The Influence of Seizure Type on the Efficacy of Plasma Concentrations of Phenytoin, Phenobarbital, and Carbamazepine

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Abstract
• Plasma concentrations of phenytoin, phenobarbital, or carbamazepine were monitored prospectively during successful single-drug therapy in 78 patients who had various types of epileptic seizures. Mean plasma concentrations necessary for complete control of tonic-clonic seizures alone were as follows: phenytoin, 14μg/mL(n = 28); phenobarbital, 18 μg/mL (n = 10); and carbamazepine, 5.5 μg/mL (n = 2). Epilepsy with simple or complex partial seizures alone or together with tonic-clonic seizures was completely controlled at the following plasma concentrations: phenytoin, 23 μg/mL (n = 25); phenobarbital, 37 μg/mL (n = 5); and carbamazepine, 7 μg/mL (n = 7). Higher plasma concentrations of phenytoin, phenobarbital, and carbamazepine are necessary for control in epilepsy with simple or complex partial seizures compared with epilepsy with tonic-clonic seizures alone. The efficacy of plasma concentrations of phenytoin, phenobarbital, and carbamazepine varies with the type of seizure.