Long-term Anticonvulsant Therapy Research Articles

Assessment of bone mineral density in epileptic patients with long-term antiepileptic therapy: pilot data

Currently, there are numerous anticonvulsants with a favorable pharmacological profile and high safety are available. However, there is still a risk of drug-induced adverse events during long-term administration of antiepileptic therapy. One of the most unfavorable changes in bone tissue associated with anticonvulsant use is osteoporotic disorders, which result in a loss of bone density, making the bones more fragile and prone to fractures. The problem of decreased bone mineral density and frequent fractures in patients with epilepsy is an important and understudied issue that significantly reduces quality of life and involves significant economic costs for the treatment and rehabilitation of epileptic patients. Studying the interaction between osteoporosis and epilepsy is of great importance for the development of effective methods for timely diagnosis, treatment and prevention of bone metabolism disorders. This article presents pilot results of a study to investigate the effect of antiepileptic therapy on mineral metabolism and bone density. The aim of the study: to evaluate bone mineral density in adult patients with epilepsy long-term receiving antiepileptic therapy. Materials and methods. Thirty-eight adult patients with epilepsy taking antiepileptic drugs for a long time were examined. All patients underwent general clinical, neurologic examination and densitometric study by quantitative computed tomography at three points (L1, L2 and femoral neck). Results. Decreased bone mineral density was found in 34.2% of the patients. Of them, 29% had osteopenia and 5.2% - osteoporosis. The change in mineral density was observed at a median duration of antiepileptic therapy of 8 years. ROC analysis showed that bone mineral density decreased statistically significantly with increasing duration of anitconvulsant therapy (SROC 0.929±0.052; 95% CI: 0.827-1.000). Correlation analysis revealed a markedly close association (ρ = -0.626, p < 0.001) between bone mineral density and duration of antiepileptic therapy. Conclusion. The results of the study confirm the effect of antiepileptic therapy on bone mineral density. And show that the probability of developing osteopenia and osteoprosis with longer duration of anticonvulsant therapy is higher than in the general population. The study of the effects of antiepileptic drugs on bone metabolism has important clinical implications for effective strategies for prescribing antiepileptic therapy in epileptic patients and requires further research.

A prospective study on clinical signs, management, outcomes, and delayed neurologic sequelae due to metaldehyde poisoning in 26 dogs.

Metaldehyde poisoning in dogs is well known and described issue. Several studies focused on the incidence, epidemiological features, and clinical and pathological findings associated with this intoxication. However, there are no prospective studies of metaldehyde poisoning and late-onset seizures. To prospectively describe clinical signs, therapeutic management, outcomes, and delayed-onset seizures due to metaldehyde poisoning in dogs. A 15-month prospective study on dogs with a diagnosis of metaldehyde poisoning, either via phone call to the animal poison control center or analysis at the toxicology laboratory in Lyon, France. Clinical signs, therapeutic management and outcomes, and the late onset of seizures were assessed for at least 3 years. Twenty-six dogs were enrolled in the study. The most prevalent clinical signs were ataxia (18 dogs), convulsions (17), hypersalivation (15), and tremors (15). Treatment was symptomatic (e.g., activated charcoal, emetic therapy, and intravenous fluids) with anticonvulsant therapy (mainly diazepam). The overall survival rate was 81% (21/26 dogs). All dogs that received active charcoal (11/11) or emetic therapy (4/4) survived. Twelve of 17 dogs had convulsions and survived; 9 were followed up for at least 3 years after poisoning, and none had any other seizure episode or neurological sequelae. This prospective study describes clinical signs, therapeutic management and outcome of metaldehyde poisoning in dogs, and late-onset neurologic sequelae. None of the nine cases that were followed for 3 years developed neurological signs after metaldehyde poisoning. Therefore, long-term antiepileptic therapy is not indicated.

The Clinical Characteristics and Prognosis of Children Presenting with New Onset Refractory Status Epilepticus in COVID-19 Related Multisystem Inflammatory Syndrome

AbstractMultisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory process leading to multiorgan failure and shock, occurring during the acute or post-infectious stage of severe acute respiratory syndrome coronavirus (SARS-CoV-2), and has two subtypes: para-infectious and post-infectious varieties. The new onset of refractory status epilepticus has rarely been described as the presenting feature of MIS-C. This retrospective study, conducted at Dr. B.C. Roy Post Graduate Institute of Pediatric Sciences, included children hospitalized between August 1, 2020 and July 31, 2021, with new-onset refractory status epilepticus (NORSE) and subsequently diagnosed to have MIS-C. Their clinico-demographic variables, treatment courses during hospital stays, laboratory reports, radiological and electrophysiological findings, and outcomes at discharge and follow-up over 1 year were recorded. At their 12 month visits, their motor disabilities (primary) and continuation of anti-epileptic drugs, and persistence of magnetic resonance imaging (MRI) brain abnormalities (secondary) were the outcome measures. The characteristics of the patients in the para-infectious and post-infectious groups were compared using the Mann-Whitney U test for continuous variables and the Chi-square test for categorical variables. There were eight and 10 patients in groups A and B, respectively. Patients in group B had significantly higher age, more prolonged refractory status epilepticus (RSE), use of anesthetics and ventilation, and longer pediatric intensive care unit (PICU) stay, while other clinical and laboratory parameters and short and long-term outcomes were not significantly different between the two groups. Eight patients developed hemiparesis, while two had quadriparesis in the acute stage, but 15 (83%) patients had complete recovery from their motor deficits by 1 year. At 1-year follow-up, 33 and 39% of patients, respectively, had abnormal MRI and electroencephalogram (EEG). Acute disseminated encephalitis and acute leukoencephalopathy were the most commonly observed MRI abnormalities in the acute phase, with prolonged persistence of cerebritis in patients in the post-infectious group, warranting long-term immunomodulation. Combined immunotherapy with intravenous immunoglobulin and steroids was effective in the acute phase. However, long-term anti-epileptic therapy was needed in both groups.

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

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.

Epilepsy and psychosis– where are we now?

IntroductionEpilepsy has long been considered a risk factor for psychosis, and studies estimate that up to 80% of patients with epilepsy will experience a psychotic episode at some point in the course of their disease. However, data on the treatment of psychotic disorders in epilepsy is limited and the management of these problems is still founded on individual clinical experience.ObjectivesTo assess evidence pertaining psychosis related to epilepsy, especially its risks factors and treatment approaches available.MethodsBibliographic research was made through the PubMed/NCBI database. No time limit was specified on the search. Pertinent manuscripts were individually reviewed for additional relevant citations.ResultsRecent literature shows a prevalence in psychotic disorders of 5.6%, and up to 7% in patients with epilepsy. So far, mechanisms of psychosis in epileptic patients remain unknown. Risk factors are earlier age of epilepsy onset, more frequent seizures, longer duration of epilepsy, high number of relatives with epilepsy and long-term antiepileptic drugs therapy. Psychiatric manifestations may include both positive and negative symptoms, including auditory hallucinations, paranoid delusions, and disorganized thought and/or behaviour. Poor adherence to treatment with oral antipsychotics occurs in more than 40% of patients; long-acting injectable medication should be considered, bearing in mind interactions with anti-epileptic medication and possibility of increased side effects.ConclusionsOur findings emphasize the importance of early recognition and management of psychosis in epileptic patients. Unfortunately, there is lack of evidence for the use of antipsychotic medication in epileptic patients, since available studies pertain to populations with primary psychiatric disorders.

Eucalyptus Oil-Induced Seizures in Children: A Single-Center Prospective Study.

ObjectiveEucalyptus oil (EO) is known to have proconvulsant properties. EO is present in many over-the-counter preparations and used orally or topically to treat many ailments. In this study, we seek to describe clinical features, neuroimaging, and electroencephalographic findings and follow up outcome in children with eucalyptus oil-induced seizures (EOIS).Materials and methodsThis was a single-center prospective observational study, conducted at a tertiary care hospital from South India over a period of two years. Children (up to 18 years of age) with a first afebrile seizure or breakthrough seizures with preexisting epilepsy and with a recent exposure to EO were included. Data from all the children including demographic data, exposure to EO, mode of exposure, time to onset of seizures in relation to exposure, duration of seizure, type of seizure, investigations, and antiepileptic drug therapy were noted. All the patients were followed up for recurrence of seizures for six to nine months. ResultsDuring the study period of two years, a total of 17 children met the inclusion criteria, with a median (range) age of 3.75 years (23 - 150 months) and 10 (59%) were male. Only one patient had breakthrough seizures and all other 16 children had a first episode of seizure. All the children had generalized tonic-clonic seizures with median duration of three minutes (30 sec - 30 minutes). The median (range) interval between EO exposure and the onset of seizures was 20 minutes (10 - 120 minutes). All the children had taken EO drops orally mixed in either water or milk in different amounts. All the patients' brain neuroimaging was normal. All the patients had normal electroencephalography except for four children. Only five patients were treated with antiepileptic drugs for two weeks and one patient with preexisting epilepsy was continued on the same antiepileptic drug. None of the patients had a recurrence of seizures during the follow-up period of six to nine months.Conclusion EOIS is an underrecognized and rare entity of seizures in children. EOIS can occur as first seizures or as breakthrough seizures in preexisting epilepsy patients. Despite the previous case reports in the literature quoting the seizurogenic potential of EO, this awareness is lacking in both clinicians and parents. We also recommend clinicians inquire about exposure to EO while approaching a child with first afebrile seizures or breakthrough seizures, which can prevent unnecessary investigations and long-term antiepileptic drug therapy.

The effects of antiepileptic drugs on bone health: A systematic review

PurposeEpilepsy may be treated with antiepileptic drugs (AEDs), which have been reported to decrease bone mineral density (BMD). Current data is conflicting and variable, and little is known with regard to how duration of AED use or specific AEDs, such as CYP-450 enzyme-inducing (EIAEDs) versus non-enzyme inducing (NEIAEDs) drugs affect BMD. We sought to systematically review BMD changes due to AED use to identify trends in reporting. MethodsA literature search via Medline (PubMed), EMBASE, and Cochrane databases was performed. Peer-reviewed articles were identified that reported on BMD measurements in conjunction with AEDs. ResultsTwenty-six studies met inclusion criteria. Long-term therapy was shown across multiple, well-controlled studies to have the most significant BMD loss. Carbamazepine had the most frequent reporting of unfavorable effects on bone health and Lamotrigine seemed to show the most bone-protective qualities. Serum biochemical markers of bone turnover did not significantly correlate with measured BMD changes. ConclusionThe present study provides evidence that long-term AED therapy is the most significant risk factor for BMD loss. Furthermore, there was little compelling evidence to support that EIAEDs, as a class, were more harmful to bone than NEIAEDs, which has been previously suggested in multiple studies. Early clinical concern for significant loss of BMD may not be warranted as lower BMD was less likely to be observed during the initial years of AED therapy. Furthermore, serum markers of bone turnover are not clinically reliable in assessing BMD changes in patients taking AEDs.

Longterm Antiepileptic Therapy and Bone Health: Implications for Patients with Brain Tumors.

The objective of our study was to investigate the effects of carbamazepine (CBZ) and lamotrigine (LTG) treatment on bone metabolism in epileptic patients. A cross-sectional study was performed on normal controls (N=30) and 100 patients with symptomatic epilepsy caused by a primary brain tumor, divided into two groups according to the treatment: LTG monotherapy group (N=50) and CBZ monotherapy group (N=50). For each participant serum levels of 25-OHD and osteocalcin (OCLN) were measured, and bone mineral density (BMD) was evaluated by the dual-energy X-ray absorptiometry method. There was no statistically significant difference in the average values of vitamin D in serum between the CBZ and LTG groups (Vitamin D CBZ 17.03±12.86 vs. Vitamin D LTG 17.97±9.15; F=0.171, P=0.680). There was no statistically significant difference in the average values of OCLN between the CBZ and LTG groups (OCLN CBZ 26.06±10.87 vs. OCLN LTG 27.87±28.45; F=0.171, P=0.674). The BMD value was lower in both groups using antiepileptic agents compared to the controls, but when comparing the CBZ group to the LTG group, a statistically significant difference was only observed for the Z score (T-score CBZ: 0.08± 1.38 vs. T-score LTG: 0.37± 1.02; F=1.495, P=0.224; Z score CBZ: -0.05±1.17 vs. Z. score CBZ: 0.38±0.96; F=4.069, P=0.046) (Table 3). The choice of antiepileptic agents for treating seizures in patients with brain tumors should be carefully evaluated in relation to their impact on bone health. These patients could benefit from supplementation and regular measurement of biochemical markers of bone turnover and BMD.

Eucalyptus Oil-Induced Seizures in Children: Case Reports and Review of the Literature.

Objective Eucalyptus oil (EO)-induced seizures (EOIS) in children is a less recognized entity and a rare cause of acute symptomatic seizures. The purpose of this review outlines the clinical features and outcomes of EOIS with observed cases. Patients and Methods We identified three pediatric patients with EOIS who were treated at Prathima Institute of Medical Sciences, Karim Nagar, India. Results Seizures were developed in three children within 15 to 25 minutes after the ingestion of EO. All the children have taken EO first time and all have the first episode of seizures. One child had status epilepticus. Neuroimaging and electroencephalogram were normal. Two children were treated with antiepileptic drugs for 2 weeks. All the children were recovered within 2 days and none of them had a recurrence of seizures. Conclusion EOIS is an underrecognized and rare entity. The knowledge or awareness of EOIS among health care professionals can prevent unnecessary investigations and long-term antiepileptic drug therapy.

Effects of Long-term Antiepileptic Therapy on Carotid Artery Intima- Media Thickness.

ABSTRACTBackground:Common first-line antiepileptic drugs (AEDs) used in children are valproate, phenytoin, and levetiracetam. Many side effects for these AEDs are reported including obesity, atherosclerosis, and metabolic syndrome. The aim of our study was to evaluate changes in carotid artery intima-media thickness (CIMT) in epileptic children and to correlate with lipid profile of those who are on long-term antiepileptic therapy.Materials and Methods:This case–control study was done over 18 months in department of pediatrics. Sample size was 84 with equal number of cases and controls. Epileptic children between 1 and 18 years of age receiving monotherapy with valproate, phenytoin, or levetiracetam for at least 6 months were included in the study. Measurement of CIMT was done by B mode ultrasonography. Lipid profile was analyzed. Statistical analysis was performed using one-way analysis of variance (ANOVA) test and Pearson correlation.Results:Among 42 cases of epilepsy, 30 were on valproate, 9 on phenytoin, and 3 on levetiracetam monotherapy. No significant difference was noted in body mass index (BMI) among children receiving AED compared with that of controls (P = 0.82). Mean value for CIMT was significantly higher among valproate (0.43 ± 0.04, P ≤ 0.001), phenytoin (0.44 ± 0.04, P ≤ 0.001), and levetiracetam group (0.43 ± 0.03, P = 0.01) compared to controls (0.39 ± 0.01). Significant correlation was noted between CIMT and total cholesterol (P = 0.034), triglyceride (P = 0.011), low-density lipoprotein (P = 0.008), and very low-density lipoprotein (P = 0.011).Conclusion:Children on long-term monotherapy with valproate, phenytoin, and levetiracetam have significantly abnormal CIMT. This might be associated with atherosclerotic changes, and these children may require close follow-up to prevent cardiovascular and cerebrovascular risks.

A Case Report of Idiopathic Ketotic Hypoglycemia Masquerading as Epilepsy

AbstractIdiopathic ketotic hypoglycemia (IKH) is characterized by recurrent neurohypoglycemic symptoms with ketosis. Hypoglycemic episodes typically occur during early mornings, especially either with illness and/or prolonged fasting. We reported a case of IKH which presented with recurrent episodes of seizures during early morning with intercurrent illness and which was labeled as epilepsy and started on antiepileptic medication. The purpose of this case report is to alert clinicians about this condition, which is not an uncommon entity, but rarely thought of. Therefore, in view of keeping the IKH in mind, which can be prevented with proper diet advice during illness, unnecessary long-term antiepileptic therapy can be avoided.

Medication Use and the Risk of Newly Diagnosed Diabetes in Patients with Epilepsy

Epilepsy is a common neurological disorder that affects millions of people worldwide. Patients with epilepsy generally require long-term antiepileptic therapy and many of them receive polypharmacy. Certain medications, including older-generation antiepileptic drugs, have been known to predispose patients to developing diabetes. Although data mining techniques have become widely used in healthcare, they have seldom been applied in this clinical problem. Here, the authors used association rule mining to discover drugs or drug combinations that may be associated with newly diagnosed diabetes. Their findings indicate in addition to the most common culprits such as phenytoin and valproic acid, prescriptions containing carbamazepine, oxcarbazepine, or lamotrigine may be related to the development of newly diagnosed diabetes. These mined rules are useful as guidance to both clinical practice and future research.

Low-velocity simultaneous bilateral femoral neck fracture following long-term antiepileptic therapy: A case report

Low-velocity simultaneous bilateral femoral neck fracture following long-term antiepileptic therapy: A case report

Psychosis in adults with epilepsy and its relationship to demographic, clinical and treatment variables

ABSTRACTObjectives: Psychiatric symptoms and disorders are commonly reported with epilepsy. This study aimed to determine the prevalence of interictal psychosis (IIP) in adults with epilepsy and its risk predictors.Methods: The study included 710 patients (mean age: 36.40 years; age at onset: 13.58 years; duration of epilepsy: 22.80 years). All underwent neurological and psychiatric interviewing, electroencephalography and brain imaging.Results: IIP was reported in 20.65%, of them 50% had temporal lobe epilepsy with impaired awareness and/or to bilateral tonic clonic, 42.47% had frontal lobe epilepsy with impaired awareness and/or to bilateral tonic clonic and 7.53% had generalized tonic-clonic seizures. Compared to patients without psychosis, patients with psychosis were older at age of examination, had earlier age at onset, frequent seizures, longer duration of epilepsy and long-term antiepileptic drugs therapy and many relatives with epilepsy. Nearly 76.71% had history of postictal psychosis (PIP). The mean age of onset of IIP was 30.45 years and its mean duration was 3.84 months. Approximately 22% of patients with IIP had family history of psychosis. Patients developed IIP 10 years or more after epilepsy onset. Multivariate logistic regression analyses showed that predictors for IIP were the age at onset and duration of epilepsy, number of seizures, family history of epilepsy or psychosis, history of PIP and different types of epilepsy.Conclusion: IIP is not infrequent with chronic epilepsy regardless to its type. These findings emphasize the importance of optimizing patients’ treatment and early recognition and management of IIP.Abbreviations: IIP: interictal psychosis; PIP: post-ictal psychosis; TLE: temporal lobe epilepsy; FLE: frontal lobe epilepsy; GTC: generalized tonic clonic; AEDs: antiepileptic drugs; CBZ: carbamazepine; VPA: valproate; LEV: levetiracetam; APDs: antipsychotic drugs

Multimorbidity and epilepsia in the elderly.

Epilepsia is a frequent disease in the elderly. Most of the time seizures are the consequence of another or other comorbidities and they are generally partial. Causal pathologies are either cerebral or general. The most common is the stroke, especially if it is haemorrhagic. If the seizure is delayed in relation to stroke, it defines vascular epilepsy and is an indication for long-term antiepileptic therapy. Neurodegenerative diseases, primarily Alzheimer's disease, are associated with epilepsy, but the pathophysiological links between the two are poorly understood. The clinical presentation of seizures is often atypical and the existence of memory disorders complicates the diagnosis because they make it difficult to reconstruct the anamnesis. Cranial trauma and tumours are the other classic brain causes of epilepsy. The general causes include metabolic and hydroelectrolytic disorders (especially hypoglycaemia and hyponatremia), drugs (either by their toxicity or by a withdrawal syndrome), and uraemic encephalopathy of renal failure. Finally, alcohol is a common cause not to be neglected, including among institutionalised patients.

Ognitive Disorders and Their Correction in Children With Epilepsy

The article is devoted to the analysis of literature data on the study of cognitive disorders in children. The issues of the prevalence of these disorders are considered. Ir was noted the fact that the high prevalence of epilepsy in the population, frequent combination with mental retardation and personality changes and the need for long-term therapy anticonvulsant therapy determine the exceptional importance of this problem in pediatric neurology and psychiatry. The issues under consideration are due to the fact that the presence of cognitive disorder is one of the essential aspects in epileptological practice, as well as the fact that neurologists and psychiatrists involved in the treatment of epilepsy in children and adolescents often underestimate these disorders. The article pays attention to the etiological and pathogenetic aspects of the cognitive disorders formation, the dependence of the occurrence of these disorders on the localization of the epileptic focus, on the nature of the seizures and age-related features of the epilepsy course. It is indicated that cognitive disorders in patients with epilepsy is determined by biological and social factors interaction complex. The main points that can explain the cognitive and behavioral problems in children with epilepsy are underlined. Two mechanisms in the violation of the cognitive activity of patients with epilepsy are identified. It is indicated that psychosocial problems for patients often come to the fore, including cases when control over seizures has not been achieved yet. In particular, depression in patients with difficult to control epilepsy affects quality of life more than frequent suizures. In addition, depression can have a significant impact on cognitive function. Complaints on speech functions, memory, attention, thinking disorders that patients can present at the doctor’s appointment, are in second place after complaints on seizures. It was also given attention to the views on approaches to the treatment of cognitive disorders. It is indicated, that providing assistance to children with cognitive disorders should have a comprehensive and individual approach, combining non-medicament and medication methods.bThe funds belonging to the group of nootropic drugs, and also directed psychological correction, supported by antiepileptic therapy are applied traditionally for the treatment of cognitive disorders.

Febrile seizures: what pediatricians should know

Febrile seizures are the age-dependent and predictively favorable condition, which is observed in children under 6 years. All febrile seizures are divided into simple (2/3 of all cases), complex and febrile status. Complicated seizuresinclude attacks with focalsymptoms, prolonged and recurring throughout the day. Simple febrile seizures are short, generalized, not repeated. Simple seizures do not harm the child’s neuropsychic development, they do not transform into epilepsy, and do not need chronic prescription of anticonvulsant therapy. A child with normal development and simple febrile seizures does not need an obligatory EEG and MRI of the brain. All the patients of 18 months old or less with the first episode of febrile seizures need to be hospitalized. The risk of recurrence of seizures and their transformation into epilepsy is higher in a child with complex seizures. There is a small group of children with prolonged seizures and / or febrile status, often with neuropsychiatric developmental delay, which needs to be monitored by a neurologist and further examination. Sometimes doctor prescribes long-term anticonvulsant therapy for the children of this group. Febrile seizures can be prevented with special dosage of anticonvulsant drugs quickly reaching a therapeutic concentration in the child’s brain. Febrile seizures are not a contraindication to vaccination and revaccination, attention should be paid in case of DTP vaccination in children with repeated prolonged seizures and / or febrile status.Conflict of interest: The author of this article confirmed the lack of conflict of interest and financial support, which should be reported.

Risk of Microangiopathy in Patients with Epilepsy under Long-term Antiepileptic Drug Therapy.

Long-term antiepileptic drug (AED) therapy is considered a risk factor of atherosclerosis. Furthermore, the duration of therapy contributes to acceleration of large-vessel atherosclerosis. Therefore, in this study, we tested the hypothesis that long-term AED therapy plays a crucial role in the pathogenesis of microangiopathy in patients with epilepsy. We recruited 120 patients with epilepsy (age, 18-60 years) and 40 healthy controls. Optical coherence tomography (OCT) was used to measure the central macular thickness and diameters of the retinal artery and vein to evaluate atherosclerotic retinopathy; microalbumin and creatinine levels in urine were assessed to evaluate atherosclerotic nephropathy. In addition, high-sensitivity C-reactive protein (hs-CRP), lipid profiles, homocysteine, folate, uric acid, and body mass index were determined. The ratio of urine albumin to creatine and OCT findings showed that patients with epilepsy had higher abnormal microalbuminuria and narrowing retinal vein diameters, respectively. Multiple linear regression analysis showed that increased triglyceride and hs-CRP levels might contribute to microalbuminuria. In addition, serum creatinine, duration of AED therapy, enzyme-inducing AED therapy, and duration of enzyme-inducing AED therapy were candidate risk factors for retinal vein narrowing. Patients with epilepsy are at a higher risk for microangiopathy presented as retinopathy and nephropathy. Long-term AED therapy, particularly with enzyme-inducing AEDs; high triglyceride levels, and inflammatory processes play an important role in the development of microangiopathy in patients with epilepsy.

Serum calcium deficiency and bone mineral density in patients on long-term anti-epileptic therapy

Introduction: Epilepsy is a common chronic neurological disorder, usually requiring long-term treatment with anti-epileptic drugs (AEDs). AED therapy is associated with metabolic bone disease and is a major iatrogenic risk factor for fractures. There remains uncertainty about the type(s) of bone disease due to AED treatment and the pathogenesis of AED-associated fractures. The fracture rate in patients with epilepsy is 2–6 times higher than the rate observed in the general population. Only a few studies in India have studied the prevalence of osteopenia in patients on long-term AEDs. Purpose of Study: The purpose of this study is to find out the prevalence of osteoporosis and osteopenia and to correlate serum calcium levels with bone mineral density (BMD) by bone densitometer in patients with epilepsy on long-term AED therapy. Materials and Methods: The study was carried out at Government Medical College and Hospital where 50 cases having epilepsy of more than or equal to 2 years duration and 50 age- and sex-matched healthy controls were taken by comparing BMD and associated parameters. Results: Mean BMD value was low in cases as compared to controls in all age groups with a significant decrease in young age group and as the duration of AED therapy increased the mean BMD decreased.

Effect of Long-term Carbamazepine Therapy on Bone Health.

Introduction:Recent research reported that prolonged use of AET is associated with changes in bone metabolism, with consequent reduction in bone mineral density (BMD) and increased risk of fractures.Objectives:Therefore, the aim of our study was to investigate the effects of carbamazepine on serum levels of 25 -hydroxyvitamin D and on biomarker of bone formation and resorption (serum levels of osteocalcin).Material and methods:We measured serum levels of 25-OHD and osteocalcin (OCLN) in normal controls (n=30) and in epilepsy patients taking carbamazepine (CBZ) (n=50) in monotherapy for a period of at least twelve months. For each participant, mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry method.Results:The average value of vitamin D in serum was significantly lower in CBZ group than in control group (Vit D 17.03+12.86 vs. 32.03+6.99, p=0.0001). The average value of osteocalcin in serum was significantly higher in CBZ group than in control group (26.06+10.78 vs. 19.64+6, 54, p=0.004).BMD value in CBZ group was significantly lower than in control group (T. score CBZ: 0.08+1.38 vs. T. score control: 0.73+ 1.13, p=0.031; Z score CBZ:-0.05+1.17 vs. Z. score control: 0.55+0.79, p=0.015).Conclusion:AEDs are associated with bone disease, as evidenced by biochemical abnormalities and decreased BMD. Patients on long-term antiepileptic therapy, especially with enzyme-inducing agents, could benefit of routine measurement of biochemical markers of bone turnover, and BMD measurement as part of osteoporosis investigation.