1%), this was due to poor compliance. Low levels were equally frequent in mono- or polytherapy. Drugs that were most frequently found out of range were phenytoin, valproate, and topiramate. In monotherapy, lamotrigine was often prescribed in too low dosages. CONCLUSION:Low drug levels are frequently observed in surgical candidates due to pharmacological interference or insufficient dosing. Poor compliance or incorrect diagnosis does not appear to be a significant concern in this patient group. Our data strengthen the need for regular drug monitoring even in advanced chronic epilepsy to avoid unnecessary health costs by too low and ineffective dosages.

journal_name

Eur Neurol

journal_title

European neurology

authors

Constantinescu I,Korff CM,Vulliemoz S,Picard F,Seeck M

doi

10.1159/000479003

subject

Has Abstract

pub_date

2017-01-01 00:00:00

pages

105-110

issue

1-2

eissn

0014-3022

issn

1421-9913

pii

000479003

journal_volume

78

pub_type

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