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Therapeutic drug monitoring in epilepsy treatment

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SBU Assessment

Presents a comprehensive, systematic assessment of available scientific evidence for effects on health, social welfare or disability. Full assessments include economic, social and ethical impact analyses. Assessment teams include professional practitioners and academics. Before publication the report is reviewed by external experts, and scientific conclusions approved by the SBU Board of Directors.

Findings by SBU Alert

This is a translation of version 1, published on May 18, 1998. The latest version of this report is not available in English.

Drug monitoring as a means to adapt the dosage of antiepileptic drugs to achieve a particular concentration in blood is well documented. However, there are few studies showing the extent to which drug monitoring contributes toward greater effectiveness in epilepsy treatment as measured by better seizure control. The findings of SBU Alert show that there is currently poor* evidence to demonstrate the benefits of the method for patients.

Hence, it is essential to assess patient benefits and costs, and how to optimally use the method.

*This assessment by SBU Alert uses a 4-point scale to grade the quality and evidence of the scientific documentation. The grades indicate: (1) good, (2) moderate, (3) poor, or (4) no scientific evidence on the subject.

This summary is based on a report prepared at SBU in collaboration with Assoc Prof Torbjörn Tomson, MD PhD, The Karolinska Hospital.

Alert is a joint effort by the Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.

References

  1. Chadwick DW. Overuse of monitoring of blood concentrations of antiepileptic drugs. Br Med J 1987; 294: 723-724.
  2. Fröscher W, Eichelbaum M, Gugler R, Hildebrandt G, Penin H. A prospective randomised trial on the effect of monitoring plasma anticonvulsant levels in epilepsy. J Neurol 1981;224: 193-201.
  3. Beardsley RS, Freeman JM, Appel FA. Anticonvulsant serum levels are useful only if the physician appropriately uses them: an assessment of the impact of providing serum level data to physicians. Epilepsia 1983; 24: 330-335.
  4. Lund L. Anticonvulsant effect of diphenylhydantoin relative to plasma levels. Arch Neurol 1974;31: 289-294.
  5. Gram L, Flachs H, Würtz-Jorgensen A, Parnas J, Andersen B. Sodium valproate, serum level and clinical effect in epilepsy: A controlled study. Epilepsia 1979;20:303-312.
  6. McKee PJW, Larkin JG, Brodie AF, Percy-Robb IW, Brodie MJ. Five years of anticonvulsant monitoring on site at the epilepsy clinic. Ther Drug Monitor 1993; 15:83-90.
  7. Ried LD, McKenna DA, Horn JR. Meta-analysis of research on the effect of clinical pharmacokinetics services on therapeutic drug monitoring. American Journal of Hospital Pharmacy 1989;46:945.
  8. Pearce GA, Day RO. Compliance with criteria necessary for effective drug concentration monitoring. Ther Drug Monitor 1990;12:250-257.
  9. Wing DS, Duff HJ. The impact of a therapeutic drug monitoring program for phenytoin. Ther Drug Monitor. 1989; 11:32-37.
  10. Hasselström J, Azavoglou M, Bergman U, Sjöqvist F. Therapeutic drug monitoring in Sweden: Antiepileptic drugs. Abstract. Quimica Clinica 1990;9:368.
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Published: Revised: 4/3/2000
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