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Kocaoglu C, Akturk S. Just a vitamin? Should cobalamin (Vitamin B12) levels be checked in children with neurological disadvantages? North Clin Istanb 2023; 10:790-796. [PMID: 38328734 PMCID: PMC10846572 DOI: 10.14744/nci.2022.33279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/20/2022] [Accepted: 12/13/2022] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE The assay of serum cobalamin (Cbl) level is commonly used to diagnose Cbl deficiency. Unexpectedly, the elevated Cbl levels may be determined in some of the patients and its interpretation is difficult. We investigated the association between elevated Cbl levels and a variety of clinical entities in patients presenting with various neurological symptoms. METHODS The data were obtained from the patients' electronic medical records in a tertiary hospital affiliated with a university. The pediatric patients with serum Cbl levels above 1000 pg/mL were included in the study. The patients with serum Cbl levels below 900 pg/mL and above 200 pg/mL constituted the control group. RESULTS The mean Cbl level of the patients with neurological problems was 1424.2±354.2 pg/mL, whereas the average Cbl level of neurologically healthy was 1316±317.8 pg/mL, and the difference was statistically significant. While the rate of having neurological deficits or symptoms in the study group was found to be 24%, this rate was only 18% in the control group. Unexpectedly, despite elevated Cbl level, the high mean corpuscular volume rate was higher in the study group compared to the control group. CONCLUSION This study highlights the importance of the disorders of Cbl metabolism in patients presenting with various neurological symptoms. In children with neurological deficits, serum Cbl levels should be checked. In case of high Cbl level is determined, patients should be followed up closely, and further investigations should be performed in terms of Cbl metabolism disorders.
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Affiliation(s)
- Celebi Kocaoglu
- Department of Pediatric Intensive Care, University of Health Sciences, Konya City Hospital, Konya, Turkiye
| | - Seyma Akturk
- Department of Pediatrics, University of Health Sciences, Konya City Hospital, Konya, Turkiye
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2
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Nasef KA, Elmala MK, Sayed Ahmed AM, Al-shokary AH, Ibrahim AO, Kamal NM, Suliman HA, Ismail NS, Sobhi A, Elshorbagy HH, Abdelnasser AM, Torky AA, Abdelghani WE. The Study of Carotid Artery Intima-Media Thickness in Children With Epilepsy on Anti-Epileptic Drugs. Glob Pediatr Health 2023; 10:2333794X231200205. [PMID: 37809362 PMCID: PMC10559707 DOI: 10.1177/2333794x231200205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives. To evaluate carotid artery intima-media thickness (CIMT) and lipid profile in children with epilepsy on long-term antiepileptic drug (AED) monotherapy. Methods. We included 60 children with epilepsy receiving valproate, carbamazepine, or levetiracetam monotherapy and 60 controls. A high-resolution B-mode ultrasound was used to measure (CIMT). Measurement of serum lipids was done. Results. Patients on valproate (0.44 ± 0.03, P ≤ .001), carbamazepine (0.43 ± 0.03with P ≤ .001), and levetiracetam (0.44 ± 0.02 with P ≤ .001) monotherapy showed significantly higher CIMT compared to controls. CIMT was correlated with age (P = .041, r = .112) AEDs{valproate (P = .005, r = .731), carbamazepine (P = .038, r = .365), and levetiracetam (P = .036, r = .155)}, duration of treatment (P = .001, r = .313), TC(P = .001, r = .192), TG (P = .014, r = .018), and LDL (P = .001, r = .219). HDL (P = .003, r = -.126). Seizure severity and Apo A1 were insignificantly involved. Conclusion. Long-term monotherapy with valproate, carbamazepine, and levetiracetam in epileptic children was associated with significant abnormalities in CIMT.
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3
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George LJ, Singh P, Aneja S, Singh R, Solanki RS, Seth A. Insulin Resistance in children on Sodium Valproate - A hospital based cross-sectional study in Indian children. Trop Doct 2023; 53:91-96. [PMID: 36321168 DOI: 10.1177/00494755221134141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Our objective was to compare the point prevalence of insulin resistance (IR) in children taking sodium valproate (VPA) and phenytoin sodium (PS) monotherapy for >1 year. 150 children, aged 6-18 years, were categorized (50 each) into - group A (VPA), group B (PS) and group C (healthy controls age-sex matched with group A). Groups were compared for metabolic complications and risk factors assessed. The point prevalence of IR and non-alcoholic fatty liver disease was significantly higher in children on VPA (12% and 34% respectively) than on PS and healthy controls, regardless of age, sex, pubertal and nutritional status. The presence of central obesity, acanthosis, hypertension, dyslipidaemia was significantly associated with IR but none showed an independent association on multivariate analysis. Therapy with VPA makes children susceptible to metabolic complications. Close monitoring will facilitate early detection and timely intervention.
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Affiliation(s)
- Lydia James George
- MD, Senior Resident, Department of Pediatrics, LHMC, New Delhi, India.,MD (Pediatrics), Assistant Professor, Department of Pediatric Cardiology, Trivandrum Medical College, Trivandrum, India
| | - Preeti Singh
- MD (Pediatrics), Associate Professor, Department of Pediatrics, 28856Lady Hardinge Medical College, New Delhi, India
| | - Satinder Aneja
- MD (Pediatrics), Rtd, Former Director Professor and Head, Department of Pediatrics, 28856Lady Hardinge Medical College (LHMC), New Delhi, India
| | - Ritu Singh
- MD (Biochemistry), Director- Professor and Head, Department of Biochemistry, 28856Lady Hardinge Medical College (LHMC), New Delhi, India
| | - R S Solanki
- MD (Radio-diagnosis), Director- Professor and Head, Department of Radio- Diagnosis, 28856Lady Hardinge Medical College (LHMC), New Delhi, India
| | - Anju Seth
- MD (Pediatrics), Director- Professor, and Head Department of Pediatrics, 28856Lady Hardinge Medical College (LHMC), New Delhi, India
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LoPinto-Khoury C. Long-Term Effects of Antiseizure Medications. Semin Neurol 2022; 42:583-593. [PMID: 36216358 DOI: 10.1055/a-1958-0802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Most patients with epilepsy will benefit from seizure control with one of an array of chronic antiseizure medications. Knowledge of the potential long-term effects of these medications is critical to prevent adverse consequences on overall health. Antiseizure medications vary in their capacities to affect the brain and peripheral nerves, hormones, bone mineralization, cardiovascular risk, renal health, hepatic, hematological, and dermatological systems. Understanding of pathophysiology and population risk has evolved, although most of the data available are still on older generation antiseizure medications such as phenytoin, carbamazepine, and valproic acid. The enzyme-inducing properties of some antiseizure medications make their effects on cardiovascular risk and bone health detrimental. Few clear guidelines exist for monitoring long-term effects of medication therapy for epilepsy. When selecting an antiseizure medication, consideration should be given to the individual patient's risks of adverse consequences on other organ systems. During monitoring of patients on chronic therapy, screening tools such as metabolic panels and bone density measurements can help stratify risk and guide management.
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Affiliation(s)
- Carla LoPinto-Khoury
- Department of Neurology, Lewis Katz Temple School of Medicine, Philadelphia, Pennsylvania
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5
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Influence of Different Antiseizure Medications on Vascular Risk Factors in Children with Epilepsy. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101499. [PMID: 36291435 PMCID: PMC9600762 DOI: 10.3390/children9101499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022]
Abstract
Many studies have proposed that plasma homocysteine levels are increased as a side effect with the prolonged use of antiseizure medications. This is associated with an increase in carotid intima media thickness; hence, it increases the threat of atherosclerosis at a young age. We aimed to assess serum levels of homocysteine in epileptic children on long-standing antiseizure medications and its association with increased occurrence of cardiovascular disease. The study included 60 epileptic children aged between 2 and 15 years old who visited our pediatric neurology outpatient clinic and 25 apparently healthy children served as a control group. All included children were subjected to careful history taking, clinical examination, anthropometric measures, laboratory investigations including serum homocysteine levels and lipid profile, along with radiological assessment involving carotid intima media thickness and carotid stiffness. Results demonstrated a significant increase in the serum levels of homocysteine, carotid intima media thickness, and carotid stiffness in children on monotherapy of old generation antiseizure medications and polytherapy than that in children on monotherapy of new generation antiseizure medications and control children. Epileptic children on old generation and polytherapy antiseizure medications have an increased risk for cardiovascular diseases and need follow up for early intervention when needed.
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Bisi-Onyemaechi AI, Chikani UN, Uwaezuoke NA, Aronu AE, Ojinnaka NC. Serum folate levels in children on long-term anti-seizure medication in a Nigerian tertiary center-Implications for practice and public health. Sci Prog 2021; 104:368504211057680. [PMID: 34816782 PMCID: PMC10461376 DOI: 10.1177/00368504211057680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Epilepsy is the most common childhood neurological disorder in Nigeria. Treatment of epilepsy is long-term and sometimes lifelong with anti-seizure medications. There are conflicting reports on the effect of anti-seizure medications on serum folate. There is therefore a need to determine the effect of a commonly used anti-seizure medication's on serum folate levels of children. This would provide an evidence-based consideration for folic acid supplementation in children on anti-seizure medication as has been suggested by some studies. STUDY OBJECTIVES To determine whether serum folate levels were lower in children taking long-term carbamazepine or sodium valproate, compared to a control group. METHODS Serum folic acid levels were measured from well-nourished children between the ages of 1-17 years on carbamazepine and sodium valproate monotherapy and their age/sex-matched controls, using spectrophotometry. RESULTS The mean serum folate levels of patients on carbamazepine (43) and sodium valproate (22) were 0.032 mg/l ± 0.009 and 0.028 mg/l ± 0.008, respectively. The mean folate levels of the controls were 0.046 mg/l ± 0.03 (p = 0 001). No statistically significant difference was observed between the serum folate levels of children on the two anti-seizure medications, that is, carbamazepine and valproate. CONCLUSION The children on treatment with carbamazepine and sodium valproate for more than 6 months had statistically significantly lower serum levels of folic acid compared to the standard reference range and controls. The serum folate levels of children on carbamazepine were not statistically different from those on sodium valproate.
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Affiliation(s)
- Adaobi I Bisi-Onyemaechi
- Institute of Maternal and Child Health,
College of Medicine, University of Nigeria Ituku-Ozalla, Nigeria
- Department of Paediatrics, College of
Medicine, University of Nigeria Ituku-Ozalla, Nigeria
| | - Ugo N Chikani
- Department of Paediatrics, College of
Medicine, University of Nigeria Ituku-Ozalla, Nigeria
| | - Ndubuisi A Uwaezuoke
- Department of Paediatrics, College of
Medicine, University of Nigeria Ituku-Ozalla, Nigeria
| | - Ann E Aronu
- Department of Paediatrics, College of
Medicine, University of Nigeria Ituku-Ozalla, Nigeria
| | - Ngozi C Ojinnaka
- Department of Paediatrics, College of
Medicine, University of Nigeria Ituku-Ozalla, Nigeria
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Karacan N, Çalik M, Kazanasmaz H, Ethemoğlu Ö, Güzelçiçek A, Yaşin S, Kandemir H, Çeçen E. The Serum Prolidase Enzyme Activity as a Biomarker for Evaluation of the Subclinical Vascular Damage in Children with Epilepsy. Ann Indian Acad Neurol 2021; 23:787-791. [PMID: 33688128 PMCID: PMC7900735 DOI: 10.4103/aian.aian_640_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/23/2019] [Accepted: 02/07/2020] [Indexed: 01/14/2023] Open
Abstract
Backgroud: Epilepsy is a chronic medical condition requiring long term or even lifelong therapy. Various researches have shown that epilepsy patients have vascular risk factors such as abnormal lipids, insulin, elevated oxidative stress, chronic inflammation, and subclinical atherosclerosis. Objectives: The purpose of the present study was to determine serum prolidase enzyme activity as a biomarker in children taking antiepileptic drug treatment through comparison with control cases. Materials and Methods: The present study group consists of 61 children (20 females, 41 males) with epilepsy and a control group was formed of 32 healthy individuals (14 females, 18 males). Aspectrophotometric method was used to measure serum prolidase enzyme activity. Results: The epilepsy group demonstrated statistically significantly higher prolidase enzyme activity values when compared with the control group (P = 0.003). It was measured that the serum TOS and OSI values were significantly elevated in patients with epilepsy compared to controls (P < 0.001). However, serum TAS values were significantly lower in the epilepsy group than in the control group (P = 0.032). Conclusions: These results supported that epileptic patients taking the antiepileptic treatment had increased serum prolidase enzyme activity, suggesting that it may show an increased risk of subclinical vascular damage related to both chronic inflammation and fibrotic process associated with degenerated collagen turnover. Therefore, serum prolidase enzyme activity could be considered a useful biomarker for evaluation of the subclinical vascular damage in children with epilepsy on some antiepileptic drugs.
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Affiliation(s)
- Nurettin Karacan
- Department of Pediatrics, Harran University School of Medicine, Sanliurfa, Turkey
| | - Mustafa Çalik
- Department of Pediatric Neurology, Harran University School of Medicine, Sanliurfa, Turkey
| | - Halil Kazanasmaz
- Department of Pediatrics, Harran University School of Medicine, Sanliurfa, Turkey
| | - Özlem Ethemoğlu
- Department of Neurology, Harran University School of Medicine, Sanliurfa, Turkey
| | - Ahmet Güzelçiçek
- Department of Pediatrics, Harran University School of Medicine, Sanliurfa, Turkey
| | - Sedat Yaşin
- Department of Pediatric Neurology, Harran University School of Medicine, Sanliurfa, Turkey
| | - Hasan Kandemir
- Department of Child and Adolescent Psychiatry, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Emre Çeçen
- Department of Pediatric Oncology, Harran University School of Medicine, Sanliurfa, Turkey
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Bhavani N, Bhadran K, Vinayan K, Pavithran P. Metabolic effects of long-term antiepileptic drug therapy in South Indian children. J Pediatr Neurosci 2021. [DOI: 10.4103/jpn.jpn_228_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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9
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Stenberg R, Böttiger A, Nilsson TK. High levels of vitamin B12 are fairly common in children with cerebral palsy. Acta Paediatr 2020; 109:1493-1494. [PMID: 32056285 DOI: 10.1111/apa.15195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Reidun Stenberg
- School of Health and Medical Sciences University Health Care Research Center Örebro University Örebro Sweden
| | - Anna Böttiger
- Department of Laboratory Medicine Faculty of Medicine and Health Örebro University Orebro Sweden
| | - Torbjörn K. Nilsson
- Department of Medical Biosciences/Clinical Chemistry Umeå University Umea Sweden
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10
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Karatoprak E, Tosun O. Effects of valproic acid and levetiracetam monotherapy on carotid intima-media and epicardial adipose tissue thickness in non-obese children with epilepsy. Brain Dev 2020; 42:165-170. [PMID: 31806254 DOI: 10.1016/j.braindev.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 11/11/2019] [Accepted: 11/16/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the risk of subclinical atherosclerosis independent from obesity and high blood lipid levels in pediatric patients with idiopathic epilepsy receiving valproic acid or levetiracetam monotherapy by evaluating carotid intima-media thickness (CIMT) and Epicardial adipose tissue thickness (EATT). METHODS A total of 75 patients (38 males, 37 females; mean age 127.2 ± 37.9 months) with epilepsy receiving either valproic acid or levetiracetam monotherapy for more than 12 months (Epilepsy Group) and 75 sex, age, body mass index (BMI) matched healthy children (40 males, 35 females; mean age 133.8 ± 38.7 months) (Control Group) were included in the study. The mean duration of therapy was 27.6 ± 10.5 months. Serum lipid levels (total cholesterol, triglycerides, low density lipoprotein, high density lipoprotein) and CIMT-EATT of the patients and controls were assessed. Also, epilepsy group were divided according to antiepileptic drugs (valproic acid group and levetiracetam group). RESULTS The CIMT was determined as 0.6 ± 0.08 mm in epilepsy group and 0.49 ± 0.15 mm in control group (p < 0.001). The EATT was measured as 5.96 ± 0.8 mm in epilepsy group and 3.7 ± 0.5 mm in control group (p < 0.001). Of epileptic patients, 45 were using valproic acid monotherapy and 30 were on levetiracetam monotherapy. There was no significant difference in terms of CIMT between valproic acid and levetiracetam groups (0.61 ± 0.09 mm vs. 0.57 ± 0.07 mm; p = 0.07). EATT measurements were significantly higher in valproic acid group compared to levetiracetam group (6.14 ± 0.8 mm vs. 5.7 ± 0.7 mm; p = 0.02). CIMT and EATT values were not associated with the dosage and duration of each antiepileptic drug. CONCLUSION Non-obese children with epilepsy receiving valproic acid or levetiracetam monotherapy might have an increased risk for developing subclinical atherosclerosis despite normal lipid levels. The effect of valproic acid was more evident especially on EATT.
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Affiliation(s)
- Elif Karatoprak
- Medeniyet University, Faculty of Medicine, Department of Pediatric Neurology, Istanbul, Turkey.
| | - Oyku Tosun
- Medeniyet University, Faculty of Medicine, Department of Pediatric Cardiology, Istanbul, Turkey
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Talari HR, Bahrami M, Ardestani AT, Bahmani F, Famili P, Asemi Z. Effects of Folate Supplementation on Carotid Intima-Media Thickness, Biomarkers of Inflammation, and Oxidative Stress in Carbamazepine-Treated Epileptic Children. Int J Prev Med 2019; 10:4. [PMID: 30774838 PMCID: PMC6360991 DOI: 10.4103/ijpvm.ijpvm_152_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 11/02/2018] [Indexed: 11/05/2022] Open
Abstract
Background: This study was conducted to assess the effects of folate supplementation on carotid intima-media thickness (CIMT), biomarkers of inflammation, and oxidative stress in carbamazepine-treated epileptic children. Methods: This randomized, double-blind, placebo-controlled trial was carried out in 54 epileptic children aged 2–12 years old receiving carbamazepine monotherapy. Participants were randomly allocated into two groups to receive either 5 mg folate supplements or placebo (n = 27 in each group) for 12 weeks. Results: After the 12-week intervention, compared with the placebo, folate supplementation resulted in a significant reduction in plasma homocysteine (Hcy) (changes from baseline − 2.1 ± 2.5 vs. +0.1 ± 0.4 μmol/L, P < 0.001), serum high-sensitivity C-reactive protein (hs-CRP) (changes from baseline − 1.5 ± 3.5 vs. +0.4 ± 1.4 mg/L, P = 0.01), a significant increase in plasma nitric oxide (NO) (changes from baseline + 1.9 ± 5.8 vs. −2.0 ± 6.4 μmol/L, P = 0.02), and total antioxidant capacity (TAC) concentrations (changes from baseline + 88.6 ± 116.0 vs. +1.8 ± 77.4 mmol/L, P = 0.002). We did not observe any significant effects in mean levels of left and right CIMT, maximum levels of left and right CIMT, and total glutathione (GSH) and malondialdehyde (MDA) levels following the supplementation of folate compared with the placebo. Conclusions: Overall, folate supplementation at a dosage of 5 mg/day for 12 weeks among epileptic children receiving carbamazepine had beneficial effects on Hcy, hs-CRP, NO, and TAC levels, but did not affect CIMT, and GSH and MDA levels.
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Affiliation(s)
- Hamid Reza Talari
- Department of Radiology, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Mansour Bahrami
- Department of Radiology, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Ahmad Talebian Ardestani
- Department of Pediatrics, School of Medicine, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Fereshteh Bahmani
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Peyman Famili
- Department of Radiology, Kashan University of Medical Sciences, Kashan, I.R. Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran
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Calik M, Ozkan HY, Ethemoglu O, Koca B, Kazanasmaz H, Karacan N, Dokumaci DS. The measurement of both carotid intima-media thickness and epicardial adipose tissue thickness in children with epilepsy receiving antiepileptic drug therapy. Epilepsy Behav 2018; 85:110-114. [PMID: 29940373 DOI: 10.1016/j.yebeh.2018.05.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/28/2018] [Accepted: 05/28/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the carotid intima-media thickness together with the thickness of the epicardial adipose tissue in patients receiving antiepileptic drug therapy and to investigate the presence of increased cardiovascular risk in these patients. METHODS The study included a total of 52 patients comprising 32 males and 20 females who were diagnosed as having epilepsy and who were using one or more antiepileptic drugs. The control group consisted of 34 healthy individuals comprising 16 males and 18 females. The individuals selected for the study group were requested to go to the hospital after overnight fasting. After blood sampling for serum lipid value, the carotid intima-media thickness was measured with high resolution B-mode ultrasonography and epicardial adipose tissue thickness with echocardiography in the patients and the control group subjects. RESULTS The carotid intima-media thickness was determined as 0.47 ± 0.05 mm in the patient group and 0.44 ± 0.04 mm in the control group (p = 0.028). The carotid intima-media thickness was measured as 0.45 ± 0.05 mm in patients with epilepsy taking monotherapy and 0.49 ± 0.04 mm in those taking polytherapy (p = 0.003). The epicardial adipose tissue thickness was determined as 3.42 ± 0.09 mm in the patient group and 1.72 ± 0.90 mm in the control group (p = 0.000). The epicardial adipose tissue thickness was measured as 3.16 ± 0.87 mm in patients with epilepsy taking monotherapy and 3.77 ± 0.83 mm in those taking polytherapy (p = 0.041). CONCLUSIONS It was determined that carotid intima-media thickness and epicardial adipose tissue thickness were significantly high in children with epilepsy taking long-term antiepileptic drugs. These results demonstrate that these patients could be at increased risk of the development of cardiovascular complications. There is a need for more extensive studies on this subject.
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Affiliation(s)
- Mustafa Calik
- Department of Pediatric Neurology, Harran University School of Medicine, Sanliurfa, Turkey.
| | - Hatice Yıldız Ozkan
- Department of Pediatrics, Harran University School of Medicine, Sanliurfa, Turkey
| | - Ozlem Ethemoglu
- Department of Neurology, Harran University School of Medicine, Sanliurfa, Turkey
| | - Bulent Koca
- Department of Pediatric Cardiology, Harran University School of Medicine, Sanliurfa, Turkey
| | - Halil Kazanasmaz
- Department of Pediatrics, Harran University School of Medicine, Sanliurfa, Turkey
| | - Nurettin Karacan
- Department of Pediatrics, Harran University School of Medicine, Sanliurfa, Turkey
| | - Dilek Sen Dokumaci
- Department of Radiology, Harran University School of Medicine, Sanliurfa, Turkey
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13
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Lai Q, Shen C, Zheng Y, Zhang Y, Guo Y, Ding M. Effects of Antiepileptic Drugs on the Carotid Artery Intima-Media Thickness in Epileptic Patients. J Clin Neurol 2017; 13:371-379. [PMID: 28884979 PMCID: PMC5653625 DOI: 10.3988/jcn.2017.13.4.371] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/06/2017] [Accepted: 06/08/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND PURPOSE It has been reported that taking antiepileptic drugs (AEDs) may increase the risk of atherosclerosis. We performed a meta-analysis to evaluate the carotid artery intima-media thickness (CA-IMT) as a surrogate factor for atherosclerosis in epileptic patients. METHODS We searched NCBI (PubMed), ISI Web of Knowledge, EMBASE, and the Cochrane Library databases for studies of the association between AEDs and CA-IMT in epileptic patients. A random-effects meta-analysis was used to pool results across studies. RESULTS Fifteen studies involving 1,775 epileptic patients were included in the analysis. The overall CA-IMT was significantly larger among users of AEDs [mean difference (MD)=0.09 mm, 95% confidence interval (CI)=0.06-0.12 mm). When stratified by age, the MD was similar in adult patients (MD=0.09 mm, 95% CI=0.06-0.13 mm), but no significant difference was observed in children (MD=0.03 mm, 95% CI=0.00-0.07 mm). Regarding specific AEDs, monotherapy with carbamazepine (CBZ) or valproic acid (VPA) was associated with a larger CA-IMT, while phenytoin monotherapy was not and the result for lamotrigine was inconclusive. CONCLUSIONS This study suggests that using AEDs is associated with the CA-IMT in patients with epilepsy, particularly for adult patients. In particular, CBZ and VPA may be related to a significant increase in CA-IMT.
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Affiliation(s)
- Qilun Lai
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Chunhong Shen
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yang Zheng
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yinxi Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Guo
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meiping Ding
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Płonka-Półtorak E, Zagrodzki P, Kryczyk-Kozioł J, Westermarck T, Kaipainen P, Kaski M, Atroshi F. Does valproate therapy in epileptic patients contribute to changing atherosclerosis risk factors? The role of lipids and free fatty acids. Pharmacol Rep 2016; 68:1339-1344. [PMID: 27701058 DOI: 10.1016/j.pharep.2016.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/01/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND We aimed to demonstrate the relationship between the valproate (VPA) treatment versus lipid and serum free fatty acids (FFAs) profiles to be the potential atherosclerosis risk factor in epileptic patients. METHODS Fasting blood samples were taken from 21 adult VPA-treated patients and 21 controls. The profiles of lipids, FFAs, clinical parameters and body mass index (BMI) were evaluated. RESULTS No significant differences between the study group and controls were found for any of the studied parameters. However, significant differences in the total cholesterol (CHOL), low-density-lipoprotein cholesterol (LDL), triglycerides, the CHOL/HDL (high-density-lipoprotein cholesterol) ratio, and Atherogenic Index of Plasma were observed for overweight patients when compared to those of normal weight. Patients with uncontrolled epilepsy tended to have significantly lower palmitic acid level than seizure-free patients. Oleic acid was found to be positively correlated with VPA concentration for patients with uncontrolled epilepsy, and with the dose corrected VPA concentration for all the patients. The acid was however negatively correlated with stearic acid for both the controls and the patients with uncontrolled epilepsy. PLS method revealed CHOL, LDL, triglycerides and myristic acid to be positively interrelated for the whole group under the study, whereas these parameters were found to be negatively correlated with VPA concentration, and positively with BMI. Furthermore, high sensitivity C-reactive protein was found to be negatively correlated with palmitic acid levels. CONCLUSION Overweight VPA-treated patients are exposed to higher risk of atherosclerosis. Alterations in FFAs are likely to depend on seizures control, and on VPA levels.
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Affiliation(s)
| | - Paweł Zagrodzki
- Henryk Niewodniczański Institute of Nuclear Physics, Kraków, Poland; Department of Food Chemistry and Nutrition, Medical College Jagiellonian University, Kraków, Poland
| | - Jadwiga Kryczyk-Kozioł
- Department of Food Chemistry and Nutrition, Medical College Jagiellonian University, Kraków, Poland
| | | | | | - Markus Kaski
- Rinnekoti Research Centre, FIN 02980 Espoo, Finland
| | - Faik Atroshi
- Department of Pharmacology and Toxicology, ELTDK, FIN 00014 University of Helsinki, Finland
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Keenan N, Sadleir L, Wiltshire E. Response to "Asymmetric dimethylarginine and vascular risk in patients treated with antiepileptic drugs". Epilepsy Res 2014; 108:1962. [PMID: 25449365 DOI: 10.1016/j.eplepsyres.2014.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- N Keenan
- Department of Paediatrics and Child Health, University of Otago Wellington, P.O. Box 7343, , Wellington South 6242, New Zealand
| | - L Sadleir
- Department of Paediatrics and Child Health, University of Otago Wellington, P.O. Box 7343, , Wellington South 6242, New Zealand
| | - E Wiltshire
- Department of Paediatrics and Child Health, University of Otago Wellington, P.O. Box 7343, , Wellington South 6242, New Zealand.
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Asymmetric dimethylarginine and vascular risk in patients treated with antiepileptic drugs. Epilepsy Res 2014; 108:1960-1. [PMID: 25178671 DOI: 10.1016/j.eplepsyres.2014.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 08/11/2014] [Accepted: 08/12/2014] [Indexed: 11/23/2022]
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An evaluation of serum paraoxonase together with arylesterase activities and oxidative stress in children with intractable epilepsy: a cross-sectional study. Epilepsy Res 2014; 108:1591-6. [PMID: 25218892 DOI: 10.1016/j.eplepsyres.2014.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/24/2014] [Accepted: 08/21/2014] [Indexed: 12/11/2022]
Abstract
Epilepsy is the most common chronic neurological illness in childhood and adolescence. The aim of this study was to investigate paraoxonase and arylesterase activities along with oxidative status parameters in children with intractable epilepsy. The study comprised 42 subjects with intractable epilepsy and a control group of 35 healthy subjects. Serum paraoxonase and arylesterase activities, and lipid hydroperoxide levels were determined. All paraoxonase and arylesterase activities were significantly lower in the intractable epilepsy subjects than in the controls (P<0.001), whereas lipid hydroperoxide levels were significantly higher (P<0.05). In conclusion, paraoxonase and arylesterase activities were decreased and the lipid hydroperoxide level was increased in patients with intractable epilepsy. These results showed that intractable epilepsy subjects may be more prone to the development of atherosclerosis.
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Talaat FM, Kamel T, Rabah AM, Ahmed SM, El-Jaafary SI, Abdelaziz GH. Epilepsy and antiepileptic drugs: risk factors for atherosclerosis. Int J Neurosci 2014; 125:507-11. [DOI: 10.3109/00207454.2014.949704] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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