Influence of anti-epileptic drugs on hematological and biochemical parameters in patients with epilepsy
Keywords:Antiepileptic drug, Biochemical, Epilepsy, Hematological, Investigations
Background: Epilepsy is a chronic neurological condition which may require long-term treatment with antiepileptic drugs (AEDs). The challenge in AED management is to attain freedom from seizures, without side-effects and with good quality-of-life. However, AEDs are reported to induce potential adverse effects, which can remain unnoticed over long time. In this regard, earlier studies report inconsistent results in hematological and biochemical toxicity of AEDs. The objective of the present study was to evaluate the effects of AED monotherapy and polytherapy on hematological and biochemical parameters.
Methods: This was a cross-sectional, observational study carried out among patients with epilepsy (PWE) receiving AEDs. The data on baseline demographic characteristics, treatment, adverse drug reactions, hematological, and biochemical investigations were collected. Statistical analysis was performed using the SPSS version 18 and descriptive statistics such as mean and median were used to summarize the data and inferential tests like Chi-square was used to compare categorical variables between groups.
Results: There were 255 PWE in mean age range of 28.68±9.29 years, with 56.54% males. A total of 78.04% had focal, 18.04% had generalized seizures and remaining 3.92% were unclassified. Majority of (55.69%) PWE received polytherapy with AEDs. Females had significantly lower levels of hemoglobin (Hb) when compared with males (p=0.000), and patients on AED polytherapy showed significant difference in low Hb (p=0.006) and high alkaline phosphatase (ALP) levels (p=0.001).
Conclusions: The results of this study showed significant alterations in the levels of Hb and ALP with the use of AED polytherapy in PWE. Routine hematological and biochemical investigations may be considered during AED treatment in those patients receiving AED polytherapy.
Bachmann T, Bertheussen KH, Svalheim S, Rauchenzauner M, Luef G, Gjerstad L, et al. Haematological side effects of antiepileptic drug treatment in patients with epilepsy. Acta Neurol Scand Suppl. 2011;191:23-7.
Dhillon S, Sander JW. Epilepsy. In: walker R, whittlesia C, editors. Clinical Pharmacy and Therapeutics. China: Curchill Livingstone; 2007: 447-60.
Mathura S, Sen S, Rajesh L, Kumar S. Utilization pattern of antiepileptic drugs and their adverse effects in a teaching hospital. Asian J Pharm Clin Res. 2010;3:55-09.
Cloyd JC, Remmel RP. Antiepileptic drug pharmacokinetics and interactions: impact on treatment of epilepsy. Pharmacotherapy. 2000;20(8):139S-51.
Tolou-Ghamari Z, Zare M, Habibabadi JM, Najafi MR. Antiepileptic drugs: a consideration of clinical and biochemical outcome in patients with epilepsy. Int J Prev Med. 2013;4:S330-7.
Uma AB, Neha RL, Radha Y, Nilofar Q. Study of effects of antiepileptic therapy on various biochemical and hematological parameters patients suffering with epilepsy. Int J Basic Clin Pharmacol. 2014;3(1):79-85.
Radhakrishnan K, Nayak SD, Kumar SP, Sarma PS. Profile of antiepileptic pharmacotherapy in a tertiary referral center in South India: a pharmacoepidemiologic and pharmacoeconomic study. Epilepsia. 1999;40(2):179-85.
Kamen B. Folate and antifolate pharmacology. Semin Oncol. 1997;24 (5 Suppl 18):S18-30.
Brosh K, Matok I, Sheiner E, Koren G, Wiznitzer A, Gorodischer R, et al. Teratogenic determinants of first-trimester exposure to antiepileptic medications. J Popul Ther Clin Pharmacol. 2011;18:e89-98.
Arai M, Osaka H. Acute leukoencephalopathy possibly induced by phenytoin intoxication in an adult patient with methylenetetrahydrofolate reductase deficiency. Epilepsia. 2011;52(7):e58-61.