Daily salivary anticonvulsant monitoring in patients with intractable epilepsy.
Daily salivary anticonvulsant monitoring in epileptic patients with frequent seizures appears a promising, practicable and inexpensive approach which may assist in the management of drug therapy. It offers the possibility of predicting the optimal drug concentration likely to minimise seizure activity in a given patient, and sometimes allows the inference that different anticonvulsant drugs should be tried forthwith. The use of the method is described in one patient who collected daily saliva specimens and recorded any seizure activity over periods of several weeks. Whilst taking carbamazepine monotherapy, her seizures tended to occur on days where the salivary carbamazepine level was lower than on seizure-free days. As the predicted level of carbamazepine to allow full seizure control (obtained from linear regression analysis of seizures against drug concentration) could not be tolerated by the patient, methylphenobarbitone was added to her therapy. Saliva was again collected daily over another 3 months. Analysis of the data on this occasion suggested that carbamazepine, in the presence of methylphenobarbitone, may have played little role in seizure prevention, and also predicted the salivary level of phenobarbitone likely to minimise seizures. Unfortunately the patient again could not tolerate the drug doses necessary to attain this phenobarbitone concentration.
Herkes
G K
GK
Department of Medicine, University of Queensland, Brisbane.
Eadie
M J
MJ
D000328:Adult; D000927:Anticonvulsants / Q000032:analysis / Q000493:pharmacokinetics* / Q000627:therapeutic use; D002220:Carbamazepine / Q000493:pharmacokinetics / Q000627:therapeutic use; D004827:Epilepsy / Q000188:drug therapy / Q000378:metabolism*; D005260:Female; D006801:Humans; D008991:Monitoring, Physiologic; D010634:Phenobarbital / Q000493:pharmacokinetics / Q000627:therapeutic use; D010672:Phenytoin / Q000493:pharmacokinetics / Q000627:therapeutic use; D012463:Saliva / Q000032:analysis*
D000927:Anticonvulsants; D002220:Carbamazepine; D010672:Phenytoin; D010634:Phenobarbital