Long-Term Effects of Antiseizure Medications

Abstract

Most patients with epilepsy will benefit from seizure control with one of an array of chronic antiseizure medications. Knowledge of the potential long-term effects of these medications is critical to prevent adverse consequences on overall health. Antiseizure medications vary in their capacities to affect the brain and peripheral nerves, hormones, bone mineralization, cardiovascular risk, renal health, hepatic, hematological, and dermatological systems. Understanding of pathophysiology and population risk has evolved, although most of the data available are still on older generation antiseizure medications such as phenytoin, carbamazepine, and valproic acid. The enzyme-inducing properties of some antiseizure medications make their effects on cardiovascular risk and bone health detrimental. Few clear guidelines exist for monitoring long-term effects of medication therapy for epilepsy. When selecting an antiseizure medication, consideration should be given to the individual patient's risks of adverse consequences on other organ systems. During monitoring of patients on chronic therapy, screening tools such as metabolic panels and bone density measurements can help stratify risk and guide management.

Bone health in children with Angelman syndrome at the ENCORE Expertise Center

“…In literature, use of ASM (in particular use of enzyme-inducing ASM such as phenytoin, carbamazepine, and also the non-enzyme-inducing valproic acid) is indicated as a strong risk factor for low bone health [ 8 , 23 , 25 , 26 ]. ASM can activate the CYP450 pathway leading to a lower 1,25(OH) 2 vitamin D level (carbamazepine, phenytoin, phenobarbital, valproic acid), inhibits osteoblast and stimulates osteoclast activity (carbamazepine, phenytoin, phenobarbital and valproic acid), and/or creates a weak acidosis with decreased bone mineralization (topiramate, zonisamid).…”

“…ASM can activate the CYP450 pathway leading to a lower 1,25(OH) 2 vitamin D level (carbamazepine, phenytoin, phenobarbital, valproic acid), inhibits osteoblast and stimulates osteoclast activity (carbamazepine, phenytoin, phenobarbital and valproic acid), and/or creates a weak acidosis with decreased bone mineralization (topiramate, zonisamid). A longer period of ASM use might have a stronger negative effect on bone health [ 8 , 25 , 26 ]. Use of three or more ASM induces a stronger risk of osteoporosis than use of one ASM [ 25 ].…”

“…A longer period of ASM use might have a stronger negative effect on bone health [ 8 , 25 , 26 ]. Use of three or more ASM induces a stronger risk of osteoporosis than use of one ASM [ 25 ]. We found a similar association of BHI-SDS with ASM use in general, with valproic acid specifically, and with the number of ASM.…”

Bone health in children with Angelman Syndrome at the ENCORE Expertise Center

“…In literature, use of ASM (in particular use of enzyme-inducing ASM such as phenytoin, carbamazepine and also the non-enzyme-inducing valproic acid), is indicated as a strong risk factor for low bone health [8, 22,24,25]. ASM can activate the CYP450 pathway leading to a lower 1,25 (OH)2 vitamin D level (carbamazepine, phenytoin, phenobarbital, valproic acid), inhibits osteoblast and stimulates osteoclast activity (carbamazepine, phenytoin, phenobarbital and valproic acid), and/or creates a weak acidosis with decreased bone mineralization (topiramate, zonisamid).…”

“…ASM can activate the CYP450 pathway leading to a lower 1,25 (OH)2 vitamin D level (carbamazepine, phenytoin, phenobarbital, valproic acid), inhibits osteoblast and stimulates osteoclast activity (carbamazepine, phenytoin, phenobarbital and valproic acid), and/or creates a weak acidosis with decreased bone mineralization (topiramate, zonisamid). A longer period of ASM use might have a stronger negative effect on bone health [8, 24,25]. Use of three or more ASM induces a stronger risk of osteoporosis than use of one ASM [24].…”