Bedeutung der Serumkonzentrationen von Antikonvulsiva : Aktuelle Übersicht (Übersicht)

In general, the determination of the concentration of anticonvulsants in body fluids, usually in serum, allows the relation between dose, concentration in body fluids, and pharmacological effects to be investigated and, thus, to better understand and plan the drug therapy for each individual case. Especially in times when the number of new anticonvulsant compounds was only slowly increasing, improved knowledge about analytic methods and the interpretation of analytic results played a major role in epileptology. It was demonstrated quite convincingly for anticonvulsants of the first and second generation that there is an almost obligatory therapeutic range below which no major anticonvulsant effects may be expected and beyond which most patients will experience adverse effects without any further anticonvulsant efficacy. The overwhelming number of new anticonvulsants do not allow the investigation of therapeutic ranges on the same quality level as previously; thus, many open questions remain. In some instances, the mode of action or the discordance between serum concentration and efficacy suggest that a therapeutic range most probably does not exist. For other new compounds, meticulous studies remain to be performed. In no case is the therapeutic range exclusively obligatory. By no means should it be mistaken that the individual reference concentration can be transferred to another patient; however, its determination in individual cases can be useful in further therapy decisions. Based on the current literature, practical, helpful recommendations of how to use serum concentrations of anticonvulsants are given.