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Category: Volume 06 Issue 10 October 2018
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Title: A Hospital Based Comparative Study on Effect of Lipid Profile in Patients Treated with Older and Newer Anti Epileptic Drugs

Authors: Vishal, Madhurima Prasad, Anuj Kumar Pathak

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i10.73

Abstract

Objective: To study the effect of commonly prescribed anti epileptic drugs as Carbamazepine, Phenytoin and  newer antiepileptic drug as Lamotrigine, Levetiracetam on lipid profile of epileptic children (2-12 yrs) who had taken them for long term presented in outdoor or indoor  Department of Pediatrics, Darbhanga Medical College and Hospital, Laheriasarai.

Method: Prospective observational study done in indoor and outdoor 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, Lamotrigine, Levetiracetam) were selected for 6 months from March 2012 to august 2012. 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 4 groups: (1) PHT-treated subgroup (22 patients); (2) CBZ-treated group (23 patients); (3) Lamotrigine - treated group (6patients) (4). Levetiracetam treated group (10 patients) 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: Cases were selected for 6 months from March 2012 to august 2012 and followed up for 12 months, total 18 months .79 cases were selected and followed up. 18 patients were lost to follow-up and 61 cases were followed up till 12 months. So we ended up with 61 patients in which 31.1% (n=19) were females and 68.8 %( n=42) were males.77.0 %(n=47) patients were above 6 yr of age.  73.7% patients were taking older enzyme inducing AED (CBZ & PHT, n=45) while 26.2% (n=16) of patients taking Levetiracetam & Lamotrigine. 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. Lamotrigine produces no significant increase in the Total Cholesterol, HDL, LDL, Triglycerides or any other alterations in the ratio of Total Cholesterol: HDL and LDL: HDL  Levetiracetam  showed a significant increase in Total cholesterol , Triglycerides , HDL, But there was no statistical significance of its effect on LDL cholesterol or the ratios of Total Cholesterol: HDL and LDL: HDL ratio.

Conclusion: Hepatic enzyme inducers like Carbamazepine, Phenytoin and new AED Levetiracetam 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). Lamotrigine has no significant 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 Phenytoin and levetiracetam.

Keywords: older antiepileptic drugs, Newer antiepileptic drugs, serum lipid profile, hepatic enzyme inducers, cardiovascular disease.

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Corresponding Author

Madhurima Prasad M.B.B.S, MS (Surgery)

Address: Mahalaxmi Nursing Home, Thana Chowk, Ramgarh Cantt, Jharkhand-829122, India

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