Department of Neurology and Clinical Neurophysiology, St. Olav's University Hospital, Trondheim, Norway.
Epilepsia. 2014 Nov;55(11):e125-8. doi: 10.1111/epi.12801. Epub 2014 Sep 23.
The aim was to assess the clinical relevance of antiepileptic drug (AED) nonadherence by means of therapeutic drug concentration monitoring (TDM). Two hundred eighty-two consecutive patients with epilepsy acutely admitted to hospital for seizures were included. Nonadherence was defined as having a serum concentration/dose ratio at admission of <75% of the patient's own control value (probable nonadherence: 50-75%; definite: <50%). Nonadherence was identified in 39% of patients (definite 24%; probable 15%). It was significantly more common in patients with generalized seizures compared to those with focal onset seizures, and in patients <30 years compared to older patients. When specifically asked, 44% of nonadherent patients claimed regular intake. Nonadherence is a major cause of seizure breakthrough in patients with epilepsy, particularly in young adults. Many patients seem to be unaware of missed drug intake. Prompt measurements of AED serum concentrations should be available as part of the emergency care for patients acutely hospitalized for seizures to permit this issue to be thoroughly addressed prior to discharge.
目的是通过治疗药物监测（TDM）评估抗癫痫药物（AED）不依从的临床相关性。纳入 282 例因癫痫发作而急性住院的癫痫连续患者。不依从被定义为入院时血清浓度/剂量比低于患者自身对照值的 75%（可能不依从：50-75%；确定：<50%）。39%的患者存在不依从（确定：24%；可能：15%）。与局灶性发作的患者相比，全身性发作的患者更常见，与年龄较大的患者相比，<30 岁的患者更常见。当被具体问到是否按时服药时，44%的不依从患者声称有规律服药。不依从是癫痫患者癫痫发作突破的主要原因，尤其是在年轻成年人中。许多患者似乎没有意识到漏服药物。在因癫痫发作而急性住院的患者的紧急护理中，应提供及时的 AED 血清浓度测量，以便在出院前彻底解决这个问题。
