EFFECT OF COMMONLY USED ANTIEPILEPTIC DRUGS ON SERUM LIPID PROFILE IN CHILDREN

Vishal; Madhurima Prasad; Anuj Kumar Pathak

Volume : VII, Issue : XI, November - 2018

EFFECT OF COMMONLY USED ANTIEPILEPTIC DRUGS ON SERUM LIPID PROFILE IN CHILDREN

Vishal, Madhurima Prasad, Anuj Kumar Pathak

Abstract :

Objective: To study the effect of commonly prescribed anti epileptic drugs both enzyme inducers as Carbamazepine, Phenytoin and non enzyme inducers as Valproate on lipid profile of epileptic children(2–12 yrs) who had taken them for long term, presented in outdoor or indoor of Department of Pediatrics�, Darbhanga Medical College and Hospital, Laheriasarai.

Method: prospective observational study done in indoor and outdoor patients of Department of Pediatrics, Darbhanga Medical College and Hospital, Laheriasarai. All children aged 2 years to 12 years, of either sex having partial or generalized seizures and recently started on anti–epileptic drugs, (Carbamazepine, Phenytoin, Valproate,) were selected for 6 months from March 2012 to august 2012 and followed up for 12 months. Patients who had taken prior anticonvulsant or taking more than one AED , family history of dyslipidemia , metabolic disease or disease which has propensity to alter lipid profile like diabetes mellitus, nephrotic syndrome, hypothyroidism, storage diseases, renal failure and cholestatis were excluded from the study. Patients were classified into 3 groups: (1) PHT–treated subgroup (22 patients); (2) CBZ–treated group (23 patients); (3) VPA– treated group (18patients). In all cases patients were adequately treated. Serum lipid profile included total cholesterol (TC), triglycerides (TG), LDL–Cholesterol (low density lipoprotein cholesterol) and HDL–Cholesterol (high density lipoprotein cholesterol). These were done before and after treatment with AED over 6 and 12 months the study was approved by ethical committee of DMCH. All investigations were done in department of pathology, DMCH.

Results: 83 patients were enrolled for the study out of which 20 patients were lost to follow up .so we ended up with 63 patients in which 31.7%(n=20)were females and 68.25%(n=43) were males.77.7%(n=49) patients were above 6 yr of age. 71.4% patients were taking older enzyme inducing AED (CBZ &PHT, n=45) while 28.5 %(n=18) of patients taking VPA .Carbamazepine (CBZ) significantly increases the total cholesterol , HDL cholesterol, Triglycerides ,LDL cholesterol. Increase in the Total Cholesterol: HDL and LDL: HDL ratio is not significant. There was significant increase in mean Total Cholesterol, Triglycerides, HDL, LDL in patients treated with Phenytoin (PHT). There was no significant increase in ratio of LDL/HDL and Total cholesterol / HDL. Valproate showed a significant decrease in Total Cholesterol, Triglycerides, LDL .Change in HDL was not significant however decrease in ratio of LDL/HDL and Total cholesterol / HDL ratio was significant.

Conclusion: Hepatic enzyme inducers like Carbamazepine and Phenytoin may have adverse effect on serum lipid profile. These alterations in serum lipids may have clinical relevance in development of atherosclerosis thus causing cardiovascular disease (CVD). Valproate has protective effect on lipid profile thus may be preferred over enzyme inducing AED when effect on serum lipid profile is considered. . Monitoring of serum lipid should be done in children with epilepsy taking Carbamazepine and Phenytoin