Assessment of asymmetric dimethylarginine and homocysteine in epileptic children receiving antiepileptic drugs

Abstract

Background Epilepsy is a neurological disease that requires long-term antiepileptic drugs (AEDs). The old generation of AEDs may affect serum homocysteine and asymmetric dimethylarginine (ADMA) and disturb lipid levels. The aim of the study was to evaluate serum ADMA, homocysteine, lipid profile, and carotid intima-media thickness (CIMT) in epileptic children. Methods This study was implemented on 159 epileptic children who were subdivided into 3 subgroups, with 53 receiving sodium valproate, 53 receiving levetiracetam, and 53 receiving polytherapy, for over 6 months and 53 healthy children. Results Low-density lipoprotein, triglycerides, and cholesterol levels were increased in epileptic children (p < 0.001), which were higher in those receiving multidrug followed by a valproate receiver. While high-density lipoprotein was lower in those receiving multidrug more than those receiving valproate. ADMA and homocysteine levels increased in epileptic patients than in controls (p < 0.001). Higher ADMA was also observed in the multidrug receiver (5.78 ± 0.62), followed by the levetiracetam group (5.56 ± 0.61). Homocysteine levels were significantly higher in multidrug and valproate-treated children than those treated with levetiracetam. CIMT was significantly higher in multidrug and valproate-treated patients (p < 0.001). Conclusions Long-term use of AEDs, especially old-generation polytherapy, can elevate lipid profiles, homocysteine, ADMA levels, and carotid intima-media thickness compared to the minimal effect of new AEDs. Impact The long-term use of antiepileptic drugs, especially old-generation polytherapy, can increase lipid profiles, homocysteine levels, ADMA, and carotid intima thickness compared to the minimal effect of new antiepileptic generation. A routine follow-up of these markers and a lifestyle modification are recommended to avoid cerebrovascular events as much as possible.

Effects of New Antiepileptic Drugs on Homocysteine in Epileptic Patients: A Systematic Review and Meta-Analysis

“…A meta-regression analysis was used to identify the source of heterogeneity among studies. Publication biases were assessed by Egger's tests (Stata 16.0) [20]. Two-sidedP < 0.05 was considered statistically signifcant.…”

“…Compared with older AEDs, these new AEDs are less likely to infuence hepatic enzymes [9] and are supposed to be less likely to disrupt Hcy metabolism [10]. In recent years, some case-control studies have been conducted to explore the correlation between Hcy and new AEDs [11][12][13][14][15][16][17][18][19][20]. In a case study, Sun et al argued that the new AEDS do not cause elevated blood ammonia and Hcy levels, so they have high drug safety.…”

Do Antiepileptic Drugs Change the Levels of Arginine Derivatives in Epileptic Children Treated with Polytherapy? The Results of a Case–Control Study

“…Epileptic children receiving VPA were characterized by a simultaneous increase in ADMA and HCys concentrations compared to controls [ 7 ]. The latest research by Mahmoud et al [ 19 ] found that long-term use of AEDs can increase lipid profiles, homocysteine, and ADMA levels. The authors also observed that this effect is particularly noticeable in the case of polytherapy with old-generation drugs, while in the case of new AEDs, a minimal effect was observed.…”

“…The authors also observed that this effect is particularly noticeable in the case of polytherapy with old-generation drugs, while in the case of new AEDs, a minimal effect was observed. [ 19 ].…”