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Updated: Apr 28, 2026
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Author Spotlight: Obtaining High-Quality CSF and Blood Samples for Epilepsy Biomarker Discovery
Published on: September 1, 2023
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Advances in anti-epileptic drug testing
Matthew D Krasowski1, Gwendolyn A McMillin2
1Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States.
Summary
Therapeutic drug monitoring aids in managing epilepsy with 17 new antiepileptic drugs. Key drugs like lamotrigine and levetiracetam benefit most from monitoring, with alternative specimens like saliva also discussed.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Neurology
Background:
- Over the last 21 years, 17 new antiepileptic drugs (AEDs) have been approved in the US and/or Europe.
- These newer AEDs represent significant advancements in epilepsy treatment.
- Therapeutic drug monitoring (TDM) is a crucial tool in optimizing drug therapy.
Purpose of the Study:
- To review the role and necessity of TDM for recently approved AEDs.
- To identify which of the newer AEDs have the strongest justification for TDM.
- To discuss alternative biological matrices for TDM.
Main Methods:
- Review of recently approved AEDs and their pharmacokinetic properties.
- Identification of AEDs with narrow therapeutic indices or significant inter-individual variability.
- Evaluation of existing literature on TDM for newer AEDs.
- Consideration of alternative specimen types such as saliva and dried blood spots.
Main Results:
- Lamotrigine, levetiracetam, oxcarbazepine, stiripentol, and zonisamide are identified as having the best justifications for TDM.
- Perampanel, stiripentol, and tiagabine exhibit high protein binding, suggesting monitoring of free drug fractions may be beneficial.
- Saliva and dried blood spots are presented as viable alternative specimens for TDM.
Conclusions:
- TDM is essential for effective clinical dosing of many newer AEDs.
- Specific AEDs warrant focused TDM strategies based on their properties.
- Exploring alternative specimens can enhance TDM accessibility and patient convenience in epilepsy management.
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