February 6, 2020

Investigators Found No Notable Difference in Seizure Control Between Patients Whose Blood Levels of Antiepileptic Drugs Were Monitored and Those Whose Levels Were Not Monitored

Article featuring commentary from CURE Grantee Dr. Pavel Klein

Doing routine monitoring of drug levels of the newer antiepileptic drugs (AEDs) may not lead to better seizure control or treatment tolerance for patients with epilepsy, according to a randomized trial from Switzerland.

The trial compared a group of patients whose doctors knew the results of their patient’s systematic therapeutic drug monitoring with a group of patients whose blood test results were not revealed to the treating physician. The investigators found no notable difference between the two groups when it came to seizure control and adverse events over the length of the study, which was published in the January issue of Annals of Neurology.

“The main finding is that despite the variable bioavailability of the newer- generation AEDs, the systematic monitoring of their plasma levels does not bring a tangible benefit for patients,” said Jan Novy, MD, PhD, the study supervisor, neurologist, and senior lecturer at the University of Lausanne.

However, therapeutic drug monitoring of the newer AEDs is advisable in certain situations, such as when the patient is pregnant or there is a suspicion the patient is not taking the medication as prescribed, Dr. Novy told Neurology Today in an interview.

Pavel Klein, MD, FAAN, founder and director of the Mid-Atlantic Epilepsy Center In Bethesda, MD, said the new study echoes an epilepsy treatment mantra he learned in residency that “you treat the patient, not blood levels.”

“The study confirms the general clinical practice impression that usefulness of getting drug levels on the newer AEDs is limited when you compare a patient against the general population, especially given the broad therapeutic ranges of the newer AEDs, which are so broad as to be virtually meaningless.”

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