Therapeutic drug monitoring for new generation anti-seizure medications

Newer generation anti-seizure medications are increasingly replacing older ones. Therapeutic drug monitoring (TDM) of these medications is one of the controversial topics in epilepsy management. The main purpose of TDM is optimizing treatment outcome, however, studies have shown its usefulness only in appropriate indications including suspicion of noncompliance, unsatisfactory seizure control, pregnancy, elderly, renal or hepatic failure, pharmacokinetic changes, drug interactions and suspicion of toxicity.methods for TDM of AEDs involve using serum/plasma, saliva, and dried blood spots. Saliva sampling is noninvasive and particularly useful in children. Also, for most ASMs (including levetiracetam) measured concentrations in saliva reflect the free concentration in blood.Anti-seizure medications therapeutic drug monitoring helps to individualize treatment. many patients may require serum concentrations outside the reference ranges, and thus, patient management is best guided by determination of the “individual therapeutic concentration,” which can be defined as the range of concentrations which has been found to produce the optimal response in the individual patient.