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Alhyan P, Aggarwal A, Chhillar N, Sharma S, Narang M, Malhotra RK. Effect of Valproate Monotherapy on Thyroid Function Tests and Magnesium Levels in Children With Epilepsy. Cureus 2023; 15:e39712. [PMID: 37398753 PMCID: PMC10309172 DOI: 10.7759/cureus.39712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Antiseizure drug valproate alters thyroid functions. Magnesium is implicated in the pathogenesis of epilepsy and it may affect the efficacy of valproate and thyroid functions. OBJECTIVE To study the effect of six months of valproate monotherapy on thyroid functions and serum magnesium levels. To study the association among these levels and the effects of clinicodemographic profile. MATERIALS AND METHOD Children aged three to 12 years presenting with newly diagnosed epilepsy were enrolled. A venous blood sample was collected for estimation of thyroid function test (TFT), magnesium, and valproate levels at onset and after six months of valproate monotherapy. Valproate levels and TFT were analyzed by chemiluminescence and magnesium by colorimetric method. RESULTS Thyroid stimulating hormone (TSH) increased significantly from 2.14±1.64 µIU/ml at enrollment to 3.64±2.15 µIU/ml at six months (p<0.001), free thyroxine (FT4) decreased significantly (p<0.001). Serum magnesium (Mg) decreased from 2.30±0.29 mg/dl to 1.94±0.28 mg/dl (p<0.001). At six months, eight out of 45 (17.77%) participants had significantly increased mean TSH levels (p=0.008). Serum valproate levels were not associated significantly with TFT and Mg (p<0.05). There was no effect of age, sex, or repeat seizures on the measured parameters. CONCLUSION The TFT and Mg levels are altered by six months of valproate monotherapy in children with epilepsy. Hence we suggest monitoring and supplementation if required.
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Affiliation(s)
- Pinki Alhyan
- Pediatrics, University College of Medical Sciences, Delhi, IND
| | - Anju Aggarwal
- Pediatrics, University College of Medical Science, New Delhi, IND
| | - Neelam Chhillar
- Neurochemistry, Insititute of Human Behaviour and Appiled Sciences, New Delhi, IND
| | - Sangeeta Sharma
- Neuropsychopharmacology, Institute of Human Behaviour and Allied Sciences, New Delhi, IND
| | - Manish Narang
- Pediatrics, University College of Medical Sciences, New Delhi, IND
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Han Y, Yang J, Zhong R, Guo X, Cai M, Lin W. Side effects of long-term oral anti-seizure drugs on thyroid hormones in patients with epilepsy: a systematic review and network meta-analysis. Neurol Sci 2022; 43:5217-5227. [DOI: 10.1007/s10072-022-06120-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/02/2022] [Indexed: 11/08/2022]
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Ekim C, Ulufer C, Bilge PC, Mustafa A, Esra DA, Tugrul AH. Thyroid functions as a parameter in monitoring of antiepileptic drugs. Neurol Res 2022; 44:614-621. [PMID: 35019830 DOI: 10.1080/01616412.2021.2025317] [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: 11/08/2022]
Abstract
INTRODUCTION Epilepsy is a chronic neurological disorder that is treated with multiple medications that can have significant side effects. This study investigated the potential effects of antiepileptic drugs on thyroid function. METHODS The participants in this study were epileptic adults who had been consistently monitored in follow-up care. The effects of antiepileptic drugs on the serum levels of the thyroid stimulating hormone (TSH), free T3 (fT3), and free T4 (fT4) of these patients were investigated retrospectively by comparing laboratory recordings in three defined periods: prior to antiepileptic drug treatment, between 6 months and 1 year of treatment (early stage), and after 1 year of treatment (late stage). RESULTS A total of 300 epileptic patients (F/M: 175/125) were included in the study. Significant differences in TSH and fT4 serum levels in the late stage compared to the pre-treatment stage (p = 0.006 and p = 0.0005, respectively) were found. TSH values in the late stage of treatment were abnormally high in one case and low in five cases; all six of these cases had normal pre-treatment and early-stage TSH values. Patients who received monotherapy with valproic acid, levetiracetam or carbamazepine were evaluated separately and there was no statistically significant difference in TSH and fT3 levels, while fT4 levels were significantly increased during treatment in each treatment group. CONCLUSIONS A significant increase in TSH levels was found in epileptic patients on polytherapy. Our results give us the opportunity to highlight the potential unique or cumulative effect of antiepileptic drugs on thyroid hormone levels.
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Affiliation(s)
- Comert Ekim
- Department of Neurology, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
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Is the prevalence of thyroid disease higher in children receiving antiepileptic medication? A systematic review and meta-analysis. Seizure 2021; 94:117-125. [PMID: 34896814 DOI: 10.1016/j.seizure.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Antiseizure medications (ASM) have long been examined for their potential to induce thyroid dysfunction. The aim of this systematic review and meta-analysis was to assess the prevalence of thyroid disease in children up to 16 years receiving monotherapy with valproate (VPA), carbamazepine (CBZ) and levetiracetam (LEV). METHODS PubMed/MEDLINE, Cochrane/CENTRAL databases and the gray literature were searched to identify observational studies providing the prevalence of thyroid dysfunction in the target population under VPA, CBZ, or LEV monotherapy schemes. The results were pooled using a random-effects model, and additional subgroup analyses were performed for the three ASM groups. RESULTS Fifteen and thirteen studies met inclusion criteria for the qualitative and the quantitative analysis, respectively, with a total of 945 pediatric patients with prevalence data. Only VPA and CBZ were associated with thyroid dysfunction. The overall prevalence of thyroid abnormality was higher in children receiving ASM [odds ratio (OR) 6.82, 95% confidence interval (CI) 3.96-11.75]. In the subgroup analysis, the prevalence of biochemical thyroid abnormality with increased TSH was higher in the VPA (OR 9.54, 95%CI 5.25-17.34) and the CBZ group (OR 4.08, 95%CI 1.84-9.04) compared with controls. CONCLUSION This study confirms the higher prevalence of biochemical thyroid abnormality in children under VPA and CBZ monotherapy, whereas no such evidence is present for LEV. In children with a predisposition for thyroid disease, LEV should be considered over VPA and CBZ, if appropriate for seizure type and epilepsy syndrome. More studies are needed to reach a consensus on monitoring and management of thyroid dysfunction in children receiving ASM therapy.
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Rochtus AM, Herijgers D, Jansen K, Decallonne B. Antiseizure medications and thyroid hormone homeostasis: Literature review and practical guideline. Epilepsia 2021; 63:259-270. [PMID: 34750814 DOI: 10.1111/epi.17117] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 12/11/2022]
Abstract
Thyroid hormones play an essential role in central nervous system development, normal physiological brain function, and repair mechanisms. On one hand, thyroid hormone alterations influence cortical excitability, and on the other hand antiseizure medications (ASMs) are associated with alterations in thyroid hormone metabolism. Although this interaction has long been described, and epilepsy is a common and chronic neurological disease, studies describing the interplay are often small and retrospective. We performed a systematic review of the current literature on epilepsy, ASMs, and thyroid hormone metabolism. Forty-seven studies were included. Most studies were retrospective cross-sectional studies (n = 25) and investigated thyroid function alterations in patients on older ASMs such as phenobarbital, phenytoin, carbamazepine, and valproate. Overall, almost one third of patients with epilepsy had thyroid hormone alterations, especially patients on valproate (25%) and carbamazepine (10%-25%). Studies with patients receiving polytherapy are scarce, but reported a higher risk for hypothyroidism in patients with older age (p = .004), female sex (p = .014), longer duration of epilepsy (p = .001), intractable epilepsy (p = .009), and polytherapy. Studies on newer ASMs are also limited, and further studies on an interplay with thyroid hormone homeostasis are essential to improve the care for epilepsy patients. ASMs are associated with alterations in thyroid hormone metabolism. Thyroid function monitoring is indicated in patients on ASMs, especially those with refractory epilepsy and those on polytherapy. We provide a practical guideline for thyroid function monitoring for the clinician taking care of patients on ASMs.
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Affiliation(s)
- Anne Maria Rochtus
- Department of Pediatric Endocrinology, University Hospitals Leuven, Leuven, Belgium.,Department of Pediatric Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Dorien Herijgers
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Jansen
- Department of Pediatric Neurology, University Hospitals Leuven, Leuven, Belgium
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Abstract
RATIONALE Antiepileptic drugs (AEDs) are one of the causative drugs of drug-induced hypothyroidism. In most cases, AED-induced hypothyroidism is subclinical and indicated only by abnormalities of free thyroxine (T4) and/or thyroid-stimulating hormone (TSH) levels. Severe symptomatic hypothyroidism following AEDs is rarely reported in the literature. PATIENT CONCERNS A 75-year-old man experienced neurologic symptoms including memory impairment, ataxic gait, sensory polyneuropathy and myopathy, lethargy, and edema of the face and lower extremities. He had been administered phenytoin and gabapentin for the treatment of symptomatic traumatic epilepsy 8 years before. DIAGNOSES The patient had low free T4 (0.21 ng/dL) and high TSH (113.2 μIU/mL), which indicated hypothyroidism. Negative thyroid-related autoantibody tests and the lack of goiter excluded the possibility of Hashimoto disease. Phenytoin and/or gabapentin were strongly suspected as causing his hypothyroidism. INTERVENTION The patient was treated with replacement therapy (levothyroxine 25 μg/day). OUTCOMES His symptoms markedly and promptly improved alongside continued antiepileptic therapy. LESSONS In this case, the patient's hypothyroidism was assumed to result from different mechanisms of the 2 AEDs leading to thyroid hormone reduction. AEDs can not only cause asymptomatic thyroid hormone abnormalities but also clinically observable hypothyroidism. Therefore, clinicians should be aware of the association between anticonvulsants and symptomatic hypothyroidism.
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Bartsch R, Brinkmann B, Jahnke G, Laube B, Lohmann R, Michaelsen S, Neumann I, Greim H. Human relevance of follicular thyroid tumors in rodents caused by non-genotoxic substances. Regul Toxicol Pharmacol 2018; 98:199-208. [PMID: 30076866 DOI: 10.1016/j.yrtph.2018.07.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/27/2018] [Accepted: 07/28/2018] [Indexed: 12/31/2022]
Abstract
Chronic stimulation of the thyroid gland of rodents by TSH leads to thyroid follicular hyperplasia and subsequently to thyroid follicular adenomas and carcinomas. However, the interpretations of rodent thyroid tumors are contradictory. The U.S. Food and Drug Administration (FDA) concluded that findings with drugs that lead to increased levels of thyroid-stimulating hormone (TSH) in rats are not relevant to humans, whereas the U.S. Environmental Protection Agency (US EPA) concluded that chemicals that produce rodent thyroid tumors may pose a carcinogenic hazard for humans although the thyroid of rodents appears to be more sensitive to a carcinogenic stimulus than that of humans. Meanwhile, based on the CLP Criteria of the European Chemicals Agency (ECHA), rodent thyroid tumors caused by the induction of uridine-diphosphate-glucuronosyl transferases (UDGT) were assessed as not relevant to humans. To clarify these discrepant positions, the function and regulation of the thyroid gland are described and the types of thyroid tumors and the causes of their development in humans and animals are examined. Based on these data and the evidence that so far, except radiation, no chemical is known to increase the incidence of thyroid tumors in humans, it is concluded that rodent thyroid tumors resulting from continuous stimulation of the thyroid gland by increased TSH levels are not relevant to humans. Consequently, compounds that induce such tumors do not warrant classification as carcinogenic.
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Affiliation(s)
- Ruediger Bartsch
- Institute for Applied Biosciences, Karlsruhe Institute of Technology (KIT), Department of Food Chemistry and Toxicology, Karlsruhe, Germany
| | - Britta Brinkmann
- Institute for Applied Biosciences, Karlsruhe Institute of Technology (KIT), Department of Food Chemistry and Toxicology, Karlsruhe, Germany
| | - Gunnar Jahnke
- Institute for Applied Biosciences, Karlsruhe Institute of Technology (KIT), Department of Food Chemistry and Toxicology, Karlsruhe, Germany
| | - Britta Laube
- Institute for Applied Biosciences, Karlsruhe Institute of Technology (KIT), Department of Food Chemistry and Toxicology, Karlsruhe, Germany
| | - Ruth Lohmann
- Institute for Applied Biosciences, Karlsruhe Institute of Technology (KIT), Department of Food Chemistry and Toxicology, Karlsruhe, Germany
| | - Sandra Michaelsen
- Institute for Applied Biosciences, Karlsruhe Institute of Technology (KIT), Department of Food Chemistry and Toxicology, Karlsruhe, Germany
| | - Ingrid Neumann
- Institute for Applied Biosciences, Karlsruhe Institute of Technology (KIT), Department of Food Chemistry and Toxicology, Karlsruhe, Germany
| | - Helmut Greim
- Institute for Applied Biosciences, Karlsruhe Institute of Technology (KIT), Department of Food Chemistry and Toxicology, Karlsruhe, Germany.
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Shih FY, Chuang YC, Chuang MJ, Lu YT, Tsai WC, Fu TY, Tsai MH. Effects of antiepileptic drugs on thyroid hormone function in epilepsy patients. Seizure 2017; 48:7-10. [DOI: 10.1016/j.seizure.2017.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 03/17/2017] [Accepted: 03/18/2017] [Indexed: 01/07/2023] Open
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Pitetzis DA, Spilioti MG, Yovos JG, Yavropoulou MP. The effect of VPA on bone: From clinical studies to cell cultures—The molecular mechanisms revisited. Seizure 2017; 48:36-43. [DOI: 10.1016/j.seizure.2017.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/19/2017] [Accepted: 03/21/2017] [Indexed: 01/10/2023] Open
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Lambert CG, Mazurie AJ, Lauve NR, Hurwitz NG, Young SS, Obenchain RL, Hengartner NW, Perkins DJ, Tohen M, Kerner B. Hypothyroidism risk compared among nine common bipolar disorder therapies in a large US cohort. Bipolar Disord 2016; 18:247-60. [PMID: 27226264 PMCID: PMC5089566 DOI: 10.1111/bdi.12391] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/20/2016] [Accepted: 02/26/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Thyroid abnormalities in patients with bipolar disorder (BD) have been linked to lithium treatment for decades, yet other drugs have been less well studied. Our objective was to compare hypothyroidism risk for lithium versus the anticonvulsants and second-generation antipsychotics commonly prescribed for BD. METHODS Administrative claims data on 24,574 patients with BD were analyzed with competing risk survival analysis. Inclusion criteria were (i) one year of no prior hypothyroid diagnosis nor BD drug treatment, (ii) followed by at least one thyroid test during BD monotherapy on lithium carbonate, mood-stabilizing anticonvulsants (lamotrigine, valproate, oxcarbazepine, or carbamazepine) or antipsychotics (aripiprazole, olanzapine, risperidone, or quetiapine). The outcome was cumulative incidence of hypothyroidism per drug, in the presence of the competing risk of ending monotherapy, adjusted for age, sex, physician visits, and thyroid tests. RESULTS Adjusting for covariates, the four-year cumulative risk of hypothyroidism for lithium (8.8%) was 1.39-fold that of the lowest risk therapy, oxcarbazepine (6.3%). Lithium was non-statistically significantly different from quetiapine. While lithium conferred a higher risk when compared to all other treatments combined as a group, hypothyroidism risk error bars overlapped for all drugs. Treatment (p = 3.86e-3), age (p = 6.91e-10), sex (p = 3.93e-7), and thyroid testing (p = 2.79e-87) affected risk. Patients taking lithium were tested for hypothyroidism 2.26-3.05 times more frequently than those on other treatments. CONCLUSIONS Thyroid abnormalities occur frequently in patients with BD regardless of treatment. Therefore, patients should be regularly tested for clinical or subclinical thyroid abnormalities on all therapies and treated as indicated to prevent adverse effects of hormone imbalances on mood.
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Affiliation(s)
- Christophe G Lambert
- Center for Global HealthDepartment of Internal MedicineUniversity of New Mexico Health Sciences CenterAlbuquerqueNMUSA,Division of Translational InformaticsDepartment of Internal MedicineUniversity of New Mexico Health Sciences CenterAlbuquerqueNMUSA
| | | | - Nicolas R Lauve
- Department of Computer ScienceUniversity of New MexicoAlbuquerqueNMUSA
| | | | | | | | | | - Douglas J Perkins
- Center for Global HealthDepartment of Internal MedicineUniversity of New Mexico Health Sciences CenterAlbuquerqueNMUSA
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral SciencesUniversity of New Mexico Health Sciences CenterAlbuquerqueNMUSA
| | - Berit Kerner
- Semel Institute for Neuroscience and Human BehaviorDavid Geffen School of MedicineUniversity of CaliforniaLos AngelesCAUSA
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Zhang YX, Shen CH, Lai QL, Fang GL, Ming WJ, Lu RY, Ding MP. Effects of antiepileptic drug on thyroid hormones in patients with epilepsy: A meta-analysis. Seizure 2016; 35:72-9. [DOI: 10.1016/j.seizure.2016.01.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/06/2016] [Accepted: 01/08/2016] [Indexed: 12/26/2022] Open
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Effects of long-term valproic acid treatment on hematological and biochemical parameters in adolescent psychiatric inpatients: a retrospective naturalistic study. Int Clin Psychopharmacol 2015; 30:241-8. [PMID: 26020713 DOI: 10.1097/yic.0000000000000084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to determine the long-term hematological and biochemical side effects of valproic acid (VPA) in psychiatric adolescent inpatients. A retrospective naturalistic study design was used. Participants were psychiatric inpatients treated with VPA, alone or in combination with other medications. Electronic medical files were reviewed for changes in hematological and biochemical parameters following a course of VPA treatment. One hundred and four adolescents aged 12-18 (mean 15.76±1.58) years fulfilled the study criteria. The mean blood level and duration of VPA treatment were 65.81±22.18 mcg/ml and 98.57±135.94 days, respectively. The mean levels of thyroid-stimulating hormones and triglyceride levels increased significantly from the first to the last measurement. Platelet count decreased significantly following VPA treatment. No correlation was observed between these parameters and age, duration of treatment, or VPA levels. No serious adverse events were reported. Long-term VPA treatment in adolescents with psychiatric disorders is associated with significant increases in triglyceride levels. Moreover, VPA-treated adolescent psychiatric inpatients may be at risk of developing pituitary-thyroid axis dysregulation and decreased platelet count. Therefore, baseline measurement of thyroid functions and metabolic and hematological parameters and monitoring throughout the treatment are recommended.
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Kafadar İ, Kılıç BA, Arapoglu M, Yalçın K, Dalgıç N. Evaluation of thyroid hormones in children receiving carbamazepine or valproate: a prospective study. J Child Neurol 2015; 30:63-8. [PMID: 24736121 DOI: 10.1177/0883073814529822] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to determine the alterations in thyroid function during carbamazepine or valproate monotherapy in a prospective study. Forty patients treated with valproate, 33 patients treated with carbamazepine, and 36 control patients, all aged between 2 and 18 years, were enrolled in our study. Serum levels of thyroid hormones were measured before the beginning of the antiepileptic therapy and at 6 and 12 months of treatment. Carbamazepine-treated patients showed mean serum thyroid hormone levels significantly lower than baseline evaluation and the control group. Thyroid-stimulating hormone levels at 6 and 12 months were not significantly different in carbamazepine treated patients. Serum hormone levels did not change during valproate treatment. Thyroid-stimulating hormone levels were significantly higher at the 12th month of valproate treatment. Our data suggest that although carbamazepine causes significant alterations in thyroid hormone levels, these changes do not lead to clinical symptoms at the follow-up period of 12 months.
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Affiliation(s)
- İhsan Kafadar
- Department of Pediatrics, Division of Pediatric Neurology, Sisli Etfal Training & Research Hospital, Istanbul, Turkey
| | - Betül Aydın Kılıç
- Department of Pediatrics, Sisli Etfal Training & Research Hospital, Istanbul, Turkey
| | - Mujde Arapoglu
- Department of Pediatrics, Acibadem University, Istanbul, Turkey
| | - Koray Yalçın
- Department of Pediatrics, Okmeydanı Training & Research Hospital, Istanbul, Turkey
| | - Nazan Dalgıç
- Department of Pediatrics, Sisli Etfal Training & Research Hospital, Istanbul, Turkey
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The effect of antiepileptic drugs on thyroid function in children. Seizure 2014; 23:29-35. [DOI: 10.1016/j.seizure.2013.09.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/06/2013] [Accepted: 09/08/2013] [Indexed: 11/21/2022] Open
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Nanau RM, Neuman MG. Adverse drug reactions induced by valproic acid. Clin Biochem 2013; 46:1323-38. [PMID: 23792104 DOI: 10.1016/j.clinbiochem.2013.06.012] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/11/2013] [Accepted: 06/12/2013] [Indexed: 12/11/2022]
Abstract
Valproic acid is a widely-used first-generation antiepileptic drug, prescribed predominantly in epilepsy and psychiatric disorders. VPA has good efficacy and pharmacoeconomic profiles, as well as a relatively favorable safety profile. However, adverse drug reactions have been reported in relation with valproic acid use, either as monotherapy or polytherapy with other antiepileptic drugs or antipsychotic drugs. This systematic review discusses valproic acid adverse drug reactions, in terms of hepatotoxicity, mitochondrial toxicity, hyperammonemic encephalopathy, hypersensitivity syndrome reactions, neurological toxicity, metabolic and endocrine adverse events, and teratogenicity.
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Affiliation(s)
- Radu M Nanau
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, In Vitro Drug Safety and Biotechnology, Toronto, Ontario, Canada
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