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Smith ECC, Au E, Pereira S, Sharma E, Venkatasubramanian G, Remington G, Agarwal SM, Hahn M. Clinical improvement in schizophrenia during antipsychotic treatment in relation to changes in glucose parameters: A systematic review. Psychiatry Res 2023; 328:115472. [PMID: 37722239 DOI: 10.1016/j.psychres.2023.115472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/20/2023]
Abstract
Antipsychotics (APs) are the cornerstone of treatment for schizophrenia (SCZ) spectrum disorders. Previous research suggests that there may be a positive association between AP-induced weight gain and/or dyslipidemia and improvement in psychiatric symptoms, often referred to as a "metabolic threshold". To determine whether a similar relationship exists for glucose parameters, we conducted a systematic search in six databases from inception to June 2022 for all longitudinal studies that directly examined the relationship between changes in glucose-related outcomes and changes in psychopathology among patients with SCZ treated with APs. We identified 10 relevant studies and one additional study that considered cognition. In most cases, we found that increased levels of fasting glucose and insulin following treatment were associated with clinical improvement. These findings contribute to existing literature that could suggest a common mechanism between AP action and metabolic side effects and support a need for additional work aimed at exploring the validity of a glucose-psychopathology relation in SCZ.
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Affiliation(s)
- Emily Chen Chen Smith
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen St. W, Toronto, ON M6J 1H3, Canada; Institute of Medical Sciences, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2374, Toronto, ON M5S 1A8, Canada
| | - Emily Au
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen St. W, Toronto, ON M6J 1H3, Canada; Department of Pharmacology, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 4207, Toronto, ON, Canada
| | - Sandra Pereira
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen St. W, Toronto, ON M6J 1H3, Canada; Department of Physiology, University of Toronto, 1 King's College Circle, Medical Sciences Building, 3rd floor, Toronto, ON M5S 1A8, Canada
| | - Eesha Sharma
- National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore - 560029, Karnataka, India
| | | | - Gary Remington
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen St. W, Toronto, ON M6J 1H3, Canada; Institute of Medical Sciences, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2374, Toronto, ON M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON M5T 1R8, Canada
| | - Sri Mahavir Agarwal
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen St. W, Toronto, ON M6J 1H3, Canada; Institute of Medical Sciences, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2374, Toronto, ON M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON M5T 1R8, Canada; Banting and Best Diabetes Centre, University of Toronto, 200 Elizabeth Street, Eaton Building, 12th Floor, Room 12E248, Toronto, ON M5G 2C4, Canada
| | - Margaret Hahn
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen St. W, Toronto, ON M6J 1H3, Canada; Institute of Medical Sciences, University of Toronto, 1 King's College Circle, Medical Sciences Building, Room 2374, Toronto, ON M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON M5T 1R8, Canada; Banting and Best Diabetes Centre, University of Toronto, 200 Elizabeth Street, Eaton Building, 12th Floor, Room 12E248, Toronto, ON M5G 2C4, Canada.
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Meenaghan T, Hayat A, Walpole G, Dowling M. Advances in the management of myeloma: an update. Br J Nurs 2023; 32:S4-S12. [PMID: 37737854 DOI: 10.12968/bjon.2023.32.17.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Myeloma is an aggressive B-cell malignancy resulting from an uncontrolled production of plasma cells in the bone marrow. A multitude of drugs and combinations of drugs are now approved for use to treat this complex disease and nurses require knowledge and skills in recognising and managing new side effects associated with these treatments. This article presents an overview of some of the newer and recently approved drugs and the important side effects that have been associated with them. Clinical nurse specialists and advanced nurse practitioners are at the forefront of patients' treatment journeys and play a central role in supporting patients and families to manage side effects. Through this support, patients can continue the treatments for as long as possible with the aim of maintaining a good quality of life.
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Affiliation(s)
- Teresa Meenaghan
- Advanced Nurse Practitioner, Haematology Department, Galway University Hospital, Ireland
| | - Amjad Hayat
- Consultant Haematologist and Director of Blood and Tissue Establishment and the Stem Cell Lab, Haematology Department, Galway University Hospital, Ireland
| | - Geraldine Walpole
- Advanced Nurse Practitioner, Haematology, Sligo University Hospital, Ireland
| | - Maura Dowling
- Associate Professor, School of Nursing and Midwifery, University of Galway, Ireland
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Osmani F, Arab-Zozani M, Shahali Z, Lotfi F. Evaluation of the effectiveness of electronic prescription in reducing medical and medical errors (systematic review study). Ann Pharm Fr 2023; 81:433-445. [PMID: 36513154 PMCID: PMC9737496 DOI: 10.1016/j.pharma.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 08/29/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The use of electronic systems in prescription is considered as the final solution to overcome the many problems of the paper transcription process, especially with the outbreak of Coronavirus needs more attention than before. But despite the many advantages, its implementation faces many challenges and obstacles. Therefore, the present study was conducted to review the effectiveness of computerized physician order entry systems (CPOE) on relative risk reduction on medication error and adverse drug events (ADE). METHOD This study is one of the systematic review studies that was conducted in 2021. In this study, searching for keywords such as E-Electronic Prescription, Patient safety, Medication Errors prescription, Drug Interactions, orginal articles from 2000 to October-2020 in the valid databases such as ISI web of Science PubMed Embase, Scopus and search engines like google was done. The included studies were based on the main objectives of the study and based on the inclusion criteria after several stages of review and quality evaluation. In fact, the main criteria for selecting articles were studies that compared the rate of medication errors with or without assessing the associated harms (real or potential) before and after the implementation of EMS. RESULTS Out of 110 selected studies after initial screening, only 16 articles were selected due to their relevance. Among the final studies, there was a significant heterogeneity. Only 6 studies were of good quality. Of the 10 studies prescribing error rates, 9 reported reductions, but variable denominators prevented meta-analysis. Twelve studies provided specific examples of systemic drug errors. 5 cases reported their occurrence slightly. Out of 9 cases that analyzed the effects on drug error rate, 7 cases showed a significant relative reduction between 13 and 99%. Four of the six studies that analyzed the effects on potential ADEs showed a significant relative reduction of between 35 and 98%. Two of the four studies that analyzed the effect of ADEs showed a relative reduction of between 30 and 84%. CONCLUSION Finally, e-prescribing seems to reduce the risk of medication errors and ADE. However, the studies differed significantly in terms of setting, design, quality and results. More randomized controlled trials (RCTs) are needed to further improve the evidence of health informatics information.
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Affiliation(s)
- F Osmani
- Infection disease Research center, Birjand University of Medical Sciences, Birjand, Iran.
| | - M Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Z Shahali
- National Center for Health Insurance Research, Tehran, Iran
| | - F Lotfi
- National Center for Health Insurance Research, Tehran, Iran
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Vawter-Lee M, Natarajan N, Rang K, Horn PS, Pardo AC, Thomas CW. Topiramate Is Safe for Refractory Neonatal Seizures: A Multicenter Retrospective Cohort Study of Necrotizing Enterocolitis Risk. Pediatr Neurol 2022; 129:7-13. [PMID: 35131568 DOI: 10.1016/j.pediatrneurol.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND A previously published, single-institution, case series suggested an association between topiramate administration in neonates and subsequent development of necrotizing enterocolitis (NEC). This contradicted our more extensive experiences using topiramate in this population. We therefore studied safety and tolerability of topiramate for treating refractory neonatal seizures, hypothesizing that the risk of developing NEC following topiramate exposure was low and that most infants tolerate topiramate. METHODS This multicenter retrospective cohort study included seventy-five neonates who received topiramate to treat seizures from January 2011 to October 2019 at three geographically diverse level IV neonatal intensive care units affiliated with pediatric tertiary hospitals. Data included demographics, birth history, seizure etiology, treatment response, side effects, and occurrence and details of NEC. RESULTS Three of seventy-five infants (4%) developed NEC following topiramate exposure. These infants did not differ in gestational age, birth weight, seizure etiology, postmenstrual age, weight when topiramate was initiated, or dosing of topiramate. Topiramate was well tolerated. Only three infants (4%) discontinued due to side effects. The most common side effect (20%) was weight loss (typically <5%). Topiramate was felt to be efficacious (61%). Most infants (72%) continued topiramate when discharged. CONCLUSIONS Our multicenter, 75-infant study demonstrated that development of NEC after treatment with topiramate was rare (4%) and refutes prior literature suggesting an association. Topiramate was felt to be efficacious and was well tolerated. Although limited by retrospective design, study data are broadly applicable and support thoughtful use of topiramate as a safe, reasonable option for treating refractory neonatal seizures.
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Affiliation(s)
- Marissa Vawter-Lee
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Niranjana Natarajan
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington; Division of Pediatric Neurology, Department of Neurology, University of Washington, Seattle, Washington
| | - Kelly Rang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Paul S Horn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrea C Pardo
- Division of Pediatric Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Cameron W Thomas
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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Hegeman MC, Schoemaker-Delsing JA, Luttikholt JTM, Vonkeman HE. Patient perspectives on how to improve education on medication side effects: cross-sectional observational study at a rheumatology clinic in The Netherlands. Rheumatol Int 2021; 41:973-979. [PMID: 33730208 PMCID: PMC8019410 DOI: 10.1007/s00296-021-04815-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Abstract
Rheumatoid arthritis (RA) patients often report lacking information on medication side effects. The aims of this study were to observe how rheumatology healthcare providers deliver medication information and to determine in which specific domains information is missing. First, 12 single-blinded structured observations were performed during regular RA patient consultations. The observers noted whether and how medication and medication side effects were discussed. Second, 100 RA patients were asked to fill out an adaptation of the Satisfaction with Information about Medicines Scale (SIMS). Medication was discussed during all observed consultations. With new medication, its purpose and mode of action were explained in all cases, but possible side effects in only 33%. Overall, medication side effects were discussed in 58% of consultations. Most information delivery was verbal (92%). Response rate to the questionnaire was 61%. Overall satisfaction with medication education was mean 7.3 (± 1.9) (NRS 0-10) with a comparable high SIMS total satisfaction sum score of mean 12.3 (± 4.4). At subscale score levels, 89% were satisfied with the amount of information on the action and usage of medication, but only 47% with the information on the potential problems of medication. RA patients express overall high satisfaction with their medication education but there is still an unmet need for information on potential risks and side effects. Using the SIMS questionnaire in daily clinical practice may help focus medication education to the needs of the individual patient.
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Affiliation(s)
- Mirjam C Hegeman
- Department Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | | | - Harald E Vonkeman
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands. .,Department Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands.
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Abstract
Interstitial lung disease in children (chILD) comprises a range of different rare diseases. There is limited evidence for the treatment of chILD and no randomised clinical trials of treatment have been undertaken. Most treatments are therefore prescribed off-label based on expert opinion. The off-label nature of prescription of drugs for chILD highlights the importance of a solid understanding of the side effects to facilitate risk-benefit assessment. The European Respiratory Society chILD guidelines recommend the use of systemic glucocorticosteroids, hydroxychloroquine and azithromycin. Side effects of these drugs will be discussed followed by consideration of other drugs used for the treatment of chILD.
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Affiliation(s)
- Oded Breuer
- Telethon Kids Institute, University of Western Australia, Perth, Australia; Princess Margaret Hospital for Children, Perth, Australia
| | - André Schultz
- Telethon Kids Institute, University of Western Australia, Perth, Australia; Princess Margaret Hospital for Children, Perth, Australia; School of Paediatric and Child Health, University of Western Australia, Australia.
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Abstract
Vocal tremor is a neurologic disorder with myriad etiologies (eg, Parkinson disease, medications, or essential tremor). Vocal tremor can limit intelligibility and social interaction and can result in isolation in nonprofessional voice users. In a professional singer whose entire career is based on voice quality, onset of a vocal tremor is devastating. We report a case of sudden-onset vocal tremor that impeded a young professional singer's ability to perform and record her album. The etiology was determined to be a medication side effect of lamotrigine; a reaction that has not been previously reported. Diagnosis was based on perceptual assessment of the vocal tremor, laryngeal examination, and the singer's proximate history of lamotrigine dose adjustment. Two months after decreasing her dose, all symptoms resolved and the singer returned to her tour and performance schedule. To our knowledge, this is the first report of isolated vocal tremor as a side effect of lamotrigine and demonstrates that the voice may be more sensitive to this class of medication than previously described. It is incumbent on the vocal professional to inquire about and understand that new medication or dose changes may impact their voice.
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Affiliation(s)
- Bridget L Hopewell
- Department of Otolaryngology, University of Alabama, Birmingham, Alabama.
| | - Cristen Paige
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - David O Francis
- Division of Otolaryngology and Wisconsin Surgical Outcomes Research, Department of Surgery, University of Wisconsin, Madison, Wisconsin
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Wykes T, Evans J, Paton C, Barnes TRE, Taylor D, Bentall R, Dalton B, Ruffell T, Rose D, Vitoratou S. What side effects are problematic for patients prescribed antipsychotic medication? The Maudsley Side Effects (MSE) measure for antipsychotic medication. Psychol Med 2017; 47:2369-2378. [PMID: 28420450 PMCID: PMC5820531 DOI: 10.1017/s0033291717000903] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Capturing service users' perspectives can highlight additional and different concerns to those of clinicians, but there are no up to date, self-report psychometrically sound measures of side effects of antipsychotic medications. Aim To develop a psychometrically sound measure to identify antipsychotic side effects important to service users, the Maudsley Side Effects (MSE) measure. METHOD An initial item bank was subjected to a Delphi exercise (n = 9) with psychiatrists and pharmacists, followed by service user focus groups and expert panels (n = 15) to determine item relevance and language. Feasibility and comprehensive psychometric properties were established in two samples (N43 and N50). We investigated whether we could predict the three most important side effects for individuals from their frequency, severity and life impact. RESULTS MSE is a 53-item measure with good reliability and validity. Poorer mental and physical health, but not psychotic symptoms, was related to side-effect burden. Seventy-nine percent of items were chosen as one of the three most important effects. Severity, impact and distress only predicted 'putting on weight' which was more distressing, more severe and had more life impact in those for whom it was most important. CONCLUSIONS MSE is a self-report questionnaire that identifies reliably the side-effect burden as experienced by patients. Identifying key side effects important to patients can act as a starting point for joint decision making on the type and the dose of medication.
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Affiliation(s)
- T. Wykes
- Psychology Department,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
- South London and Maudsley NHS Foundation
Trust, London UK
| | - J. Evans
- NIHR Biomedical Research Centre, South London and
Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology, and Neuroscience,
King's College London, London, UK
| | - C. Paton
- Chief Pharmacist, Oxleas NHS
Foundation Trust, Dartford, UK
| | | | - D. Taylor
- Pharmacy and Pathology, South
London and Maudsley NHS Foundation Trust, London,
UK
- Institute of Pharmaceutical Science, King's
College London, London, UK
| | - R. Bentall
- Department of Psychological Sciences,
University of Liverpool, UK
| | - B. Dalton
- Department for Psychological Medicine,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
| | - T. Ruffell
- Health Service & Population
Research, Centre for Implementation Science,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
| | - D. Rose
- Health Service & Population
Research, Centre for Implementation Science,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
| | - S. Vitoratou
- Health Service & Population
Research, Centre for Implementation Science,
Institute of Psychiatry, Psychology, and Neuroscience, King's College
London, London, UK
- Psychometrics and Measurement Lab,
Biostatistics and Health Informatics, Institute of
Psychiatry, Psychology, and Neuroscience, King's College London,
London, UK
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Kretchy IA, Owusu-Daaku FT, Danquah SA, Asampong E. A psychosocial perspective of medication side effects, experiences, coping approaches and implications for adherence in hypertension management. Clin Hypertens 2015; 21:19. [PMID: 26893929 PMCID: PMC4750803 DOI: 10.1186/s40885-015-0028-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/26/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION This study examined whether psychosocial variables influenced patients' perception and experience of side effects of their medicines, how they coped with these experiences and the impact on medication adherence behaviour. METHODS A hospital-based mixed methods study using quantitative and qualitative approaches was conducted with hypertensive patients. Participants were asked about side effects, medication adherence, common psychological symptoms and coping mechanisms with the aid of standard questionnaires and an interview guide. RESULTS The experiences of side effects-such as palpitations, frequent urination, recurrent bouts of hunger, erectile dysfunction, dizziness, cough, physical exhaustion-were categorized as no/low (39.75 %), moderate (53.0 %) and high (7.25 %). Significant relationships between depression (x (2) = 24.21, p < 0.0001), anxiety (x (2) = 42.33, p < 0.0001), stress (x (2) = 39.73, p < 0.0001) and side effects were observed. A logistic regression model using the adjusted results for this association is reported-depression [OR = 1.9 (1.03-3.57), p = 0.04], anxiety [OR = 1.5 (1.22-1.77), p ≤ 0.001] and stress [OR = 1.3 (1.02-1.71), p = 0.04]. Side effects significantly increased the probability of individuals to be non-adherent [OR = 4.84 (95 % CI 1.07-1.85), p = 0.04] with social factors, media influences and attitudes of primary care givers further explaining this relationship. Personal adoption of medication modifying strategies, espousing the use of complementary and alternative treatments and interventions made by clinicians were the main forms of coping with side effects. DISCUSSION Results from this study show that, in addition to a biomedical approach, the experience of side effects has biological, social and psychological interrelations. The results offer more support for the need for a multi-disciplinary approach to healthcare where all forms of expertise are incorporated into health provision and patient care.
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Affiliation(s)
- Irene A Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, University of Ghana School of Pharmacy, College of Health Sciences, Legon, Ghana
| | - Frances T Owusu-Daaku
- Department of Clinical and Social Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Emmanuel Asampong
- Department of Social and Behavioural Health, School of Public Health, University of Ghana, Legon, Ghana
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Petty SJ, Kantor S, Lawrence KM, Berkovic SF, Collins M, Hill KD, Makovey J, Sambrook PN, O'Brien TJ, Wark JD. Weight and fat distribution in patients taking valproate: a valproate-discordant gender-matched twin and sibling pair study. Epilepsia 2014; 55:1551-7. [PMID: 25124647 DOI: 10.1111/epi.12745] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Chronic treatment with valproate (VPA) is commonly associated with weight gain, which potentially has important health implications, in particular increased central fat distribution. We utilized a VPA-discordant same-sex, twin and matched sibling pair study design to primarily examine for differences in fat distribution between patients with epilepsy treated with VPA compared to their matched twin or sibling control. Weight, blood pressure, and leptin levels were assessed. METHODS Height, weight, waist and hip measurements, exercise, blood pressure (BP), and serum leptin levels were measured. Body composition was measured using dual-energy x-ray absorptiometry (DXA). Abdominal fat was expressed as a percentage of the abdominal region (AFat%); and of whole body fat (WBF); (AFat%WBF). Mean within-pair differences were assessed (VPA-user and nonuser). Restricted maximum likelihood (REML) linear mixed model analysis was fitted to examine associations of anthropometrics, zygosity, gender, menopausal status, VPA dose and duration, with weight and AFat%. RESULTS We studied 19 pairs of VPA-discordant, gender-matched (five male, 14 female) twins and siblings. Mean (standard deviation, SD) duration of therapy for VPA users was 11.0 (7.4) years. There were no statistically significant within-pair differences in age, height, weight, body mass index (BMI), BP, leptin level, WBF, AFat%, or AFat%WBF. For pairs in which VPA-user was treated for >11 years there were statistically significant mean within-pair differences in AFat%, (+7.1%, p = 0.03, n = 10 pairs), mean BP (+11.0 mm Hg, p = 0.006, n = 8 pairs); but not in AFat%WBF. VPA duration was positively associated with weight (estimate +0.98 kg/per year of VPA, p = 0.03); VPA treatment duration and dose were not significantly associated with AFat%. SIGNIFICANCE This study demonstrated a relationship between long-term VPA use and abdominal adiposity (AFat%), which could have significant health implications. We recommend ongoing monitoring of weight, BMI, and blood pressure for patients taking VPA.
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Affiliation(s)
- Sandra J Petty
- Department of Medicine, Melbourne Brain Centre, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia; Ormond College, Parkville, Victoria, Australia
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