Monitoring the Levels of Antiepileptic Drugs for Therapeutic Purposes: an Overview of the Current Situation and Potential Future Advancements

Abstract

Antiepileptic drugs (AEDs) play a crucial role in treating epilepsy, with expected variability in their pharmacokinetics across diverse patient groups such as children, the elderly, pregnant individuals, and those undergoing polytherapy with potential drug interactions. Additionally, ensuring patient adherence is essential. Therapeutic drug monitoring (TDM) serves as a valuable tool for maintaining treatment quality. Given the prevalence of pharmacokinetic variability among AEDs, TDM enables a personalized approach to epilepsy care by allowing adjustments based on individual drug concentrations. Currently, there are 27 licensed AEDs, making them one of the most common medications subject to TDM. This review aims to provide an overview of the existing evidence on the application of AED TDM in both epilepsy and non-epilepsy conditions. The extensive pharmacokinetic variability of AEDs results in significant variations in serum concentrations among patients, making TDM beneficial for tailoring treatment to individual needs. Indications for TDM encompass scenarios where optimization of clinical outcomes is crucial. Future advancements may involve incorporating additional markers of toxicity and genetic variability to further enhance individualization and optimize AED treatment.