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. 2013 Oct 3:4:133.
doi: 10.4103/2152-7806.119232. eCollection 2013.

A study on gingival enlargement and folic acid levels in phenytoin-treated epileptic patients: Testing hypotheses

Abhishek Singh Nayyar  1 , Mubeen Khan, K R Vijayalakshmi, G T Subhas, B Nataraju, M Anitha
Affiliations

A study on gingival enlargement and folic acid levels in phenytoin-treated epileptic patients: Testing hypotheses

Abhishek Singh Nayyar et al. Surg Neurol Int. .

Abstract

Background: There have been studies that report clinical benefits of the use of folic acid as an adjuvant to the antiepileptic therapy in the prevention of antiepileptic drug-induced gingival enlargement. However, studies in the past have also reported precipitation of epileptic attacks in patients on folic acid adjuvant therapy due to fall in sera levels of phenytoin due to drug interactions. The study was planned to investigate the association of phenytoin-induced gingival enlargement and sera levels of folic acid in epileptic patients on phenytoin therapy. The statistical analysis was done using t-test and the baseline serum folate levels and the serum folate levels obtained after 6 months of phenytoin therapy were correlated with the respective grades of gingival enlargement using Pearson's coefficient formula.

Methods: A total of 25 patients aged between 18 and 50 years, clinically diagnosed with epilepsy prior to the start of phenytoin therapy were included based on selection criteria and written informed consents were obtained. Assessment of serum folic acid levels and gingival enlargement was done prior to the start of and after 6 months of phenytoin therapy.

Results: The results of the study confirmed a significant association between low serum folate levels with increasing severity as well as an early onset of phenytoin-induced gingival enlargement.

Conclusions: The results of the study suggest a higher incidence of gingival enlargement in phenytoin treated epileptic patients with a positive correlation with falling serum folic acid levels as the duration of the therapy increases.

Keywords: Epilepsy; folic acid; gingival enlargement; phenytoin.

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Figures

Figure 1
Figure 1
Clinical picture of gingival status in a male epileptic patient before the start of phenytoin therapy, after 1 week of oral prophylaxis
Figure 2
Figure 2
Clinical picture of gingival enlargement in a male epileptic patient (GRADE 1) after 2 months of initiation of phenytoin therapy
Figure 3
Figure 3
Clinical picture of gingival enlargement in a male epileptic patient (GRADE 2) after 6 months of phenytoin therapy
Figure 4
Figure 4
Clinical picture of bulbous gingival enlargement in a female epileptic patient with more prominent involvement of the interdental papillae (GRADE 3) after 6 months of phenytoin therapy
Figure 5
Figure 5
Scatter diagram comparing mean serum folate levels and grades for gingival enlargement before initiation of phenytoin treatment. Along X-axis - Mean serum folate levels in ng/mL, Along Y-axis - Grades for gingival enlargement
Figure 6
Figure 6
Scatter diagram comparing mean serum folate levels and grades for gingival enlargement after 6 months of phenytoin treatment. Along X-axis - Mean serum folate levels in ng/mL, Along Y-axis - Grades for gingival enlargement
See this image and copyright information in PMC

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