Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023;11(2):122-127.
doi: 10.22038/AOJNMB.2023.67084.1465.

Comparison of myocardial perfusion between the users of two antiepileptic medications: valproate vs. carbamazepine

Zeinab Peymani  1 , Abbas Tafakhori  2 , Saeed Farzanehfar  3 , Farnoosh Larti  4 , Ali Hosseini  3 , Mehrshad Abbasi  3
Affiliations

Comparison of myocardial perfusion between the users of two antiepileptic medications: valproate vs. carbamazepine

Zeinab Peymani et al. Asia Ocean J Nucl Med Biol. 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.

Keywords: Carbamazepine; Coronary artery disease A B S T R A C T; Myocardial perfusion scan Epilepsy; Valproate.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
The myocardial perfusion scan of 2 patients with typical perfusion abnormality (19 years old male, 14 years of Valproate use; panel A) and typical normal scan (16 years old male; panel B)
Figure 2
Figure 2
Estimated marginal means of durationof use
See this image and copyright information in PMC

References

    1. Jansen K, Lagae L. Cardiac changes in epilepsy. Seizure. 2010;19:455–460. - PubMed
    1. LoPinto-Khoury C, Mintzer S. Antiepileptic drugs and markers of vascular risk. Curr Treat Options Neurol. 2010;12:300–308. - PMC - PubMed
    1. Mehrpour M, Shojaie M, Zamani B, Gharibzadeh S, Abbasi M. Atherogenic consequence of antiepileptic drugs: a study of intima-media thickness. Neurol Sci. 2014;35:253–257. - PubMed
    1. Lu B, Elliott JO. Beyond seizures and medications: normal activity limitations, social support, and mental health in epilepsy. Epilepsia. 2012;53:e25–28. - PubMed
    1. Chuang YC, Chuang HY, Lin TK, Chang CC, Lu CH, Chang WN, et al. Effects of long‐term antiepileptic drug monotherapy on vascular risk factors and atherosclerosis. Epilepsia. 2012;53:120–128. - PubMed

LinkOut - more resources