Author response: Clinical utility of therapeutic drug monitoring of antiepileptic drugs
Kenneth A.Myers, Pediatric Neurologist and Epileptologist, Research Institute of the McGill University Health Centre
Submitted October 26, 2019
I appreciated Dr. Sethi's commentary on our recently published article as he raises a number of interesting points.[1] Certainly, intra-individual variability is another complicating aspect of therapeutic drug monitoring (TDM) in epilepsy care and, while outside the scope of our review, should be taken into account by all clinicians who choose to incorporate serum anti-epileptic drug levels into their clinical decision-making. For my personal practice, I tend to agree that the clinical utility of serum anti-epileptic drug levels is limited and that dosing adjustments are best made based on clinical response (seizure control and reported adverse effects). Although our systematic review did identify some studies showing evidence for TDM, the higher quality studies did not show convincing evidence supporting a clinical benefit. In general, we clinicians now have a wealth of diagnostic options available to us, and it is easy to forget that the patient's reported symptoms and clinical examination are almost always the most important outcome measures.
1. Al-Roubaie Z, Guadagno E, Ramanakumar AV, Khan AQ, Myers KA. Clinical utility of therapeutic drug monitoring of antiepileptic drugs. Neurol Clin Pract published ahead of print September 6, 2019.
I appreciated Dr. Sethi's commentary on our recently published article as he raises a number of interesting points.[1] Certainly, intra-individual variability is another complicating aspect of therapeutic drug monitoring (TDM) in epilepsy care and, while outside the scope of our review, should be taken into account by all clinicians who choose to incorporate serum anti-epileptic drug levels into their clinical decision-making. For my personal practice, I tend to agree that the clinical utility of serum anti-epileptic drug levels is limited and that dosing adjustments are best made based on clinical response (seizure control and reported adverse effects). Although our systematic review did identify some studies showing evidence for TDM, the higher quality studies did not show convincing evidence supporting a clinical benefit. In general, we clinicians now have a wealth of diagnostic options available to us, and it is easy to forget that the patient's reported symptoms and clinical examination are almost always the most important outcome measures.
1. Al-Roubaie Z, Guadagno E, Ramanakumar AV, Khan AQ, Myers KA. Clinical utility of therapeutic drug monitoring of antiepileptic drugs. Neurol Clin Pract published ahead of print September 6, 2019.
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