The Investigation of Insulin Resistance in Two Groups of Epileptic Patients Treated with Sodium Valproate and Carbamazepine

Najafi, Mohammad Reza; Bazooyar, Bahareh; Zare, Mohammad Reza; Aghaghazvini, Mohammad Reza; Ansari, Behnaz; Rajaei, Ali; Dashti, Masoumeh

doi:10.4103/2277-9175.201689

Cited by 8 publications

(4 citation statements)

References 45 publications

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“…Most studies have used the HOMA index, and they have reported signi cantly increased values of IR in VPA-treated cases [1,2,36,48]. However, Naja et al [19] studied the VPA-treated Iranian patients and they reported that there were normal values of insulin and no evidence of IR in VPA-treated as case and CBZ -treated as controls and this nding has also been supported by a study conducted by Kwan et al [49]. Valproate does not stimulate insulin secretion directly, but it may interfere with the liver metabolism [50].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies reported controversial results about the risk of IR in epileptic patients treated by VPA or CBZ. Naja et al suggested VPA may not cause IR and could be prescribed safely [19] on the other hand, some clinical studies pronounced a signi cant IR in epileptic patients treated with VPA [20][21][22] As different studies reported controversial results about the risk of MetS and IR in epileptic patients treated with VPA or CBZ and the paucity of evidence on MetS and IR in the Iranian persons with epilepsy, we decided to investigate the risk of MetS and IR in two groups of epileptic patients treated with VPA or CBZ and compare them with normal control.…”

Section: Introductionmentioning

confidence: 99%

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Frequency of metabolic syndrome and insulin resistance in epileptic patients treated with sodium valproate or carbamazepine monotherapy: A Case-Control Study

Bayat¹,

Jalali²,

Poursadeghfard³

et al. 2021

Preprint

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Frequency of metabolic syndrome and insulin resistance in epileptic patients treated with sodium valproate or carbamazepine monotherapy: A Case-Control Study

Bayat¹,

Jalali²,

Poursadeghfard³

et al. 2021

Preprint

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“…It is involved in dysregulation of the hypothalamic system and adipokine levels and genetic susceptibility [ 38 ]. Compared with valproic acid, carbamazepine and topiramate have a reduced risk of altering insulin homeostasis and causing obesity [ 38 , 39 ]. Moreover, although levetiracetam, which is the most commonly used drug in our DRE patients, is considered weight-neutral, its effects on insulin homeostasis are still unclear [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Association between the Serum Coenzyme Q10 Level and Seizure Control in Patients with Drug-Resistant Epilepsy

et al. 2021

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Drug-resistant epilepsy (DRE) is a chronic neurological disorder with somatic impacts and increased risk of metabolic comorbidities. Oxidative stress might play an important role in metabolic effects and as a regulator of seizure control, while coenzyme Q10 (CoQ10) could improve insulin sensitivity through antioxidant effects. We aimed to investigate the association between CoQ10 level and clinical outcome, represented by the seizure frequency and quality of life, in DRE patients. DRE patients (N = 33) had significantly higher serum insulin levels and lower scores on the physical domain of the World Health Organization Quality of Life questionnaire (WHOQoL) than gender-age matched controls. The serum CoQ10 level (2910.4 ± 1163.7 ng/mL) was much higher in DRE patients than the normal range. Moreover, the serum CoQ10 level was significantly correlated with the seizure frequency (r = −0.412, p = 0.037) and insulin level (r = 0.409, p = 0.038). Based on stratification by insulin resistance (HOMA-IR > 2.4), the subgroup analysis showed that patients with a greater HOMA-IR had higher CoQ10 levels and lower seizure frequency, and had a significantly worse quality of life. In summary, CoQ10 could be a mediator involved in the mechanism of epilepsy and serve as a biomarker of the clinical outcome in DER patients.

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“…Recent studies have shown increase in the level of markers for cardiovascular risks, such as homocysteine levels, in these patients. [ 13 14 ]…”

Section: Introductionmentioning

confidence: 99%

Vitamin B12 and folate status in patients with epilepsy under levetiracetam monotherapy

et al. 2019

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Background:Antiepileptic drugs (AEDs) may lead to an increase in the plasma concentration of homocysteine. There is limited information, especially from Iran, regarding the risk in patients who are treated with levetiracetam as a new type of AED. The aim of the present study was to investigate the effect of levetiracetam on plasma homocysteine, vitamin B12, and folate levels in adult patients with epilepsy.Methods:We conducted a case-control study and enrolled adult patients with epilepsy who had received monotherapy with levetiracetam for at least 6 months at some time prior to the study. homocysteine serum, vitamin B12, and folate were measured, and folate and vitamin B12 intake was determined by the food frequency questionnaire (FFQ).Results:Thirty-three patients on levetiracetam and 35 control subjects aged between 18 and 60 years were enrolled. No statistically significant differences in the means of the serum markers of vitamin B12, FA, and homocysteine levels were found between the two groups. In the first model, i.e., the crude model, no significant differences were observed in the serum concentrations of homocysteine, vitamin B12, and folate. In the second model, education was considered, and body mass index and folate intake was controlled with no significant difference being observed in the mean homocysteine serum level.Conclusions:Treatment with levetiracetam in patients with epilepsy has no effect on the serum levels concentrations of homocysteine, vitamin B12, and folate. This medication is suggested for patients who use AEDs on a long-term basis and at high dosages.

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The Investigation of Insulin Resistance in Two Groups of Epileptic Patients Treated with Sodium Valproate and Carbamazepine

Cited by 8 publications

References 45 publications

Frequency of metabolic syndrome and insulin resistance in epileptic patients treated with sodium valproate or carbamazepine monotherapy: A Case-Control Study

Frequency of metabolic syndrome and insulin resistance in epileptic patients treated with sodium valproate or carbamazepine monotherapy: A Case-Control Study

Association between the Serum Coenzyme Q10 Level and Seizure Control in Patients with Drug-Resistant Epilepsy

Vitamin B12 and folate status in patients with epilepsy under levetiracetam monotherapy

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