Laboratory controls and therapeutic antiepileptic drug monitoring during the treatment of children with epilepsy – sense or nonsense – Contra

Abstract

A singular laboratory control of blood parameters (i.e. red and white count, chemistry and coagulation) is necessary to perform at the beginning of antiepileptic treatment as a screening of body functions and basal determination before possible complications later on. Regular controls lack evidence based studies and are a waste of ressources in many cases. Instead genuine medical attitude should focus on well being and symptoms of the patient with epilepsy. In the guidelines for therapeutic monitoring of antiepileptic drugs (TMA) of the International League Against Epilepsy (ILAE) it is stated, that regular TMA is redundant in such cases, if the patient is free of seizures and/or no side effects can be detected. Accordingly, it is even dangerous to change antiepileptic drug (AED) dosages because the AED blood level is not in the "therapeutic range". Two categories of clinical situations are cited in which TMA might be considered: 1. Regular TMA due to theoretical considerations (after begin of AED treatment, once or twice annually for surveillance of compliance, after every change of AED or concomittant medication) and 2. tailored TMA (in cases of side effects, in situations lacking therapeutic success despite adequate medication, in cases with metabolic, hepatic and renal diseases, during pregnancies, during polytherapy). There should always be a good clinical reason for venipuncture and laboratory expense, that means the gain of knowledge of such a blood value should be of therapeutic relevance otherwise not achievable. In a recently published randomised, controlled multicenter study (2000) on the clinical importance of TMA it was shown, that the vast majority of patients with epilepsy can be treated successfully without TMA. The experience with the application of some AED without common TMA (e.g. benzodiazepines, topiramate, felbamatem acetacolamide) teaches that good AED tretament is possible without TMA. The patient with epilepsy, not the epilepsy and at least the blood values should be treated.