Serum levels of anticonvulsants and haematological sequelae in black epileptics.

SUMMARY Serum levels of phenytoin and phenobarbitone were studied in a group of Black adult epileptics. Thera­ peutically satisfactory levels of phenytoin were observed in only 11,3% of patients, and of phenobarbitone, in 63,9%. An overall non-compliance rate of about 50% was noted. The possible reasons for this are discussed. Folate deficiency was not a major problem in this group of patients. 5. Afr. med. l.o 51, 504 (1977). Jt is known that some correlation exists between the drug dose and drug levels in the blood, between drug levels in the blood and therapeutic effects, and between drug levels in the blood and some toxic effects.' These relationships are closer in individual patients than they are in group studies, where marked variations are common. The practi­ cal value of measuring serum levels of anticonvulsants is twofold. Firstly, in patients with possible toxic manifesta­ tions, an abnormally high serum level may have diagnostic value, and secondly, a proportion of patients complain of inadequate control of seizures. Kutt et al.' have shown that the majority of patients who are treated with pheny­ toin fail to take their medication regularly (non-com­ pliance). Inadequate serum anticonvulsant levels could help to confirm this.