Therapeutic monitoring of anti-seizure medications in low- and middle-income countries: a systematic review.

This study focuses on therapeutic monitoring of anti-seizure medications in low- and middle-income countries: a systematic review.. The research employs high-performance liquid chromatography (HPLC) techniques to address analytical challenges in the clinical field. The treatment gap for epilepsy is large in low- and middle-income countries (LMICs) and the effectiveness and safety of the available anti-seizure medication (ASMs) is not fully understood. We systematically reviewed available evidence on therapeutic drug monitoring (TDM) of ASM in LMIC.... Research Background and Significance Therapeutic drug monitoring (TDM) of anti-seizure medications (ASMs) plays a pivotal role in optimizing epilepsy treatment outcomes. This is especially critical in low- and middle-income countries (LMICs), where the treatment gap for epilepsy remains substantial due to limited healthcare infrastructure and resources. The variability in pharmacokinetics of ASMs among patients necessitates accurate and reliable analytical methods to ensure effective dosing and minimize adverse effects. High-performance liquid chromatography (HPLC) is widely recognized for its sensitivity and specificity in quantifying ASM plasma levels. However, its application in LMICs faces challenges such as cost, accessibility, and technical expertise. The systematic review by Odhiambo et al. (2021) addresses these challenges by evaluating existing HPLC methodologies tailored for ASM monitoring in resource-constrained environments, highlighting the clinical relevance and feasibility of these approaches. Experimental Design and Methodology The reviewed studies predominantly utilized reversed-phase HPLC techniques, employing C18 stationary phases to separate multiple ASMs from biological matrices such as plasma or serum