Gianelli M, Gentile S, Verzè L, Dimanico U, Baruchello M, Monaco F, Mutani R
Neurological Clinic, University of Turin, Italy.
Eur Neurol. 1988;28(6):349-53. doi: 10.1159/000116300.
Unbound and total plasma levels of carbamazepine (CBZ) and phenobarbital (PB) were evaluated in a group of 12 refractory patients out of 397 subjects, with normal values of total drug concentration and unbound levels below the expected ones. We established a minimal acceptable 'subtherapeutic' free drug level, i.e. less than 9.62 micrograms/ml for PB and 1.36 micrograms/ml for CBZ. PB and CBZ dosages were increased during a 3-month period. We observed a normalization of free levels, unaccompanied by a significant decrease in seizure frequency. Free drug level monitoring may prove to be an unchallenged detector of false metabolic refractory epilepsy.
在397名受试者中的12名难治性患者中评估了卡马西平（CBZ）和苯巴比妥（PB）的游离和总血浆水平，这些患者的总药物浓度正常，但游离水平低于预期值。我们确定了一个最低可接受的“亚治疗”游离药物水平，即PB低于9.62微克/毫升，CBZ低于1.36微克/毫升。在3个月的时间内增加了PB和CBZ的剂量。我们观察到游离水平恢复正常，但癫痫发作频率并未显著降低。游离药物水平监测可能被证明是检测假代谢性难治性癫痫的可靠方法。
