Correlation between Breakthrough Seizures and Serum Level of Phenytoin and Valproate in Indian Patients
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Date
2021-06
Journal Title
Journal ISSN
Volume Title
Publisher
Wolters Kluwer – Medknow
Abstract
Objectives: To determine the optimum range of phenytoin (PHT) and valproate (VAP) levels and find out the critical drug levels below which chances of breakthrough seizures increase in North Indian population. Methodology: A cross-sectional, case-controlled, record-based study was conducted in a quaternary care hospital from September 2018–2019. The case group comprised epilepsy patients on monotherapy with PHT/VAP presenting with breakthrough seizures after at least 6 months of seizure control. Noncompliant, overdose, toxicity, no or partial response, any other psychiatric or neurological disorder, adverse effects, and patients taking two or more antiepileptic drugs were excluded. Results: Data of 100 patients in each group were analyzed. Significantly lower mean levels in cases were observed in PHT (5.74 ± 3.68 mg/L vs. 13.75 ± 4.27 mg/L control) and VAP (24.13 ± 27.39 mg/L vs. 76.37 ± 17.71 mg/L control). A negative correlation of drug levels was observed with age and weight in both the groups. The level/dose ratio in controls (0.05 ± 0.03; 0.09 ± 0.06) was significantly (P < 0.0001) higher than cases (0.02 ± 0.01; 0.02 ± 0.03) in PHT and VAP, respectively. Conclusions: This study identifies the critical levels and level/dose ratio at which the risk of breakthrough seizures increases. A wide level/dose ratio was found in controls, more so in the VAP group. A prospective study with larger group size along with genetic studies should be done to evaluate further.
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Keywords
Breakthrough seizures, dose/drug level ratio, epilepsy, phenytoin, valproate
Citation
Katoch Neena,Bhardwaj Ankit,Suchal Kapil,SharmaSangeeta. Correlation between Breakthrough Seizures and Serum Level of Phenytoin and Valproate in Indian Patients. Journal of Pharmacology and Pharmacotherapeutics. 2021 Jun; 12(2): 73–78