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Single antiepileptic drug levels do not predict adherence and non-adherence.

A new interesting article has been published in Acta Neurol Scand. 2018 Sep 26. doi: 10.1111/ane.13033. and titled:

Single antiepileptic drug levels do not predict adherence and non-adherence.

Authors of this article are:
Lunardi M Lin K Walz R Wolf P.

A summary of the article is shown below:
OBJECTIVES: To investigate the significance of “subtherapeutic” versus “therapeutic” antiepileptic drug (AED) plasma levels with respect to treatment adherence.MATERIAL & METHODS: 170 patients with refractory temporal lobe epilepsy who underwent video-EEG monitoring in view of a surgical indication had their AEDs (carbamazepine, phenobarbital, phenytoin and valproate) rapidly withdrawn following a standardized schedule. Plasma levels were measured at admission, and during the two days of drug withdrawal. Adherence and non-adherence were identified by the development of Plasma levels from day 1 through day 3. Frequencies of an initial level below the reference range in both groups were compared.RESULTS: Adherence was found in 73.2% of cases, and non-adherence in 26.8%. Low levels were seen equally often (about 1/4 of cases) in adherent and non-adherent cases. The vast majority (73.7%) of low levels had another explanation than non-adherence (e.g. low-dose treatment or enzyme induction). Of 42 non-adherent cases the vast majority of 76.2% had unsuspicious Plasma levels at admission.CONCLUSIONS: “Subtherapeutic” AED Plasma levels only rarely are caused by non-adherence whereas levels in the “therapeutic range” by no means prove that the patient is adherent to treatment. For meaningful interpretation, any level needs to be compared with other levels of the same patient. Our findings strongly emphasize the principle of individualized therapeutic AED monitoring as promoted by the Therapeutic Strategies Commission of the ILAE. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.

Check out the article’s website on Pubmed for more information:



This article is a good source of information and a good way to become familiar with topics such as: Bioequivalence;enzyme induction;individualized therapeutic level;preparation shifts;rapid metabolization;therapeutic antiepileptic drug monitoring;therapeutic range;therapeutic threshold.

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