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Fukae J, Eguchi H, Wada Y, Fuse A, Chishima R, Nakatani M, Nakajima A, Hattori N, Shimo Y. Case report: Young-onset large vessel ischemic stroke due to hyperhomocysteinemia associated with the C677T polymorphism on 5,10-methylenetetrahydrofolate reductase and multi-vitamin deficiency. Front Neurol 2023; 14:1183306. [PMID: 37273715 PMCID: PMC10233819 DOI: 10.3389/fneur.2023.1183306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/24/2023] [Indexed: 06/06/2023] Open
Abstract
Hyperhomocysteinemia is an important risk factor for cerebral infarction. Herein, we report on a 30-year-old man previously diagnosed with epilepsy who presented with right hemiplegia and total aphasia. Magnetic resonance imaging showed a fronto-temporal ischemic lesion due to occlusion of the left middle cerebral artery. Clinical testing and imaging demonstrated that he had hyperhomocysteinemia induced by multiple factors including the C677T polymorphism on 5.10-methylenetetrahydrofolate reductase (MTHFR), and multiple vitamin deficiencies. The C677T polymorphism on MTHFR is closely related to hyperhomocysteinemia and folate deficiency in epileptic patients who are taking multiple anti-convulsants. Given hyperhomocysteinemia can independently cause stroke at a young age, physicians should periodically examine plasma homocysteine and serum folic acid levels in epileptic patients who are on long-term regimens of multiple anti-epileptic drugs.
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Affiliation(s)
- Jiro Fukae
- Department of Neurology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hiroto Eguchi
- Department of Neurology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Yoichi Wada
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Atsuhito Fuse
- Department of Neurology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Rika Chishima
- Department of Clinical Laboratory, Juntendo University Nerima Hospital, Tokyo, Japan
| | | | - Asuka Nakajima
- Department of Neurology, Juntendo University Nerima Hospital, Tokyo, Japan
- Department of Research and Therapeutics for Movement Disorders, Juntendo University School of Medicine, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasushi Shimo
- Department of Neurology, Juntendo University Nerima Hospital, Tokyo, Japan
- Department of Research and Therapeutics for Movement Disorders, Juntendo University School of Medicine, Tokyo, Japan
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Peymani Z, Tafakhori A, Farzanehfar S, Larti F, Hosseini A, Abbasi M. Comparison of myocardial perfusion between the users of two antiepileptic medications: valproate vs. carbamazepine. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2023; 11:122-127. [PMID: 37324229 PMCID: PMC10261687 DOI: 10.22038/aojnmb.2023.67084.1465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/23/2023] [Accepted: 03/26/2023] [Indexed: 06/17/2023]
Abstract
Objectives The prevalence of coronary artery disease (CAD) is high in patients with epilepsy using antiepileptic drugs (AED). Epilepsy, AED, or the type and duration of AED use , may contribute to higher CAD risk.In this study, myocardial perfusion imaging (MPI) was compared between patients using carbamazepine and valproate. Method Out of 73 patients receiving carbamazepine or valproate monotherapy for more than 2 years, visited at a tertiary referral clinic, 32 patients participated in a 2-day stress and rest phases MPI. For each phase, 15-25 mCi 99mTc-MIBI was injected, at peak exercise or by pharmacologic stimulation for the stress phase. SPECT with cardiac gating was done by a dual-head gamma camera and processed and quantified. Scans with at least one definite reversible hypo-perfusion segment were considered abnormal. Results Seventeen patients received carbamazepine monotherapy and 15 valproates. Age and duration of AED use were similar between the groups. Two scans were abnormal (6.3%) both in valproate group (13.3%). Duration of AED use was higher in patients with abnormal scans. In patients receiving monotherapy >2 years, the frequency of abnormal MPI was similar between groups (P-value=0.12). In patients receiving monotherapy > 5 years, prevalence of abnormal MPI was higher in the valproate group (28.6% vs. 0.0%; P-value=0.042). Considering valproate subgroup, ischemic patients had higher duration of AED use, comparing with the normal patients (17.0±4.2 vs. 6.4±4.8, P-value=0.014). Conclusion MPIs were abnormal in patients receiving valproate after 5 years compared to patients receiving carbamazepine. Long-term valproate use may increase the risk of CAD.
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Affiliation(s)
- Zeinab Peymani
- Department of Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Tafakhori
- Department of Neurology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Farzanehfar
- Department of Nuclear Medicine, Imam Khomeini Hospital Complex, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnoosh Larti
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hosseini
- Department of Nuclear Medicine, Imam Khomeini Hospital Complex, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrshad Abbasi
- Department of Nuclear Medicine, Imam Khomeini Hospital Complex, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Sarecka-Hujar B, Szołtysek-Bołdys I, Kopyta I. Serum Levels of Lipids and Selected Aminothiols in Epileptic Children—A Pilot Case-Control Study. Brain Sci 2022; 12:brainsci12010120. [PMID: 35053863 PMCID: PMC8774067 DOI: 10.3390/brainsci12010120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Standard treatment of epileptic seizures involves the use of antiepileptic drugs (AEDs). Both AEDs themselves and treatment duration may influence the levels of biochemical parameters, e.g., lipids or homocysteine (HCys), that may increase the risk of cardiovascular diseases. The aim of the present study was to compare the levels of lipid parameters, as well as the concentrations of selected aminothiols (i.e., HCys, cysteine, and glutathione) between epileptic children treated with multiple AEDs and children without epilepsy. Methods: In the study, 21 children with epilepsy treated with two or more AEDs for at least 6 months (8 girls and 13 boys, mean age 7.03 ± 4.51) and 23 children without epilepsy (7 girls and 16 boys, mean age 7.54 ± 3.90) were prospectively analyzed. Lipid parameters, i.e., total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL), and levels of selected aminothiols were determined in the blood serum. Results: No differences in the mean levels of lipid parameters and in the mean values of lipid ratios (TC/HDL, TG/HDL, LDL/HDL) were observed between the total groups as well as in the sex subgroups. HCys and cysteine levels did not differ between the patients and controls. We observed significantly lower levels of glutathione in children with epilepsy than in children without epilepsy (1.49 ± 0.35 µmol/L vs. 2.39 ± 1.17 µmol/L, respectively) (p < 0.001). Glutathione level was also lower in boys with epilepsy than in boys without epilepsy (p = 0.007). Similarly, epileptic girls had statistically decreased levels of glutathione when compared to girls without epilepsy (p = 0.006). Conclusions: A lower level of glutathione is observed in pediatric patients with epilepsy treated with two or more AEDs for at least 6 months. This indicates the oxidative stress of the patients treated with AEDs, which in turn may affect their well-being, and in the case of chronic occurrence resulting from long-term treatment, also on the function of the liver and the condition of the cardiovascular system.
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Affiliation(s)
- Beata Sarecka-Hujar
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, 41-200 Sosnowiec, Poland
- Correspondence: or ; Tel.: +48-32-2699830
| | - Izabela Szołtysek-Bołdys
- Department of General and Inorganic Chemistry, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, 41-200 Sosnowiec, Poland;
| | - Ilona Kopyta
- Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
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Bisi-Onyemaechi AI, Chikani UN, Uwaezuoke NA, Aronu AE, Ojinnaka NC. Serum folate levels in children on long-term anti-seizure medication in a Nigerian tertiary center-Implications for practice and public health. Sci Prog 2021; 104:368504211057680. [PMID: 34816782 PMCID: PMC10461376 DOI: 10.1177/00368504211057680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Epilepsy is the most common childhood neurological disorder in Nigeria. Treatment of epilepsy is long-term and sometimes lifelong with anti-seizure medications. There are conflicting reports on the effect of anti-seizure medications on serum folate. There is therefore a need to determine the effect of a commonly used anti-seizure medication's on serum folate levels of children. This would provide an evidence-based consideration for folic acid supplementation in children on anti-seizure medication as has been suggested by some studies. STUDY OBJECTIVES To determine whether serum folate levels were lower in children taking long-term carbamazepine or sodium valproate, compared to a control group. METHODS Serum folic acid levels were measured from well-nourished children between the ages of 1-17 years on carbamazepine and sodium valproate monotherapy and their age/sex-matched controls, using spectrophotometry. RESULTS The mean serum folate levels of patients on carbamazepine (43) and sodium valproate (22) were 0.032 mg/l ± 0.009 and 0.028 mg/l ± 0.008, respectively. The mean folate levels of the controls were 0.046 mg/l ± 0.03 (p = 0 001). No statistically significant difference was observed between the serum folate levels of children on the two anti-seizure medications, that is, carbamazepine and valproate. CONCLUSION The children on treatment with carbamazepine and sodium valproate for more than 6 months had statistically significantly lower serum levels of folic acid compared to the standard reference range and controls. The serum folate levels of children on carbamazepine were not statistically different from those on sodium valproate.
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Affiliation(s)
- Adaobi I Bisi-Onyemaechi
- Institute of Maternal and Child Health,
College of Medicine, University of Nigeria Ituku-Ozalla, Nigeria
- Department of Paediatrics, College of
Medicine, University of Nigeria Ituku-Ozalla, Nigeria
| | - Ugo N Chikani
- Department of Paediatrics, College of
Medicine, University of Nigeria Ituku-Ozalla, Nigeria
| | - Ndubuisi A Uwaezuoke
- Department of Paediatrics, College of
Medicine, University of Nigeria Ituku-Ozalla, Nigeria
| | - Ann E Aronu
- Department of Paediatrics, College of
Medicine, University of Nigeria Ituku-Ozalla, Nigeria
| | - Ngozi C Ojinnaka
- Department of Paediatrics, College of
Medicine, University of Nigeria Ituku-Ozalla, Nigeria
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5
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Youness ER, Shady MMA, Abd Elaziz A, Galal E, El-Sonbaty M, El-Sonbaty MM, Masoud MM, Abu Elhamd WA. Association of folic acid, vitamin B12, and intelligence scores in epileptic children. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 11:45-49. [PMID: 32356452 DOI: 10.1080/21622965.2020.1747020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Epilepsy is a serious childhood disease associated with cognitive impairment. Our aim was to investigate the possible association of serum folic acid, vitamin B12, and intelligence scores in epileptic children. A group of 30 children with established diagnosis of idiopathic epilepsy for at least one year as well as another group of 30 nonepileptic healthy children as the control group were recruited for analysis. Cognitive performance was assessed by a battery of psychological tests that covers verbal and nonverbal intelligence. Serum B12 level was significantly lower in patients than the control group (264.17 ± 58.07, 450.55 ± 134.9, respectively). No significant difference was detected between patients and the control group regarding serum folic acid level. Verbal, performance, and total IQ were significantly lower in patients than the control group (83.2 ± 3.08 vs. 95.8 ± 6.22, 78.4 ± 10.68 vs. 91.3 ± 2.45, and 180.6 ± 6.58 vs. 93.5 ± 3.02, respectively). However, no significant correlation was detected in folic acid, vitamin B 12, and cognitive scores. Epileptic children were five times more at risk of having low IQ (verbal, performance, and total) < 85 than the control group (OR = 4.754, 95% CI 13.047-1031.316, p = .000). In conclusion, children with epilepsy might be at higher risk for cognitive dysfunction than normal children. No significant association was detected between cognitive performance and either folic acid or vitamin B12 in epileptic children receiving sodium valproate. Supplementation of those vitamins should be restricted to those with documented deficiency.
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Affiliation(s)
| | - Mones M Abu Shady
- Child Health Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Ali Abd Elaziz
- Child Health Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Esam Galal
- Child Health Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Mohamed El-Sonbaty
- Child Health Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Marwa M El-Sonbaty
- Child Health Department, Medical Research Division, National Research Centre, Cairo, Egypt
| | - Mahmoud M Masoud
- Medical Biochemistry Department, National Research Centre, Cairo, Egypt
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Mu L, Lin Y, Huang X, Ning Y, Wu F, Zhang XY. Sex differences in the prevalence and clinical correlates of hyperhomocysteinemia in patients with bipolar disorder. Hum Psychopharmacol 2020; 35:e2724. [PMID: 32052509 DOI: 10.1002/hup.2724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/21/2019] [Accepted: 01/13/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Sex differences in bipolar disorder are well recognized but little attention has been paid to sex differences in homocysteine or hyperhomocysteinemia in bipolar patients. This study compared gender differences in homocysteine levels and rates of hyperhomocysteinemia in Chinese inpatients with bipolar disorder. METHODS A total of 198 BD patients and 84 healthy controls were enrolled. The Young Mania Rating Scale, Hamilton Depression Rating Scale, and the Clinical Global Impressions-Severity scale were used to assess the affective symptomatology. Fasting plasma Hcy levels were measured by high-performance liquid chromatography. RESULTS Men had higher homocysteine levels than women and the prevalence of hyperhomocysteinemia in male patients was approximately twice that in female patients. Logistic regression analyses showed that HHcy was associated with less frequent use of valproate in males and being overweight in females. Further correlation analysis and multivariate regression analysis demonstrated that Hcy levels were inversely correlated with valproate treatment in men and positively associated with overweight in women. CONCLUSIONS In bipolar patients, there are significant differences between sexes in the levels of homocysteine and prevalence of hyperhomocysteinemia. This appears to be associated with lower prevalence of valproate prescribing in men and with being overweight in women.
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Affiliation(s)
- Li Mu
- Research Center of Brain and Cognitive Neuroscience, Liaoning Normal University, Dalian, China
| | - Yezhe Lin
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Xingbing Huang
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Department of Psychiatry, Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Yuping Ning
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Department of Psychiatry, Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Fengchun Wu
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Department of Psychiatry, Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Xiang Yang Zhang
- Department of Psychiatry, Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Science, Beijing, China
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Sarycheva T, Lavikainen P, Taipale H, Tiihonen J, Tanskanen A, Hartikainen S, Tolppanen AM. Antiepileptic Drug Use and the Risk of Stroke Among Community-Dwelling People With Alzheimer Disease: A Matched Cohort Study. J Am Heart Assoc 2019; 7:e009742. [PMID: 30371186 PMCID: PMC6222965 DOI: 10.1161/jaha.118.009742] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background People with Alzheimer disease ( AD ) are more predisposed to seizures than older people in general, and use of antiepileptic drugs ( AED s) is more frequent. AED use has been linked to a higher risk of vascular events in the general population; however, it is not evident whether the same risk exists in people with AD . We assessed the risk of stroke associated with incident AED use among people with AD . Methods and Results The MEDALZ (Medication Use and Alzheimer's Disease) cohort includes all Finnish people who received a clinically verified AD diagnosis (N=70718) from 2005 to 2011. People with previous strokes were excluded. For each incident AED user (n=5617) one nonuser was matched according to sex, age, and time since AD diagnosis. Analyses were conducted with Cox proportional hazards models and inverse probability of treatment weighting. Compared with nonuse, AED use was associated with an increased risk of stroke (inverse probability of treatment weighting hazard ratio ( HR ), 1.37; 95% confidence interval [CI], 1.07-1.74). The risk was strongest during the first 90 days (adjusted HR , 2.36; 95% CI , 1.25-4.47) of AED use. According to stroke type, the association was with ischemic strokes (inverse probability of treatment weighting HR , 1.34; 95% CI , 1.00-1.79) and hemorrhagic ones (inverse probability of treatment weighting HR , 1.44; 95% CI , 0.86-2.43). The stroke risk of users of older AED s did not differ from that of the users of newer AED s (adjusted HR , 1.04; 95% CI , 0.71-1.53). Conclusions AED use was related to an increased risk of stroke, regardless of AED type. Our results highlight caution in AED use in this vulnerable population.
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Affiliation(s)
- Tatyana Sarycheva
- 1 School of Pharmacy Faculty of Health Sciences University of Eastern Finland Kuopio Finland.,2 Kuopio Research Centre of Geriatric Care University of Eastern Finland Kuopio Finland
| | - Piia Lavikainen
- 1 School of Pharmacy Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Heidi Taipale
- 1 School of Pharmacy Faculty of Health Sciences University of Eastern Finland Kuopio Finland.,2 Kuopio Research Centre of Geriatric Care University of Eastern Finland Kuopio Finland.,3 Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
| | - Jari Tiihonen
- 3 Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden.,4 Department of Forensic Psychiatry Niuvanniemi Hospital University of Eastern Finland Kuopio Finland
| | - Antti Tanskanen
- 3 Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden.,4 Department of Forensic Psychiatry Niuvanniemi Hospital University of Eastern Finland Kuopio Finland
| | - Sirpa Hartikainen
- 1 School of Pharmacy Faculty of Health Sciences University of Eastern Finland Kuopio Finland.,2 Kuopio Research Centre of Geriatric Care University of Eastern Finland Kuopio Finland
| | - Anna-Maija Tolppanen
- 1 School of Pharmacy Faculty of Health Sciences University of Eastern Finland Kuopio Finland
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Ramanujam B, Bajaj BK, Kaur K, Anand KS, Buxi G. Is Depression Related to Low Folate Levels in People with Epilepsy? An Observational Study and Meta-analysis. J Neurosci Rural Pract 2019; 8:381-388. [PMID: 28694617 PMCID: PMC5488558 DOI: 10.4103/jnrp.jnrp_468_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Both depression and low serum levels of folate are common in people with epilepsy (PWE), the latter especially in patients on hepatic enzyme-inducing antiepileptic drugs (AEDs). We did a cross-sectional study and a meta-analysis to assess if lower folate levels have any relation with depression in PWE. Materials and Methods: Two hundred and one PWE were recruited and assessed for depression using the Inventory of Depressive Symptomatology-Self-Rated (IDS-SR) and Inventory of Depressive Symptomatology-Clinician Rated; serum folate levels were measured in them at the same time. Literature search was carried out and studies with data on depression as well as folate levels in PWE were included. Statistical analysis to determine frequency of depression, low folate levels, and relation between them among our cases and the pooled data from the included studies was done. Results: Depression was observed in 65.68% and low serum folate (<4 ng/ml) in 48.75% of PWE (over 80% on older AEDs); there was no statistically significant correlation between them. However, on analyzing the pooled data of six studies including the present, the Fisher's z-transformed correlation coefficient was −0.1690 (95% confidence interval [−0.3175, −0.0124], P = 0.0464). Conclusions: Depression and low folate levels are common in PWE. Low folate levels have a mild but significant negative correlation with depression in this population, and folate supplementation would be advisable for those on the older AEDs.
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Affiliation(s)
- Bhargavi Ramanujam
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India.,Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhupender Kumar Bajaj
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Kirandeep Kaur
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kuljeet Singh Anand
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Gurdeep Buxi
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Sarecka-Hujar B, Szołtysek-Bołdys I, Kopyta I, Dolińska B, Sobczak A. Concentrations of the Selected Biomarkers of Endothelial Dysfunction in Response to Antiepileptic Drugs: A Literature Review. Clin Appl Thromb Hemost 2019; 25:1076029619859429. [PMID: 31238702 PMCID: PMC6714895 DOI: 10.1177/1076029619859429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Epilepsy is a disease arising from morphological and metabolic changes in the brain. Approximately 60% of patients with seizures can be controlled with 1 antiepileptic drug (AED), while in others, polytherapy is required. The AED treatment affects a number of biochemical processes in the body, including increasing the risk of cardiovascular diseases (CVDs). It is indicated that the duration of AED therapy with some AEDs significantly accelerates the process of atherosclerosis. Most of AEDs increase levels of homocysteine (HCys) as well as may affect concentrations of new, nonclassical risk factors for atherosclerosis, that is, asymmetric dimethylarginine (ADMA) and homoarginine (hArg). Because of the role of these parameters in the pathogenesis of CVD, knowledge of HCys, ADMA, and hArg concentrations in patients with epilepsia treated with AED, both pediatric and adult, appears to be of significant importance.
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Affiliation(s)
- Beata Sarecka-Hujar
- 1 Department of Pharmaceutical Technology, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Izabela Szołtysek-Bołdys
- 2 Department of General and Inorganic Chemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Ilona Kopyta
- 3 Department of Pediatric Neurology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Barbara Dolińska
- 1 Department of Pharmaceutical Technology, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Andrzej Sobczak
- 2 Department of General and Inorganic Chemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
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Serum Homocysteine Level and Lipid Profile in Migraine Patients Treated with Sodium Valproate. ARCHIVES OF NEUROSCIENCE 2018. [DOI: 10.5812/ans.79504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Clinical Outcomes and Electrolyte Balance Factors in Complex Cardiac Operations in Adults; Del Nido® Versus Custodiol® Cardioplegia Solutions: A Randomized Controlled Clinical Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2018. [DOI: 10.5812/ircmj.64648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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12
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Gezmen-Karadağ M, Çelik E, Kadayifçi FZ, Yeşildemir Ö, Öztürk YE, Ağagündüz D. Role of food-drug interactions in neurological and psychological diseases. Acta Neurobiol Exp (Wars) 2018. [DOI: 10.21307/ane-2018-017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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13
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Rezaei S, Shab-Bidar S, Abdulahi Abdurahman A, Djafarian K. Oxcarbazepine administration and the serum levels of homocysteine, vitamin B12 and folate in epileptic patients: A systematic review and meta-analysis. Seizure 2016; 45:87-94. [PMID: 27978484 DOI: 10.1016/j.seizure.2016.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/05/2016] [Accepted: 11/17/2016] [Indexed: 11/17/2022] Open
Abstract
The objectives were to determine the influence of oxcarbazepine (OXC) monotherapy on the serum levels of total homocysteine (tHcy), vitamin B12 and folate in patient with epilepsy pooling together case-control or interventional studies. A comprehensive literature search was done through four databases including MEDLINE/PubMed, Scopus, Embase and Web of Science from January 2000 to February 2016. A random effects model (the DerSimonian-Laird estimator) was utilized to pool the effect sizes of the individual studies. The between-study variance was assessed using the Q2 test (significance level p<0.1) and quantified using the I2 test (>50% indicated evidence of heterogeneity). Overall, six studies found eligible for inclusion. The meta-analysis for tHcy revealed that the serum level of tHcy was no significant difference between patient on OXC monotherapy and healthy people [mean difference (MD) 0.31; 95% CI -1.05, 1.67, p=0.653]. The meta-analysis for vitamin B12 [MD -46.51; 95% CI -113.63, 20.62, p=0.174] and folate [MD -0.48; 95% CI -1.06, 0.11, p=0.113] indicated that there was no significant difference between patients on OXC monotherapy and healthy people. In conclusion, the meta-analysis does not support the hypotheses that OXC monotherapy changes the serum levels of tHcy, vitamin B12 and folate.
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Affiliation(s)
- Shahabeddin Rezaei
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ahmed Abdulahi Abdurahman
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box 14155/6117, Tehran, Iran.
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Vyas MV, Davidson BA, Escalaya L, Costella J, Saposnik G, Burneo JG. Antiepileptic drug use for treatment of epilepsy and dyslipidemia: Systematic review. Epilepsy Res 2015; 113:44-67. [DOI: 10.1016/j.eplepsyres.2015.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/16/2015] [Accepted: 03/10/2015] [Indexed: 12/13/2022]
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Ghanizadeh A, Singh AB, Berk M, Torabi-Nami M. Homocysteine as a potential biomarker in bipolar disorders: a critical review and suggestions for improved studies. Expert Opin Ther Targets 2015; 19:927-39. [PMID: 25882812 DOI: 10.1517/14728222.2015.1019866] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Homocysteine levels have been associated with major depression, but associations with bipolar disorder remain less clear. Some data suggest homocysteine levels have potential as a biomarker of treatment response; however the literature is mixed. AREAS COVERED Oxidized forms of homocysteine can be potentially neurotoxic leading to glutamate toxicity, apoptotic transformation and neurodegenerative processes. High homocysteine may be a risk biomarker for bipolar disorders, but the empirical base remains too weak for firm conclusions. This review discusses the current literature for homocysteine levels as a biomarker. EXPERT OPINION It is premature to foreclose the utility of homocysteine levels as a biomarker for bipolar disorder due the methodological inadequacies in the existing literature. These methodological design issues include lack of control for the confounding variables of concurrent medication, phase of bipolar disorder, gender, age, nutritional status, thyroid, liver and renal function, smoking or lean body mass. Well-powered association studies with confounder control could help shed more light on the important clinical question of homocysteine's utility as a biomarker in bipolar disorder. Future experiments are needed to examine the outcome of interventions modulating homocysteine for treating bipolar disorder. Only prospective randomized control trials will provide definitive evidence of the utility of homocysteine as a biomarker or therapeutic target.
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Affiliation(s)
- Ahmad Ghanizadeh
- Shiraz University of Medical Sciences, School of Medicine, Research Center for Psychiatry and Behavioral Sciences, Department of Psychiatry , Shiraz , Iran +00987116273070 ;
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Luo X, Zhang M, Deng L, Zhao J. Effects of valproate on the carotid artery intima-media thickness in epileptics. Indian J Pharmacol 2015; 47:45-8. [PMID: 25821310 PMCID: PMC4375818 DOI: 10.4103/0253-7613.150328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/20/2014] [Accepted: 10/16/2014] [Indexed: 11/17/2022] Open
Abstract
Objective: The objective was to explore the effects of valproate (VPA) on the carotid artery intima-media thickness (CA-IMT) in epileptics. Materials and Methods: A total of 30 epileptic patients treated with VPA was included as disease group, while 33 healthy people who matched general basic demographic details were the control group. The IMTs of the left and right carotids of the both groups were measured, and the average CA-IMT was calculated. The IMT-related risk factors were acquired for the univariate and multivariate analysis. Results: The bilateral carotid and average CA-IMTs of the disease group were significantly higher than the control group (P < 0.001). The multivariant gradual regressive analysis screened out two CA-IMT-related factors, namely the disease duration and the drug administration duration were positively correlated with the average CA-IMT. The epileptic patients with disease course of more than 3 years had much higher average CA-IMT than that of the epileptics with ≤3 years disease (P < 0.001). The average CA-IMT of the patients with VPA-administration duration >1 year was also higher than that of the patients with VPA-administration duration <1 year, while the difference was not statistically significant (P = 0.196). Conclusions: The average CA-IMT of the epileptic patients treated with VPA was higher than that of healthy people.
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Affiliation(s)
- Xinming Luo
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Ming Zhang
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Liying Deng
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Jing Zhao
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
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Pordal AH, Hajmiresmail SJ, Assadpoor-Piranfar M, Hedayati M, Ajami M. Plasma oxysterol level in patients with coronary artery stenosis and its changes in response to the treatment with atorvastatin. Med J Islam Repub Iran 2015; 29:192. [PMID: 26157710 PMCID: PMC4476218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 03/06/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Considering the increasing incidence of coronary artery stenosis and its related complications, the importance of its etiology and inconsistent reports we aimed to determine the relationship between oxysterol, serum levels and severity of coronary atherosclerosis and effect of statins onoxysterol. METHODS A total of 85 patients referred to Taleghani Hospital, Tehran, Iran during 2011-2012 withcoronary artery stenosis more than 75%, as determined by angiography, participated in the currentstudy. Their demographic information and history of smoking and taking atorvastatin was carefullyrecorded. Two milliliters of venous blood was obtained from each patient. The serum oxysterol levelof samples was measured using the enzyme-linked immunosorbent assay (ELISA) method. Statisticalanalysis was performed using SPSS v.19. RESULTS Eighty five patients completed the study. Mean age of patients was 64.4 years; 51 (60%)were male; 55 (68%) had acute coronary syndrome and 30 (32%) had chronic stable angina.Mean±SD of plasma level of oxysterol was 24.8±0.2 pmol/ml. The normal range of oxysterol levelwas 13pmol/ml. Mean±SD of plasma oxysterol level in patients under statin therapy was 24.4±2.1pmol/ml. In patients without receiving statins, plasma oxysterol level was 26.38±1.6pmol/ml. CONCLUSION Findings of the present study indicated significant correlation between serum oxysteroland severity of coronary artery stenosis. It also demonstrated that receiving atorvastatin is associatedwith significant reduction of plasma oxysterol level.
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Affiliation(s)
- Amir-Hamzeh Pordal
- 1 PhD, Assistant Professor, Department of Basic Sciences, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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* We are very sorry to announce that the author passed away.
| | - Seyed Javad Hajmiresmail
- 2 Assistant Professor, Department of Cardiology, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Assadpoor-Piranfar
- 3 Associate Professor, Department of Cardiology, Taleghani Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran. Iran.
| | - Mehdi Hedayati
- 4 PhD, Associate Professor, Head of Cellular and Molecular Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Marjan Ajami
- 5 Assistant Professor, Department of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Ham AC, Enneman AW, van Dijk SC, Oliai Araghi S, Swart KMA, Sohl E, van Wijngaarden JP, van der Zwaluw NL, Brouwer-Brolsma EM, Dhonukshe-Rutten RAM, van Schoor NM, van der Cammen TJM, Zillikens MC, de Jonge R, Lips P, de Groot LCPGM, van Meurs JBJ, Uitterlinden AG, Witkamp RF, Stricker BHC, van der Velde N. Associations between medication use and homocysteine levels in an older population, and potential mediation by vitamin B12 and folate: data from the B-PROOF Study. Drugs Aging 2015; 31:611-21. [PMID: 24993981 DOI: 10.1007/s40266-014-0192-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Elevated homocysteine levels are a risk indicator for cardiovascular disease, fractures and cognitive decline. Previous studies indicated associations between homocysteine levels and medication use, including antihypertensive, lipid-lowering and antidiabetic medication. However, results were often contradictory and inconclusive. Our objective was to study the associations established previously in more detail by sub-classifying medication groups, and investigate the potential mediating role of vitamin B12 and folate status. MATERIALS AND METHODS Baseline data from the B-PROOF (B-vitamins for the PRevention Of Osteoporotic Fractures) study were used. We included 2,912 participants aged ≥65 years, with homocysteine levels of 12-50 μmol/L and creatinine levels ≤150 μmol/L, for whom self-reported medication data were available. We used multivariable linear regression models and analysis of covariance to assess the association between medication use and plasma homocysteine levels, and the potential mediation by serum vitamin B12 and folate. RESULTS The mean age was 74 years (standard deviation, 6.5), 50 % were women, and median homocysteine levels were 14 µmol/L [interquartile range, 13-17 µmol/L]. Higher mean homocysteine levels were observed in users vs. non-users for diuretics (15.2 vs. 14.9, p = 0.043), high-ceiling sulphonamide diuretics (16.0 vs. 14.9, p < 0.001), medication acting via the renin-angiotensin system (15.2 vs. 14.9, p = 0.029) and metformin (15.6 vs. 15.1, p = 0.006). Non-selective β-blocker use was associated with lower mean homocysteine levels (14.4 vs. 15.0, p = 0.019). Only this association was mediated by an underlying association with vitamin B12 and folate levels. CONCLUSION The associations between homocysteine levels and medication use appear to be fairly modest. Our results suggest that medication use is unlikely to contribute to clinically relevant changes in plasma homocysteine levels.
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Affiliation(s)
- Annelies C Ham
- Department of Internal Medicine, Erasmus MC, Geriatric Section, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Ziyaeifard M, Mehrabanian MJ, Faritus SZ, Khazaei Koohpar M, Ferasatkish R, Hosseinnejad H, Mehrabanian M. Premedication with oral pregabalin for the prevention of acute postsurgical pain in coronary artery bypass surgery. Anesth Pain Med 2015; 5:e24837. [PMID: 25830118 PMCID: PMC4363739 DOI: 10.5812/aapm.24837] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 11/27/2014] [Accepted: 12/04/2014] [Indexed: 12/20/2022] Open
Abstract
Background: For coronary artery bypass grafting (CABG) sternotomy should be performed. The pain after surgery is severe and requires medical intervention. Use of the analgesics is limited by their side effects and studies suggest that prevention with some medications before surgery is effective in controlling the postoperative pain. Objectives: We investigated the efficacy of pregabalin administration before surgery in the treatment of acute postoperative pain after CABG surgery. Patients and Methods: Sixty patients indicated for elective CABG surgery were randomly allocated to two groups. One group received placebo and the other received 150 mg of oral pregabalin before surgery. Heart rates, blood pressure, respiratory rate, intensive care unit (ICU) stay duration, morphine consumption, and pain score according to the visual analog scale (VAS) were measured and recorded at 4, 12, and 24 hours of surgery. Results: Pregabalin consumption did not alter hemodynamic parameters and was safe in patients after CABG. Its consumption was associated with significant reduction in the pain score (P values were 0.035, 0.026, and 0.047 respectively at 4, 12, and 24 hours of surgery). Its use was not associated with changes in the morphine consumption at 4, 12, and 24 hours of surgery (P > 0.05). Conclusions: Premedication with studied dose of pregabalin is effective for the prevention of postoperative pain in patients after CABG and has no adverse effects. Trials with other treating schedule and doses of the drug should be performed to determine the best treatment plan.
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Affiliation(s)
- Mohsen Ziyaeifard
- Department of Anesthesiology, Shahid Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Mohammad Javad Mehrabanian
- Department of Cardiac Anesthesia, Shahid Rajaie Cardiovascular Medical and Research Center, Tehran, IR Iran
| | - Seyedeh Zahra Faritus
- Department of Anesthesiology, Shahid Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
- Corresponding author: Seyedeh Zahra Faritus, Department of Anesthesiology, Shahid Rajaie Cardiovascular Medical and Research Center, Tehran, Iran. Tel: +98-2123921, Fax: +98-2122042026, E-mail:
| | - Mehrdad Khazaei Koohpar
- Department of Cardiac Anesthesia, Shahid Rajaie Cardiovascular Medical and Research Center, Tehran, IR Iran
| | - Rasool Ferasatkish
- Department of Anesthesiology, Shahid Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Heidar Hosseinnejad
- Department of Anesthesia, Shahrood Branch of Islamic Azad University, Shahrood, Iran
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