Physician preference for antiepileptic drug concentration testing

Abstract 

A four-item questionnaire asked active U.S. members of the Child Neurology Society to value painless antiepileptic drug concentration monitoring, whether members had ordered a saliva level (the best established painless method) in the last year, and whether such levels were available. Value was quantified by time per patient that the physician would willingly expend to arrange for the test. Of 945 questionnaires sent, 544 (58%) were returned. When asked the value of a painless method for children, 286/522 (55%) reported willingness to expend 10 to 30 minutes to arrange the test; 498/522 (95%) would use a painless method if available. When asked the value of an immediate sample at home during a seizure or adverse event, a substantial majority, 370/526 (70%), would make an important donation of their own time to arrange for the sample. Only 5% would not use it. Just 2/544 respondents had obtained a painless (saliva) concentration, and merely 33/544 (6%) perceived such tests as being available. We conclude that child neurologists put a high value on painless antiepileptic monitoring. These data suggest that a painless method of measuring antiepileptic drug concentrations—especially if it could be performed at home—would fulfill an unmet need in the care of children with epilepsy.