tailieunhanh - EPILEPSY: GLOBAL ISSUES FOR THE PRACTICING NEUROLOGIST- part 6

Hầu hết các tài liệu về nồng độ huyết thanh AED đã được tạo ra trong các nước công nghiệp. Do đó, sự phù hợp của ngoại suy "đầy đủ" hoặc "không đủ" nồng độ huyết thanh cho bệnh nhân di truyền khác nhau hoặc dân số ở các nước đang phát triển có thể được thử thách. | EPILEPSY GLOBAL ISSUES FOR THE PRACTICING NEUROLOGIST KEYPOINTS Most literature on AED serum levels has been generated in industrialized countries. Therefore the appropriateness of extrapolating adequate or inadequate serum levels for genetically different individual patients or populations in developing countries can be challenged. apeutic ranges for AEDs are population averages and individual patients vary greatly in response to drugs. A common mistake is to precipitously change the AED regimen solely because of specific serum level determinations disregarding both efficacy and side effects in the individual patient. It is inadequate to simply replace an AED or add a second a third or a fourth AED because seizures persist despite adequate serum levels even when there are no side effects. A key concept here is that of the maximum tolerated dosage irrespective of serum level determinations that can be achieved in an individual patient by gradually increasing the dose until either seizure control or intolerable side effects ensue. Furthermore most literature on AED serum levels has been generated in industrialized countries. Therefore the appropriateness of extrapolating adequate or inadequate serum levels for genetically different individual patients or populations in developing countries can be challenged. Validation studies in these populations are needed. There are some situations in which determination of serum levels is useful. These include the need 1 to determine for future reference in the event of clinical changes seizure breakthrough or toxic side effects the individual therapeutic range of a drug once an effective dose has been reached 2 to rule out poor compliance as a possible cause for otherwise unexplainable seizure recurrence 3 to decide whether seizure recurrence may be due to some pharmacokinetic peculiarity leading to low serum levels including rapid drug clearance or drug interaction 4 to determine which AED should be held responsible for .