Estudio de los niveles plasmaticos de los antiepilepticos en el tratamiento de la epilepsia

Paiva, Vinícius José de; Subirana, Antonio; Subirana, Manuel

doi:10.1590/S0004-282X1984000300003

Resúmenes

De un total de 560 epilépticos diferentes visitados en el transcurso de 16 meses, hemos practicado 140 dosificaciones plasmáticas de fármacos antiepilépticos utilizando la técnica EMIT. Los antiepiléticos que hemos dosificado han sido: PB, DPH, PRM, VPA, CBZ y ESM. En este trabajo hemos revisado unicamente los 70 pacientes que tomaban PB en monoterapia ó asociado a DPH, CBZ, VPA y PRM. De los 70 pacientes 45 estaban bien controlados. De entre ellos 21 (46,5%) no llegaban a niveles eficaces de ninguno de los antiepilépticos utilizados, y sin embargo hemos conseguido un buen efecto terapeutico tanto en mono como biterapia. De estos mismos 70 pacientes, 25 estaban parcialmente ó mal controlados. De entre ellos 20 (80%) tenían el PB en niveles eficaces, 13 (52%) tenían el otro antiepiléptico en niveles eficaces, 12 (47%) tenían ambos antiepilépticos en niveles eficaces y 4 (16%) no tenían ningún antiepiléptico en niveles eficaces a pesar de utilizar en todos, la dósis media considerada como eficaz y expresada en mg/Kg/día.

From a total of 560 different epileptics visited during 16 months, we have practiced 140 plasmatic dosifications of antiepileptic drugs according to EMIT technic. The antiepileptic drugs studied were: PB, DPH, PRM, VPA, CBZ and ESM. In this study only the 70 patients treated with PB in monotherapy or combined with DPH, CBZ, VPA and PRM are considered. From the 70 patients, 45 have been controlled; from them 21 (46,5%) did not reach efficient levels from anyone of the used antiepileptics. From the 70 patiens 25 have been partially or bad controlled, 20 of them (80%) had PB in efficient levels, 13 (52%) had the other antiepileptic in efficient levels, 12 (47%) had both antiepileptics in efficient levels and 4 (16%) had no antiepileptic drug in efficient levels in spite of using the efficient dose in mg/Kg/day. The conclusions of this results are: - we reached a good effect by using PB alone or combined under the considered efficient levels in a 46.5% of the patients; - the bad controlled patients, kept on being bad controlled in spite of having 80% of them PB, the other antiepileptic or both in efficient levels.

Estudio de los niveles plasmaticos de los antiepilepticos en el tratamiento de la epilepsia

Study of plasma levels of antiepileptic drugs in the treatment of epilepsy

Vinícius José de Paiva^I; Antonio Subirana^II; Manuel Subirana^III

^IAsistente Becário del Departamento de Neurologia, Instituto Neurológico Municipal, Hospital General de Ntra. Sra. del Mar, Barcelona

^IIPresidente de Honor y Fundador de la Liga Española contra la Epilepsia

^IIIJefe de Servicios de Instituciones Nosocomial es y Servicios Especial es del Ayuntamiento de Barcelona

RESUMEN

De un total de 560 epilépticos diferentes visitados en el transcurso de 16 meses, hemos practicado 140 dosificaciones plasmáticas de fármacos antiepilépticos utilizando la técnica EMIT. Los antiepiléticos que hemos dosificado han sido: PB, DPH, PRM, VPA, CBZ y ESM. En este trabajo hemos revisado unicamente los 70 pacientes que tomaban PB en monoterapia ó asociado a DPH, CBZ, VPA y PRM. De los 70 pacientes 45 estaban bien controlados. De entre ellos 21 (46,5%) no llegaban a niveles eficaces de ninguno de los antiepilépticos utilizados, y sin embargo hemos conseguido un buen efecto terapeutico tanto en mono como biterapia. De estos mismos 70 pacientes, 25 estaban parcialmente ó mal controlados. De entre ellos 20 (80%) tenían el PB en niveles eficaces, 13 (52%) tenían el otro antiepiléptico en niveles eficaces, 12 (47%) tenían ambos antiepilépticos en niveles eficaces y 4 (16%) no tenían ningún antiepiléptico en niveles eficaces a pesar de utilizar en todos, la dósis media considerada como eficaz y expresada en mg/Kg/día.

SUMMARY

From a total of 560 different epileptics visited during 16 months, we have practiced 140 plasmatic dosifications of antiepileptic drugs according to EMIT technic. The antiepileptic drugs studied were: PB, DPH, PRM, VPA, CBZ and ESM. In this study only the 70 patients treated with PB in monotherapy or combined with DPH, CBZ, VPA and PRM are considered. From the 70 patients, 45 have been controlled; from them 21 (46,5%) did not reach efficient levels from anyone of the used antiepileptics. From the 70 patiens 25 have been partially or bad controlled, 20 of them (80%) had PB in efficient levels, 13 (52%) had the other antiepileptic in efficient levels, 12 (47%) had both antiepileptics in efficient levels and 4 (16%) had no antiepileptic drug in efficient levels in spite of using the efficient dose in mg/Kg/day. The conclusions of this results are: - we reached a good effect by using PB alone or combined under the considered efficient levels in a 46.5% of the patients; - the bad controlled patients, kept on being bad controlled in spite of having 80% of them PB, the other antiepileptic or both in efficient levels.

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¹
A Guide to the Therapeutic Monitoring of Antiepileptic Drug Levels. Epilepsy Foundation of America, 1977.
2. BRUNI, J.; WILDER, B. J. & PERCHALSKI, B. J. - Valproic acid and plasma levels of phenobarbital. Neurology (NY) 30:94, 1980.
3. BUCHTAL, F. & SVENSMARK, D. - Aspects of pharmacology of phenytoin and phenobarbital relevant to their dosage in treatment of epilepsy. Epilepsia 1:373, 1960.
4. DREIFUSS, F. E. - Uso de los fármacos anticonvulsivantes. J. amer. med. Assoc. (ed. en español). 5:152, 1979.
5. GASTAUT, H. & NOEL, P. - A case of fatal toxic hepatitis: recomendations for the administration of sodium valproate. Epilepsia 22:711, 1981.
6. KENNTH, W. & ALLAN, S. - Clinical pharmacology of anti-epileptic drugs: a summary of current information. Clin. Chem. 23:1964, 1977.
7. KUTT, H. & PENRY, J. K. - Usefulness of blood levels of antiepileptic drugs. Arch. Neurol. (Chicago) 31:283, 1974.
8. LEGAZ, M. & RAISYS, V. A. - Correlation of the «Emit» antiepileptic drug assay with a gas liquid chromatographic method. Clin. Biochem. 9:35, 1976.
9. LOISEAU, P.; BRACHET-LIERMAIN, A.; LEGROUX, M. & SOGEIX. M. - Interêt du dosage des anticonvulsivants dans le traitement des epilepsies. Nouv. Presse méd. 10:813, 1977.
10. LUND, L. - Anticonvulsivant effect of diphenylhydantoin relative to plasma levels. Arch. Neurol. (Chicago) 31:289, 1974.
11. MOREL, M. A. - Dosage des anti-epileptique seriques. Encycl. Med. Chir., Masson, Paris, 17045 A40, 1976.
12. MORREL, G. & PRIBOR, H. C. - Therapeutic drug monitoring: panacea, paradox, or Pandorá's box. Lab. Management (NY), July 15, 1978.
13. OLLER DAURELLA, L. & OLLER F. V., L. - <>. Monografies Mediques, no 18. Academia de Ciencies Mediques de Catalunya y Balears, Barcelona, 1979.
14. PARSONAGE, M. - Antiepilepticos. Brit. J. Hosp. Med. (ed. en espafiol): 313, 1974.
15. PIPPENGER, C. E. - Clinical applications of a homogeneous immunoassay system (EMIT) for the detection of diphenylhydantoin and phenobarbital. Epilepsia 16:197, 1975.
16. PIPPENGER, C. E.; PENRY, J. K. & WHITE, B. G. - Interlaboratory variability in determination of plasma antiepileptic drug concentrations. Arch. Neurol. (Chicago) 33:351, 1976.
17. PIPPENGER, C. E.; PENRY, J. K. & KUTT, H. - Antiepileptic Drugs: Quantitative Analysis and Interpretation. Raven Press, New York, 1978.
18. SABATER, J.; MAYA, A. & OLLER, F. V., L. - La dosificación plasmática de antiepilépticos. Anales de Medicina (Barcelona) 66:63, 1980.
19. SABATER TOBELLA, J. - Control analítico en la terapêutica antiepileptica. Boletin de la Real Academia de Farmácia de Barcelona, 1983.
20. SACKELLARES, J.; SATO, S.; DREIFUSS, F. E.; PENRY, J. K. - Reduction of steady-state valproate levels by other antiepileptic drugs. Epilepsia 22:437, 1981.

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[1] ¹
A Guide to the Therapeutic Monitoring of Antiepileptic Drug Levels. Epilepsy Foundation of America, 1977.

[2] 2. BRUNI, J.; WILDER, B. J. & PERCHALSKI, B. J. - Valproic acid and plasma levels of phenobarbital. Neurology (NY) 30:94, 1980.

[3] 3. BUCHTAL, F. & SVENSMARK, D. - Aspects of pharmacology of phenytoin and phenobarbital relevant to their dosage in treatment of epilepsy. Epilepsia 1:373, 1960.

[4] 4. DREIFUSS, F. E. - Uso de los fármacos anticonvulsivantes. J. amer. med. Assoc. (ed. en español). 5:152, 1979.

[5] 5. GASTAUT, H. & NOEL, P. - A case of fatal toxic hepatitis: recomendations for the administration of sodium valproate. Epilepsia 22:711, 1981.

[6] 6. KENNTH, W. & ALLAN, S. - Clinical pharmacology of anti-epileptic drugs: a summary of current information. Clin. Chem. 23:1964, 1977.

[7] 7. KUTT, H. & PENRY, J. K. - Usefulness of blood levels of antiepileptic drugs. Arch. Neurol. (Chicago) 31:283, 1974.

[8] 8. LEGAZ, M. & RAISYS, V. A. - Correlation of the «Emit» antiepileptic drug assay with a gas liquid chromatographic method. Clin. Biochem. 9:35, 1976.

[9] 9. LOISEAU, P.; BRACHET-LIERMAIN, A.; LEGROUX, M. & SOGEIX. M. - Interêt du dosage des anticonvulsivants dans le traitement des epilepsies. Nouv. Presse méd. 10:813, 1977.

[10] 10. LUND, L. - Anticonvulsivant effect of diphenylhydantoin relative to plasma levels. Arch. Neurol. (Chicago) 31:289, 1974.

[11] 11. MOREL, M. A. - Dosage des anti-epileptique seriques. Encycl. Med. Chir., Masson, Paris, 17045 A40, 1976.

[12] 12. MORREL, G. & PRIBOR, H. C. - Therapeutic drug monitoring: panacea, paradox, or Pandorá's box. Lab. Management (NY), July 15, 1978.

[13] 13. OLLER DAURELLA, L. & OLLER F. V., L. - <>. Monografies Mediques, no 18. Academia de Ciencies Mediques de Catalunya y Balears, Barcelona, 1979.

[14] 14. PARSONAGE, M. - Antiepilepticos. Brit. J. Hosp. Med. (ed. en espafiol): 313, 1974.

[15] 15. PIPPENGER, C. E. - Clinical applications of a homogeneous immunoassay system (EMIT) for the detection of diphenylhydantoin and phenobarbital. Epilepsia 16:197, 1975.

[16] 16. PIPPENGER, C. E.; PENRY, J. K. & WHITE, B. G. - Interlaboratory variability in determination of plasma antiepileptic drug concentrations. Arch. Neurol. (Chicago) 33:351, 1976.

[17] 17. PIPPENGER, C. E.; PENRY, J. K. & KUTT, H. - Antiepileptic Drugs: Quantitative Analysis and Interpretation. Raven Press, New York, 1978.

[18] 18. SABATER, J.; MAYA, A. & OLLER, F. V., L. - La dosificación plasmática de antiepilépticos. Anales de Medicina (Barcelona) 66:63, 1980.

[19] 19. SABATER TOBELLA, J. - Control analítico en la terapêutica antiepileptica. Boletin de la Real Academia de Farmácia de Barcelona, 1983.

[20] 20. SACKELLARES, J.; SATO, S.; DREIFUSS, F. E.; PENRY, J. K. - Reduction of steady-state valproate levels by other antiepileptic drugs. Epilepsia 22:437, 1981.

Brasil

Brasil

Estudio de los niveles plasmaticos de los antiepilepticos en el tratamiento de la epilepsia

Study of plasma levels of antiepileptic drugs in the treatment of epilepsy

Resúmenes

Fechas de Publicación