Influence of Different Antiepileptic Drugs on Blood Ammonia and Homocysteine Levels in Children with Epilepsy

Abstract

In this study, we performed a study on 106 children with epilepsy who were treated with sodium valproate (the VPA group, n = 37), oxcarbazepine (the OXC group, n = 34), or levetiracetam (the LEV group, n = 35). In addition, the clinical data of epileptic children who were newly diagnosed in the same period without antiepileptic drug (AED) treatment (the untreated group, n = 35) and normal children who received physical examination in our hospital (the healthy group, n = 35) were selected as controls. We analyzed the efficacy and safety of different AEDs, used blood ammonia and homocysteine levels as the observation indicators, and calculated the incidence of hyperammonemia (VAH) and hyperhomocysteinemia (HHcy) treated with different AEDs. And, based on the effect of epilepsy status on the cognitive function of patients, we also analyzed the effect of different AED treatments on children’s cognitive function. Our results show that sodium valproate, oxcarbazepine, and levetiracetam are all effective in the treatment of children with epilepsy and can be used as the first-line choice of antiepileptic treatment for children with epilepsy. However, compared with sodium valproate, levetiracetam and oxcarbazepine have a lower incidence of adverse drug reactions and do not cause an increase in blood ammonia and Hcy levels, so they have higher safety of drug treatment. In addition, compared with sodium valproate, levetiracetam and oxcarbazepine have better recovery of cognitive function in children with epilepsy and so they have better application value.

Age Related Homocysteine Serum Levels Elevate in Men with Epilepsy

“…However, it is still not clearly known whether Hcy levels elevate in response to epilepsy disorders, AEDs, a collective effect, and/ or other factors. Though it has further been found that sodium valproate, oxcarbazepine, and levetiracetam are all effective as the first-line choice for the treatment of epilepsy and that levetiracetam and oxcarbazepine show lower incidence of adverse effects and do not increase blood Hcy 12 , it is still confusing to interpret the alterations in Hcy in patients with epilepsy 14 .…”

“…The free Hcy might be more harmful than the protein-bound Hcy3, though few studies have distinguished between the two forms of Hcy. Epilepsies showing a variety of alterations, including elevated levels of Hcy 11 and related disorders, are treated by long-term AEDs 12 . Some of those, e.g., phenytoin (PHT) and carbamazepine that are enzyme-inducing AEDs, may cause disorders with elevated blood levels of Hcy 12 .…”

“…Epilepsies showing a variety of alterations, including elevated levels of Hcy 11 and related disorders, are treated by long-term AEDs 12 . Some of those, e.g., phenytoin (PHT) and carbamazepine that are enzyme-inducing AEDs, may cause disorders with elevated blood levels of Hcy 12 . However, a case-control study in patients with epilepsy receiving PHT does not confirm considerable elevated Hcy levels 13 .…”

“…Another AED levetiracetam does not cause considerable change in the levels of Hcy, though used with high dosages for long-term treatment 11,12 . It has further been found that sodium valproate, oxcarbazepine, and levetiracetam are all effective as the first-line choice for the treatment of epilepsy, though levetiracetam and oxcarbazepine showed a lower incidence of adverse effects and did not increase blood Hcy 12 .…”

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

“…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.…”