Postictal serum levels of antiepileptic drugs for detection of noncompliance

• Published in: Epilepsy & behavior Vol. 4; no. 5; pp. 487 - 495
• Main Authors: Specht, U, Elsner, H, May, T.W, Schimichowski, B, Thorbecke, R
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2003
• Subjects: Adolescent; Adult; Anticonvulsants - blood; Anticonvulsants - pharmacokinetics; Anticonvulsants - therapeutic use; Antiepileptic drugs; Compliance; Epilepsy; Female; Humans; Male; Recurrence; Seizures - blood; Seizures - physiopathology; Serum concentration; Treatment Refusal; Compliance; Serum concentration; Antiepileptic drugs; Epilepsy
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/S1525-5050(03)00151-3

Medication noncompliance (NC) is thought to be a major cause of insufficient seizure control. In an explorative study we investigated whether postictal serum levels (PISLs) of antiepileptic drugs (AEDs) are a reliable indicator of NC. Young adults with epilepsy on a stable AED regimen were asked to contact medical service as soon as possible when a seizure occurred to obtain serum levels of their AEDs. PISLs were compared with the mean value of two routine serum levels of the same medication. PISLs lower than 50% of the individual reference value were regarded as an indicator of NC. PISL samples in 61 seizures of 52 patients treated mainly with carbamazepine, valproic acid, or lamotrigine were evaluated. A drop in serum levels >50% indicating NC was noted in 44.3% of the seizures. Determination of PISLs seems to be a simple and useful method for detecting or ruling out irregular intake patterns as a cause of “breakthrough” seizures.