Metabolic effects of long-term antiepileptic drug therapy in South Indian children

Abstract

Abstract Background and Objectives: The adverse metabolic effects of long-term antiepileptic drug (AED) therapy are well known. But there is limited data on the same in children from India. This study was designed to look into the effect of long-term AEDs on anthropometry, glycemic parameters, insulin resistance, lipid profile, and hepatic steatosis in a cohort of South Indian children compared to healthy controls. This cross-sectional study was done in a pediatric epilepsy clinic of a tertiary care university teaching hospital. Materials and Methods: Ambulant children aged 5 to 15 years with epilepsy on AEDs for at least one year were identified. This cohort was divided into monotherapy and polytherapy groups. Age- and sex-matched controls were selected from healthy children in the community. All the cases and controls underwent a detailed general physical examination and investigations, including fasting blood glucose, fasting insulin, fasting lipid profile, and liver transaminases along with ultrasonogram of abdomen. Statistical Analysis Used: Student’s t-test, chi-square test, ANOVA/Kruskall–Walli test with Bonferroni adjustment. Results: Fifty children on long-term AED therapy (25 on monotherapy and 25 on polytherapy) and 22 controls were included in the study. Children on AED had significantly higher LDL-cholesterol, fasting blood glucose, and insulin resistance compared to controls. Four children on multiple AEDs had non-alcoholic fatty liver disease (NAFLD). Children taking oxcarbazepine regimen were found to have an adverse metabolic profile compared to those on other drugs. Conclusion: This cohort of South Indian children with epilepsy on long-term AED therapy had an adverse metabolic profile compared to matched healthy controls. Further larger community-based studies are needed to further characterize the association and develop successful intervention strategies. Emphasis on a healthy life style should be part of comprehensive epilepsy care program.