CEREBROSPINALECTOMY
Insurer: "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." Developmental and epileptic encephalopathies caused by sodium-channel variants are the clearest case in neurology where genotype should steer drug choice — the wrong mechanism can make seizures worse, not just fail to help. Step therapy was designed for interchangeable drugs in common conditions. Applied here, the required 'trial and failure' is measured in a child's seizures. Send this to whoever writes step-therapy policy. 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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