PubMed · 427448
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1979-03-03. Epilepsy and learning.. https://pubmed.ncbi.nlm.nih.gov/427448/
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Therapeutic drug monitoring (TDM) of antiepileptic agents has been an invaluable aid in efforts to individualise epilepsy treatment since the 1970s. In few series, however, have attempts been made to assess the impact of TDM on the outcome of epilepsy therapy. The value of TDM has often been questioned in recent years, mainly due to the poor results obtained with its inappropriate use. Guidelines for the use of TDM of antiepileptic agents are therefore presented and discussed in this review. The usefulness of TDM varies according to the drug monitored, depending on its pharmacokinetic properties and on whether correlation is known to exist between the serum concentration of the drug and its effect. TDM is a prerequisite for the safe use of phenytoin, for example, but is of very limited value in connection with vigabatrin treatment. Of other novel antiepileptics, TDM would probably be useful in connection with lamotrigine treatment, and perhaps in connection with topiramate or gabapentin treatment. However, the rational use of TDM is hampered by the lack of properly designed concentration-effect studies of the new antiepileptic drugs.
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