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Ogunjimi L, Joseph Y, Akinyinka A, Aderonke A, Bamidele O, Bolanle F, Abdullahi M, Olaide D, Mariam O, Ibironke O, Fehintola F, Adesola O. Differential effects of carbamazepine and levetiracetam monotherapy on reproductive endocrine function in Nigerian women with epilepsy. Heliyon 2023; 9:e20098. [PMID: 37810040 PMCID: PMC10559853 DOI: 10.1016/j.heliyon.2023.e20098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 08/21/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023] Open
Abstract
Objective This study is aimed at comparing differential effect of Levetiracetam (LTC) monotherapy and Carbamazepine (CZP) monotherapy in W omen with epilepsy (WWE) on gonadal hormone. Methods 87 WWE were recruited comprising randomly of 46 and 41 on CZP and LTC group respectively with diagnosis and classification based on International League Against Epilepsy (ILAE). Reproductive hormones (Luteinizing Hormone (LH), Follicle stimulating hormone, progesterone, estradiol and testosterone) were assayed. National Hospital Seizure Severity Scale (NHSS) and Zung self-reporting depression scale (ZSRDS) were used to assess the seizure severity and the mood respectively. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 20. The Chi-square test was used to compare categorical variables while Student's t-test or its non-parametric equivalent where appropriate were used to compare continuous variables. Results Clinical characteristics were comparable in both groups except for ZSRDS (p = 0.048), NHSS (p = 0.012) and hip circumference (p = 0.037). The CZP group had a higher ASEX score and proportion of WWE with clinically significant sexual dysfunction (p < 0.001). WWE on LTC had similar hormonal profiles with those on CZP except for a higher median serum testosterone level (p = 0.004), and lower median serum LH (p = 0.006). Age was negatively associated with serum testosterone level for the 25th, 50th, and 75th quartile. However, the differential effect for AED type was only significant for the 25th quartile; with higher values in LTC. Conclusion The therapeutics implication of lower LH and testosterone levels in the LTC group compared to CZP group need to be explored.
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Affiliation(s)
- Luqman Ogunjimi
- Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Remo Campus, Sagamu Ogun State, Nigeria
| | - Yaria Joseph
- Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Alabi Akinyinka
- Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Remo Campus, Sagamu Ogun State, Nigeria
| | - Aderinola Aderonke
- Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Remo Campus, Sagamu Ogun State, Nigeria
| | - Osalusi Bamidele
- Department of Medicine, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Remo Campus, Sagamu Ogun State, Nigeria
| | - Falujo Bolanle
- Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Remo Campus, Sagamu Ogun State, Nigeria
| | - Murtala Abdullahi
- Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Remo Campus, Sagamu Ogun State, Nigeria
| | - Dada Olaide
- Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Remo Campus, Sagamu Ogun State, Nigeria
| | - Oyebowale Mariam
- Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Remo Campus, Sagamu Ogun State, Nigeria
| | - Oyenuga Ibironke
- Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Remo Campus, Sagamu Ogun State, Nigeria
| | - Fatai Fehintola
- Department of Pharmacology and Therapeutics, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Ogunniyi Adesola
- Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
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Abstract
INTRODUCTION Patients with severe epilepsy are at increased risk of cardiovascular disease and arrhythmias. Although antiseizure medications (ASMs) may have indirect protective effects against cardiovascular events by reducing seizure frequency and hence sudden death in epilepsy, some of them exert cardiotoxic effects. AREAS COVERED Patients with epilepsy, mainly those with severe forms, are at higher risk of cardiac disease because their heart can have structural alterations and electrical instability as a consequence of repeated seizures. Some ASMs have direct protective effects through anti-inflammatory, antioxidant, hypotensive, and lipid-reducing properties. Antiseizure medications can also have toxic cardiac effects including both long-term consequences, such as the increased risk of atherogenesis and subsequent cardiovascular disease due to the influence on lipid profile and pro-inflammatory milieu, and immediate effects as the increased risk of potentially fatal arrhythmias due to the influence on ion channels. Sodium channel blocking ASMs may also affect cardiac sodium channels and this effect is particularly observed in subjects with genetic mutations in cardiac ion channels. Fenfluramine cause valvulopathies in obese subjects and this effect need to be evaluated in epilepsy patients. EXPERT OPINION For the selection of treatment, cardiotoxic effects of ASMs should be considered; cardiac monitoring of treatment is advisable.
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Affiliation(s)
- Gaetano Zaccara
- Department of Eidemiology, Regional Health Agency of Tuscany, Firenze, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (Sabes-asdaa), Merano-Meran, Italy
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Ahmad A, Sheikh S, Khan MA, Chaturvedi A, Patel P, Patel R, Buch BC, Anand RS, Shah TC, Vora VN, Ramasubramanian V, Rao S, Kumar N, Prasad BSV, Sathianathan R, Verma KK, Jhanwar VG, Kumar N, Shah S, Dalal PK, Sindhu B, Talukdar P, Ahmad I. Endoxifen: A new, protein kinase C inhibitor to treat acute and mixed mania associated with bipolar I disorder. Bipolar Disord 2021; 23:595-603. [PMID: 33368969 DOI: 10.1111/bdi.13041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/19/2020] [Accepted: 12/20/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Endoxifen is a protein kinase C inhibitor. The objective of the present phase III study was to demonstrate the safety and efficacy of endoxifen in treating bipolar I disorder (BPD I) patients. METHODS A multicenter, double-blind, active-controlled study was conducted using a daily dose of 8 mg endoxifen compared to 1000 mg divalproex, the current standard treatment, in patients with BPD I acute manic episodes with/without mixed features. The primary endpoint of our study was the mean change in total Young Mania Rating Scale (YMRS) score at day 21. RESULTS Endoxifen (n = 116) significantly (p < 0.0001) reduced total YMRS score (from 33.1 to 17.8. A significant (p < 0.001) improvement in Montgomery-Åsberg Depression Rating Scale (MADRS) score was observed for endoxifen (4.8 to 2.5). Early time to remission of the disease was observed with endoxifen compared to divalproex. None of the patients required rescue medication and there was no drug-associated withdrawals. Changes in Clinical Global Impressions-Bipolar Disorder and Clinical Global Impression-Severity of Illness scores showed that treatment with endoxifen was well-tolerated. CONCLUSIONS Endoxifen at a low daily dose of 8 mg was as efficacious and safe in patients with BPD I acute manic episodes with/without mixed features.
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Affiliation(s)
- Ateeq Ahmad
- Jina Pharmaceuticals Inc, Libertyville, IL, USA
| | | | | | | | - Piyush Patel
- Intas Pharmaceuticals Ltd, Ahmedabad, Gujarat, India
| | - Ronak Patel
- Lambda Therapeutic Research Ltd, Ahmedabad, Gujarat, India
| | | | | | | | | | | | | | - Narendra Kumar
- Mysore Medical College and Research Institute, K.R. Hospital, Mysore, Karnataka, India
| | - B S V Prasad
- Sujata Birla Hospital and Medical Research Center, Nasik, Maharashtra, India
| | | | | | - Venu Gopal Jhanwar
- Deva Institute of Healthcare and Research, Varanasi, Uttar Pradesh, India
| | - Nand Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - Sandip Shah
- Gujarat Medical Education & Research Society Medical College, Gotri, Vadodara, India
| | - Pronob Kumar Dalal
- King George's Medical University, G.M. Associated Hospitals, Lucknow, Uttar Pradesh, India
| | | | - Payel Talukdar
- Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Imran Ahmad
- Jina Pharmaceuticals Inc, Libertyville, IL, USA
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