Sub-therapeutic Medication Levels

[Caterina]

Hi everyone,

I am new to this forum and feel instantly relieved at having signed up.

This may already be a thread, so apologies if it is, but I wanted to ask if anyone's med levels are showing as sub therapeutic and if their seizures are still controlled. Is it something to really worry about?

I have been on Trileptal for years and for ages my seizures were totally controlled at 900mg. A recent blood test showed that my level was sub-therapeutic at 1200mg. I'm now trying 1500. My history is of grand mals, but only while I am off the meds. However, I have been taking simple partials once a month directly before my period. Also tried lamotrogine as an adjunct but had a severe reaction to it.

Any comments, suggestions would be appreciated.

[Bernard]

Hi Caterina, welcome to the forum.

Blood syrum therapeutic ranges are generally determined by the results of clinical studies. They provide a guideline based upon statistics. It's impossible for a study (or group of studies) to account for every possible variable that might affect seizure thresholds, drug tolerances, metabolism, etc. in individual patients. It's possible that any given individual will find therapeutic benefits at less (or require more) than standard guideline ranges.

Many doctors consider no seizures in two years to be a threshold indicating the possibility of the brain healing/breaking from the seizure pattern, so I wouldn't be surprised if someone has had seizures controlled for years that they might require less than the standard therapeutic dose.

However, if you are experiencing seizure activity around your menstrual cycle, I would be inclined to think you still need some help to mitigate the risk of (grand mal/tonic clonic) seizures.

[Caterina]

Thanks for that Bernard.
I am worried about the seizures around my period developing into something more serious but so far it hasn't happened. I also checked out the link to the thread you gave me which has been useful so thanks again.

[Nakamova]

Hi Caterina --

I'm always on the low end in terms of dosage, and my levels are "sub-therapeutic" according to the numbers, but not in actuality -- my seizures are controlled. As Bernard says, the established ranges are averages, and don't include outliers such as you and me.