MEASUREMENT OF CARBAMAZEPINE AND CARBAMAZEPINE EPOXIDE IN THE HUMAN BRAIN USING IN-VIVO MICRODIALYSIS

We report the first study of carbamazepine and carbamazepine-10,11-epo xide concentrations determined by using intracerebral microdialysis in three patients undergoing depth electrode studies for the evaluation of medically intractable epilepsy. Very small microdialysis catheters, affixed to and inserted with the depth electrodes, sampled drug conce ntration in the extracellular environment. We perfused artificial extr acellular fluid continuously, and varied the perfusion rate to permit estimation of the absolute drug concentration in the extracellular spa ce. Serum samples were obtained simultaneously. The relation between d ialysate and extracellular concentration (recovery fraction) depended, in vivo but not in vitro, on the relative lipophilicity of the compou nds, suggesting that diffusion of the drug within the brain is a major determinant of microdialysate drug concentration. When this is taken into account, the steady-state extracellular concentrations of these c ompounds closely mirror their unbound serum concentrations.