Background Metabolic syndrome (MetS) represents a collection of metabolic risk factors such as obesity, dyslipidemia, hyperglycemia, and hypertension. Medications can increase the incidence rate of MetS and insulin resistance (IR). Objective This study aims to evaluate the effects of Carbamazepine (CBZ) or Valproate (VPA) as monotherapy on the development of MetS and IR in the adult Iranian epileptic patients. Methods In this observational analytic case-control study, 80 epileptic patients were treated with VPA (40 patients) or CBZ (40 patients) monotherapies for more than 6 months and 45 age and sex matched controls were included. MetS was assessed based on International Diabetes Federation (IDF) and National Cholesterol Education Program (NCEP) criteria. Results In the multiple regression analysis, in VPA-treated patients the risk of MetS (by IDF criteria) was increased 19 times higher than controls (OR = 19.20; 95% CI = 2.62-140.23, P = 0. 004) and risk of IR (by HOMA and QUICKI) was increased 15 and 9 times more than controls (OR = 14.83; 95% CI = 3.03–72.56, P = 0.001) and (OR = 9.13; 95% CI = 2.55–32.65, P = 0.001) respectively. Increase in waist, DBP, and insulin level were also showed as important factors in risk of MetS. In CBZ therapy, the risk of MetS (by IDF) depressed by 17% less than controls and the risk of IR (by HOMA) increased 7 times more than controls. Conclusion Treatment with VPA can increase the likelihood of developing MetS and IR while, CBZ therapy could decrease the risk of MetS and increase risk of IR in the epileptic patients in Iran compared to the general population.
This is a case study of a 34-year-old woman who was admitted to hospital with a history of severe orthostatic headache. She was diagnosed as having spontaneous intracranial hypotension (SIH) by undetectable cerebrospinal fluid (CSF) pressure at lumbar puncture, and with evidence of diffuse dural enhancement of the brain detected by magnetic resonance imaging (MRI). However, the contrast-enhanced MRI of the spinal cord did not show a CSF leak site and she was treated conservatively. After a few days, the patient's recurrence of headache with continuous duration and progressive worsening led to further investigations by contrast-enhanced MRI, magnetic resonance venography (MRV) and computed tomography venography (CTV) that showed an extensive thrombosis in the superior sagittal sinus, left sigmoid sinus and both transverse sinuses. Then, the patient was treated successfully with heparin and oral anticoagulant. She had no neurological deficit after six months. SIH with concomitant intracranial cerebral venous thrombosis is a rare condition. We hypothesize that SIH may change cerebral bloodflow velocity and viscosity and can cause intracranial cerebral venous thrombosis.
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