CEREBROSPINALECTOMYInsurer: "Before the targeted drug, he needs to fail two others." Me: "We know his sodium-channel mutation. We know which drug." Insurer: "Policy is two failures." Me: "In this disease a failure is a seizure." Insurer: "Correct." What's the actual line your payer used? Send this to whoever writes step-therapy policy.
EXPLAINED (ACCURACY-CHECKED)
In sodium-channel developmental and epileptic encephalopathies, antiseizure medication choice is genotype-informed and a mechanistically inappropriate agent can worsen seizure control; step-therapy requirements mandate trials of agents predicted to be ineffective, with treatment failure manifesting as ongoing seizures.
Genotype-informed antiseizure selection in sodium-channel DEEs is standard epileptology teaching, including the risk of worsening with a mechanistically inappropriate agent. No specific product named. Literature tools not reachable this run.
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