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Table 5 Recommendations from guidelines on monitoring plasma concentration of ASMs during pregnancy

From: Managing reproductive problems in women with epilepsy of childbearing age

Guidelines Recommendation
AAN/AES 2009 [36] Monitoring should be considered routinely for LTG (seizure frequency is probably increased when 65% of target level is reached), CBZ, and PHT.
Monitoring may be considered routinely for OXC and LVT.
NICE 2012 (update 2016) [38] Monitoring is not recommended otherwise in routine.
Monitoring is recommended if seizures increase or are likely to increase.
Monitoring is recommended if dose needs to be adjusted (Lamotrigine and phenytoin are at risk of low serum levels).
ETDP-EFA 2007 [37] Monitoring of ASM levels is needed throughout pregnancy.
ASM levels should be monitored closely in the weeks following delivery since they may increase gradually.
LVT, OXC, and LTG showed elevated levels with days of delivery.
RCOG 2016 [35] Routine monitoring is not recommended although individual circumstances may be taken into account.
SIGN 2015 [34] Routine monitoring of ASM concentrations is not indicated.
Monitoring can be useful in the following circumstances: for adjustment of phenytoin dose, assessment of ASM adherence and suspected ASM toxicity.
  1. Abbreviations: ASM Antiseizure medication, AAN American Academy of Neurology, AES American Epilepsy Society, ETPD-EFA Epilepsy Therapy Development Project- Epilepsy Foundation of America, NICE National Institute for Health and Care Excellence, RCOG Royal College of Obstetricians and Gynaecologists, SIGN Scottish Intercollegiate Guidelines Network