Antiepileptic drugs: a consideration of clinical and biochemical outcome in patients with epilepsy

Abstract

Background: The challenge of antiepileptic drugs (AEDs) management is to attain the best compromise between the desire to maximize seizure control and the need to keep side-effects within tolerable limits for the individual patient. To reduce devastation in Iranian epileptic patients, the aim of this study was to explore the overall outcome following AEDs prescription.

Methods: A cross-sectional study of 36 patients located at the epilepsy ward, conducted to Isfahan Neurosciences Research Centre was carried out during the year 2011. Female (n = 17) and male subjects (n = 19) with a mean age of 27 years (range; 7-74 years) were studied. Variables including, sex, age, age of seizure onset, type, and number of AEDs, biochemical and hematological data were recorded in d-Base and statistical analyses were performed using SPSS (version 18) for windows.

Results: The main drug to control seizure attack was carbamazepine and valproic-acid. The following tests were the most frequently influenced; alkaline phosphatase (AP), lymphocyte (Lymph), white blood cell (WBC) counts and hemoglobin (Hgb). There was a significant increase in (AP) (mean; 534.6 u/l(↑); [P = 0.02] in three patients and (Lymph) (55%(↑); [43-84] %(↑); [P = 0.04] in seven patients. WBC was lower than 4400 mm(3↓) (P = 0.02) in six patients. Hgb was significantly lower in 70.6% of women (11.8(↓); [10-14.2] g/dl(↓); [P = 0.04] and 68.4% of men population (12.3(↓); [9.7-13.8] g/dl(↓); [P = 0.01]. Mean age of epilepsy onset was 15.6 years (range: Birth-74 years). Analysis of drug prescriptions showed that the incidence of monotherapy and polypharmacy (2 up to six AEDs simultaneously) was 19.4% plus 80.6% respectively.

Conclusions: In Iranian epileptic population, effectiveness of treatment should be attributed by the close supervising of AEDs in relation to clinical circumstance, laboratory data, and therapeutic drug monitoring. Any significant change in patients' biochemical and hematological data may require close verifying for the rapid detection of severe anemia, leukopenia, lymphocytosis, osteomalacia, or liver failure.

Keywords: Antiepileptic drugs; biochemical; hematological; side effects.

Figure 1

The incidence of monotherapy or polypharmacy (n=36)

Figure 2

Types and frequencies of AEDs (n=36). Prescriptions were concentrated on two compounds, carbamazepine ^{(a potent inductor of CYP isoenzymes)} and valproic acid ^{(a potent inhibitor of several CYP isoenzymes)}