Therapeutic monitoring of antiepileptic drugs: Recommendations to improve care of patients with epilepsy in the Palestinian practice.

BACKGROUND: Therapeutic drug monitoring (TDM) can play a major role in optimizing pharmacotherapy of epilepsy. This study was conducted to explore views and opinions of clinicians who care for patients with epilepsy (PWE) in Palestine and to develop consensus-based recommendations with regard to importance, justification, technical, and analytical issues of TDM of antiepileptic drugs (AEDs). METHODS: The study was conducted in three phases: (1) the published literature was thoroughly searched for an initial list of items relevant to TDM of AEDs, (2) the list was supplemented by items provided by key experts (n = 8) through semi-structured in-depth interviews, (3) views and opinions of clinicians (n = 20) on TDM of AEDs were explored, and (4) a two-round Delphi technique was followed among a panel of experts (n = 27) to develop consensus-based recommendations to guide TDM of AEDs in Palestine. RESULTS: Consensus was achieved on items related to importance (8 items) of TDM of AEDs, clinical justifications of TDM of AEDs (19 items), guidelines for optimal TDM of AEDs (11 items), TDM of some AEDs (21 items), TDM practice (24 items), and some technical and analytical issues in TDM of AEDs (13 items). CONCLUSION: Consensus-based recommendations that might be used in guiding TDM of AEDs in Palestine were developed. Future studies are still needed to investigate if these consensus-based recommendations can improve healthcare of PWE in Palestine.