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Influence of Different Antiseizure Medications on Vascular Risk Factors in Children with Epilepsy. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101499. [PMID: 36291435 PMCID: PMC9600762 DOI: 10.3390/children9101499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022]
Abstract
Many studies have proposed that plasma homocysteine levels are increased as a side effect with the prolonged use of antiseizure medications. This is associated with an increase in carotid intima media thickness; hence, it increases the threat of atherosclerosis at a young age. We aimed to assess serum levels of homocysteine in epileptic children on long-standing antiseizure medications and its association with increased occurrence of cardiovascular disease. The study included 60 epileptic children aged between 2 and 15 years old who visited our pediatric neurology outpatient clinic and 25 apparently healthy children served as a control group. All included children were subjected to careful history taking, clinical examination, anthropometric measures, laboratory investigations including serum homocysteine levels and lipid profile, along with radiological assessment involving carotid intima media thickness and carotid stiffness. Results demonstrated a significant increase in the serum levels of homocysteine, carotid intima media thickness, and carotid stiffness in children on monotherapy of old generation antiseizure medications and polytherapy than that in children on monotherapy of new generation antiseizure medications and control children. Epileptic children on old generation and polytherapy antiseizure medications have an increased risk for cardiovascular diseases and need follow up for early intervention when needed.
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Metabolic syndrome and obstructive sleep apnea syndrome among patients with epilepsy on monotherapy. Epilepsy Behav 2020; 111:107296. [PMID: 32769040 DOI: 10.1016/j.yebeh.2020.107296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/21/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The study aimed to determine the frequency of metabolic syndrome (MetS) and obstructive sleep apnea syndrome (OSAS) in patients with epilepsy receiving monotherapy and the relationship between these syndromes and antiepileptic drugs (AEDs). METHODS Two hundred and ninety-seven patients with epilepsy between the ages of 18-65 years receiving monotherapy for at least one year and 50 healthy participants were enrolled. Body mass indices and waist circumferences were measured. Serum fasting glucose levels, high-density lipoprotein (HDL), low density lipoprotein (LDL), total cholesterol (TC), triglyceride, and serum AED concentrations were noted. The frequency of MetS in patients with epilepsy was calculated. The snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, and male gender (STOP-Bang) questionnaire was used to determine the risk of OSAS. The relationship between these two syndromes and seizure type, disease duration, AED dosage, and treatment duration was analyzed. RESULTS Metabolic syndrome was more frequent in patients with epilepsy compared with healthy participants (32.6% vs. 12.0%), and it was diagnosed in 37.8% of patients receiving valproic acid (VPA), 36.1% of patients receiving carbamazepine (CBZ), 34.9% of patients receiving oxcarbazepine (OXC), and 30.5% of patients on levetiracetam (LEV). There was a positive correlation between VPA treatment duration and MetS existence (p < 0.05). However, MetS frequency did not change because of seizure type, disease duration, or AED dosages in patients with epilepsy receiving monotherapy. The risk for OSAS was higher in patients with epilepsy compared with healthy participants (24.6% vs. 12%), and it was calculated high in 27.7% of patients receiving CBZ, 32.2% of patients receiving LEV, and 30.2% of patients receiving OXC. The OSAS risk was higher in patients who have focal seizures than generalized seizures (p = 0.044). There was no relationship between OSAS risk and duration of epilepsy, duration of treatment, drug doses, and serum drug levels (p > 0.05). CONCLUSION Higher frequency of MetS and OSAS risk should be kept in mind on clinical follow-up of patients with epilepsy receiving monotherapy.
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Pulitano P, Franco V, Mecarelli O, Brienza M, Davassi C, Russo E. Effects of eslicarbazepine acetate on lipid profile and sodium levels in patients with epilepsy. Seizure 2017; 53:1-3. [DOI: 10.1016/j.seizure.2017.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 11/29/2022] Open
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Garoufi A, Vartzelis G, Tsentidis C, Attilakos A, Koemtzidou E, Kossiva L, Katsarou E, Soldatou A. Weight gain in children on oxcarbazepine monotherapy. Epilepsy Res 2016; 122:110-3. [PMID: 27010568 DOI: 10.1016/j.eplepsyres.2016.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/12/2016] [Accepted: 03/12/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Studies of the effect of oxcarbazepine (OXC) on body growth of children with epilepsy are rare and their results are controversial. To the contrary, many studies have shown significant weight gain following valproate (VPA) treatment. PURPOSE To prospectively evaluate the effect of OXC monotherapy on growth patterns of children with epilepsy and compare it with the effect of VPA monotherapy. METHOD Fifty-nine otherwise healthy children, aged 3.7-15.9 years, with primary generalized, partial or partial with secondary generalization seizure disorder, were included in the study. Twenty six children were placed on OXC and thirty three on VPA monotherapy. Body weight (BW), height and body mass index (BMI) as well as their standard deviation scores (SDS), were evaluated prior to as well as 8 months post initiation of OXC or VPA therapy. RESULTS Eight months post OXC-treatment, BW, SDS-BW, BMI and SDS-BMI increased significantly. The increase was similar to that observed in the VPA group. An additional 15.4% of children in the OXC group and 21.2% in the VPA group became overweight or obese. The effect of both OXC and VPA therapy on linear growth did not reach statistical significance. CONCLUSION Similarly to VPA, OXC monotherapy resulted in a significant weight gain in children with epilepsy. Careful monitoring for excess weight gain along with counseling on adapting a healthy lifestyle should be offered to children on OXC therapy.
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Affiliation(s)
- Anastasia Garoufi
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, 'P. & A. Kyriakou' Children's Hospital, Thivon & Levadias Str., 11527 Athens, Greece.
| | - George Vartzelis
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, 'P. & A. Kyriakou' Children's Hospital, Thivon & Levadias Str., 11527 Athens, Greece
| | - Charalambos Tsentidis
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, 'P. & A. Kyriakou' Children's Hospital, Thivon & Levadias Str., 11527 Athens, Greece
| | - Achilleas Attilakos
- Third Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, Attikon Hospital, Rimini 1, 12462, Haidari, Athens, Greece
| | - Evangelia Koemtzidou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, 'P. & A. Kyriakou' Children's Hospital, Thivon & Levadias Str., 11527 Athens, Greece
| | - Lydia Kossiva
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, 'P. & A. Kyriakou' Children's Hospital, Thivon & Levadias Str., 11527 Athens, Greece
| | - Eustathia Katsarou
- Department of Pediatric Neurology, 'P. & A. Kyriakou' Children's Hospital, Thivon & Levadias Str., 11527, Athens, Greece
| | - Alexandra Soldatou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, 'P. & A. Kyriakou' Children's Hospital, Thivon & Levadias Str., 11527 Athens, Greece
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Ley M, Principe A, Jiménez-Conde J, Rocamora R. Assessing long-term effects of eslicarbazepine acetate on lipid metabolism profile, sodium values and liver function tests. Epilepsy Res 2015. [DOI: 10.1016/j.eplepsyres.2015.06.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Garoufi A, Koemtzidou E, Katsarou E, Dinopoulos A, Kalimeraki I, Fotinou A, Drakatos A, Attilakos A. Lipid profile and thyroid hormone concentrations in children with epilepsy treated with oxcarbazepine monotherapy: a prospective long-term study. Eur J Neurol 2013; 21:118-23. [DOI: 10.1111/ene.12262] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 08/15/2013] [Indexed: 11/28/2022]
Affiliation(s)
- A. Garoufi
- Second Department of Pediatrics; University of Athens; ‘Panagiotis and Aglaia Kyriakou’ Children's Hospital; Athens Greece
| | - E. Koemtzidou
- Second Department of Pediatrics; University of Athens; ‘Panagiotis and Aglaia Kyriakou’ Children's Hospital; Athens Greece
| | - E. Katsarou
- Department of Neurology; ‘Panagiotis and Aglaia Kyriakou’ Children's Hospital; Athens Greece
| | - A. Dinopoulos
- Third Department of Pediatrics University of Athens; ‘Attikon’ Hospital; Athens Greece
| | - I. Kalimeraki
- Second Department of Pediatrics; University of Athens; ‘Panagiotis and Aglaia Kyriakou’ Children's Hospital; Athens Greece
| | - A. Fotinou
- Hormonological Laboratory; ‘Panagiotis and Aglaia Kyriakou’ Children's Hospital; Athens Greece
| | - A. Drakatos
- Department of Biochemistry; ‘Panagiotis and Aglaia Kyriakou’ Children's Hospital; Athens Greece
| | - A. Attilakos
- Third Department of Pediatrics University of Athens; ‘Attikon’ Hospital; Athens Greece
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Yiş U, Doğan M. Effects of oxcarbazepine treatment on serum lipids and carotid intima media thickness in children. Brain Dev 2012; 34:185-8. [PMID: 21676567 DOI: 10.1016/j.braindev.2011.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 05/18/2011] [Accepted: 05/19/2011] [Indexed: 11/28/2022]
Abstract
The aim of this study is to evaluate the carotid intima media thickness and serum lipids in pediatric patients with epilepsy treated with oxcarbazepine. The study included 21 pediatric epileptic and 22 healthy children. Intima media thickness and fasting lipid profile were assessed. Although the median value of total cholesterol was in normal limits in the oxcarbazepine group, it was significantly higher when compared with the control group. We did not observe any differences regarding triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and carotid intima media thickness. We suggest that oxcarbazepine treatment in children has a minor effect on serum lipids and it does not seem to have an atherogenic effect.
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Affiliation(s)
- Uluç Yiş
- Department of Pediatric Neurology, Gaziantep Children's Hospital, Gaziantep, Turkey.
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Abstract
The newer antiepileptic drugs (AEDs) provide more therapeutic options and overall improved safety and tolerability for patients. To provide the best care, physicians must be familiar with the latest tolerability and safety data. This is particularly true in children, given there are relatively fewer studies examining the effects of AEDs in children compared with adults. Since we now have significant paediatric literature on each of these agents, we provide a comprehensive and current literature review of the newer AEDs, focusing on safety and tolerability data in children and adolescents. Because the safety profiles in children differ from those in adults, familiarity with this literature is important for child neurologists and other paediatric caregivers. We have organized the data by organ system for each AED for easier reference.
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Affiliation(s)
- Dean P Sarco
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Children's Hospital Boston, Boston, Massachusetts, USA.
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Atherosclerotic risk among children taking antiepileptic drugs. Pharmacol Rep 2009; 61:411-23. [DOI: 10.1016/s1734-1140(09)70082-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 04/01/2009] [Indexed: 01/05/2023]
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Abstract
Epilepsy is common in the pediatric population. Nine second-generation antiepileptic drugs have been approved in the US for use in epilepsy over the past 15 years: felbamate, gabapentin, lamotrigine, topiramate, tiagabine, levetiracetam, oxcarbazepine, zonisamide, and pregabalin. Their use in pediatric patients is fairly widespread, despite most of these agents not having US FDA indications for use. Felbamate and gabapentin were the first two second-generation antiepileptic drugs to be approved in the US. Felbamate use has been limited because of the occurrence of hepatotoxicity and aplastic anemia. Although gabapentin is a fairly well tolerated antiepileptic drug, its use has also been limited as a result of inconsistent efficacy and concern about seizure exacerbation. Lamotrigine and topiramate are broad-spectrum antiepileptic drugs with efficacy in a wide variety of seizure types. Both agents have some tolerability concerns: rash with lamotrigine and neuropsychiatric events with topiramate. There are very little data on tiagabine use in children, but this agent appears to be effective and to have a good tolerability profile. Levetiracetam is a second-generation antiepileptic agent that is available intravenously. Considering its good efficacy, fast onset of action, and low incidence of serious adverse effects, its use in the acute setting could potentially increase. Oxcarbazepine and zonisamide have been relatively well studied in pediatric seizure patients, including use as monotherapy. Both agents have demonstrated good efficacy and tolerability for patients as young as 1 month old. Vigabatrin and rufinamide are currently not available in the US, but have been shown to have some success in other countries. Pregabalin is the newest antiepileptic agent, but lacks pediatric data currently.
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Affiliation(s)
- Allison M Chung
- Harrison School of Pharmacy, Pharmacy Practice, Auburn University, Auburn, Alabama, USA.
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Shin HK, Lee Y, Lee JY, Choi W, Eun SH, Eun BL, Hong YS, Lee JW. Efficacy and safety of oxcarbazepine in epileptic children. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.2.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Yoon Lee
- Korea University College of Medicine, Seoul, Korea
| | - Jee-Yeon Lee
- Department of Pediatrics, Kwangmyung-Sungae Hospital, Kwangmyung, Korea
| | - Wooksun Choi
- Korea University College of Medicine, Seoul, Korea
| | - So-Hee Eun
- Korea University College of Medicine, Seoul, Korea
| | - Baik-Lin Eun
- Korea University College of Medicine, Seoul, Korea
| | | | - Joo Won Lee
- Korea University College of Medicine, Seoul, Korea
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Franzoni E, Verrotti A, Sarajlija J, Garone C, Matricardi S, Salerno GG, Monti M, Chiarelli F. Topiramate: effects on serum lipids and lipoproteins levels in children. Eur J Neurol 2007; 14:1334-7. [PMID: 17916078 DOI: 10.1111/j.1468-1331.2007.01973.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The present controlled study aims to evaluate topiramate (TPM) effect on total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein, very low-density lipoprotein, apolipoproteins A1, B and lipoprotein (a). Seventy patients in evolving age suffering from various types of epilepsy, treated with TPM, (age range: 6 months-22 years) were evaluated before and after 12 months of treatment and compared with 110 sex- and age-matched subjects. At baseline, no significant difference was present between controls and children treated with TPM. After a year, the BMI did not show significant change in adults and remained into respective growth curve. No significant difference in lipids and lipoproteins neither between first and second evaluation nor between patients and controls was found. Some intra-group variation has been noticed: whilst controls maintained similar levels, the 70 patients on TPM monotherapy showed a slight decrease in TC, triglycerides and HDL. These fluctuations, however, occurred in the normal range so neither dietary nor pharmacological treatment of hyperlipidaemia after a year of TPM was necessary.
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Affiliation(s)
- E Franzoni
- Child Neuropsychiatry Unit, University of Bologna, Bologna, Italy.
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