Effects of phenytoin on serum levels of homocysteine, vitamin B12, folate in patients with epilepsy

Abstract

Background: To determine the influence of phenytoin (PHT) monotherapy on the serum levels of homocysteine (Hcy), folate and vitamin B12 in patients with epilepsy. Methods: Literature retrieval was performed through PubMed, Web of Science, Embase, Cochrane Library, Chinese Wanfang Data, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Database databases as of the end of March 2018. Pooled weighted mean difference (WMD) and 95% CIs were calculated using a random effect model. Results: A total of ten eligible studies were identified. The result revealed that the serum level of homocysteine in PHT-treated patients with epilepsy was significantly higher than that in control group (WMD = 8.47, 95% CI: 6.74 to 10.20, P < .001). In addition, the serum levels of folate (WMD = −3.51, 95% CI: −4.20 to −2.83, P < .001) and vitamin B12 (WMD = −62.23, 95% CI: −83.27 to −41.19, P < .001) were decreased significantly compared with the control group. Conclusions: Our meta-analysis indicates that PHT monotherapy is associated with the increase in the serum homocysteine levels and decreased levels of folate and vitamin B12, and hyperhomocysteinaemia may contribute to the acceleration of the atherosclerotic process. Therefore, the patients under these medications should be monitored plasma homocysteine.

Why Vitamin B12 Levels Are High In Children With Cerebral Palsy ?

“…Higher folate levels have been determined in children with CP fed by tube compared to those feeding normally. However, a high risk of folate deficiency, which may cause an increase in homocysteine levels, has been reported in children with CP using antiepileptic drugs (13,23,24). Vitamin D levels are determined by assessing 25 OH vitamin D levels in serum.…”

Thymoquinone Potentiates the Effect of Phenytoin against Electroshock-Induced Convulsions in Rats by Reducing the Hyperactivation of m-TOR Pathway and Neuroinflammation: Evidence from In Vivo, In Vitro and Computational Studies

“…PHT-PB (phenobarbital), carbamazepine (CBZ)-VPA, vigabatrin (VIG)-LTG, tiagabin (TGB)-VIG, gabapentin (GBP)-LTG and LTG-TPM (topiramate) [30][31][32]. However, 35% of still patients remain poor responders [33], which clearly indicates that additional mechanisms contribute to hyperexcitability and epileptogenesis. The gap in the therapeutic treatment of epilepsy prompted us to search for novel drug combinations targeting novel pathways.…”

A Complicated Case of Stroke, Epilepsy, and Mood Disorder: Hyperhomocysteinemia or Medication Cascade

“…An Antiepileptic Drug (AED) with the least effect on homocysteine metabolism, as well as minimal cognitive, mood, and behavioral complications, is preferred. Some studies showed classic AEDs such as phenytoin (13), phenobarbital ( 14), valproic acid (15), and carbamazepine (15) most probably could be associated with increased homocysteine levels. However, increased homocysteine levels may also be observed in patients treated with such new-generation AEDs as oxcarbazepine and topiramate (16).…”