The Australia and New Zealand Child Neurology Society
The Australia and New Zealand Child Neurology Society (ANZCNS) is a collaborative group of medical professionals working in the field of paediatric neurology or in allied neurosciences who are working to advance the science of paediatric neurology and advocate for improved care for young people with neurological disorders.
3.
Do not routinely undertake repeat blood level monitoring of antiepileptic drug (AED) treatments.
The serum concentration of an antiepileptic drug (AED) varies markedly between patients taking the same dosage because of differences in people’s ability to absorb, distribute, metabolise and excrete drugs. The utility of drug blood level monitoring assumes that plasma drug level correlates better with clinical response or side effects than with dosage, or provides better information than clinical review of the patient. However, evidence from a major randomised controlled trial suggests that repeat blood level monitoring of AED treatments has no discernible impact on patient outcomes in terms of remissions from seizures or incidence of adverse effects. Other studies have also shown that there is no definitive correlation between a patient’s AED blood level and clinical efficacy.
Specific exceptions where targeted AED blood level assessment can be useful include their use in assessing compliance, titrating AEDs in complex polypharmacy regimens, or adjusting for altered AED metabolism in disease states, puberty, or pregnancy.
Supporting evidence
- Kozer E, Scolnik D, Agamata WM, et al. Utility of antiepileptic drug monitoring in the pediatric emergency department. Ther Drug Monit 2003; 25(1):17-21.
- St. Louis EK. Monitoring antiepileptic drugs: a level-headed approach. Curr Neuropharmacol 2009; 7(2):115–9.
- Naik GS, Kodagali R, Mathew BS, et al. Therapeutic drug monitoring of levetiracetam and lamotrigine: is there a need? Ther Drug Monit 2015; 37(4):437-44.
- Tomson T, Dahl ML, Kimland E. Therapeutic monitoring of antiepileptic drugs for epilepsy. Cochrane Database Syst Rev 2007; 24(1):CD002216.
How this list was made
Following deliberations, the ANZCNS Board determined to investigate the evidence for nine priority recommendations regarding low-value clinical practices in paediatric neurology. An evidence review was developed for these recommendations and served as the basis for an online survey sent to all ANZCNS members asking respondents if they agreed, disagreed or were unsure if these recommendations were evidence based, undertaken in significant numbers, and important in terms of reducing patient harm and unnecessary healthcare expenditure. Based on survey responses, each of the nine was assigned a score and ranked accordingly. Based on this information and a final evidence review, these top 5 recommendations were chosen.
- 1 Do not routinely perform electroencephalographs (EEGs) for children presenting with febrile seizures.
- 2 Do not routinely perform computed tomography (CT) scanning of children presenting with new onset seizures.
- 3 Do not routinely undertake repeat blood level monitoring of antiepileptic drug (AED) treatments.
- 4 Do not routinely undertake neuroimaging for new onset primary headache without first examining for neurological abnormality.
- 5 Do not routinely perform electroencephalographs (EEGs) for children presenting with syncope (fainting).