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Hyperhomocysteinemia in children treated with antiepileptic drugs is normalized by folic acid supplementation.

Abstract

PURPOSE

To assess the prevalence of hyperhomocysteinemia in pediatric patients treated with antiepileptic drugs (AEDs) and to evaluate the effect of folic acid supplementation on plasma total homocysteine (tHcy) concentrations in hyperhomocysteinemic patients.

METHODS

123 patients from three regional hospitals participated in the study. Patients with hyperhomocysteinemia were included in a 3-month double-blind randomized trial testing oral folic acid supplementation (1 mg/day) versus placebo.

RESULTS

Hyperhomocysteinemia (tHcy >10.4 micromol/L) was present in 19 of 123 patients. Patients with hyperhomocysteinemia were older (13.7 +/- 4 vs. 11.0 +/- 3.9 years) and had significantly lower folate and cobalamin concentrations. Multidrug (two or more) AED treatment and duration of therapy correlated significantly with elevated total homocysteine (tHcy) and low folate. In contrast, polymorphisms in the methylene tetrahydrofolate reductase gene (MTHFR 677 C-->T, 1298 A-->C, 1793 G-->A) had no significant impact on tHcy. Nine of 19 patients with hyperhomocysteinemia were randomized to placebo, whereas the remaining 10 patients received folic acid supplementation. Folic acid supplementation resulted in a significant increase of folate and decrease of tHcy, whereas both parameters remained unchanged in the placebo group.

CONCLUSIONS

Hyperhomocysteinemia is present in 15.5% of children receiving long-term AED treatment. Multidrug treatment and long duration of therapy enhance the risk for hyperhomocysteinemia. Folic acid supplementation significantly reduces tHcy. We recommend assessment of serum folate and plasma tHcy in children receiving AEDs.

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  • Authors+Show Affiliations

    ,

    Department of Pediatrics, Academic Teaching Hospital Landeskrankenhaus (LKH), Feldkirch, Austria. martina.huemer@lkhf.at

    , , , , , , ,

    Source

    Epilepsia 46:10 2005 Oct pg 1677-83

    MeSH

    Anticonvulsants
    Child
    Dietary Supplements
    Double-Blind Method
    Drug Therapy, Combination
    Epilepsy
    Folic Acid
    Folic Acid Deficiency
    Homocysteine
    Humans
    Hyperhomocysteinemia
    Treatment Outcome
    Vitamin B 12

    Pub Type(s)

    Clinical Trial
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    16190942

    Citation

    Huemer, Martina, et al. "Hyperhomocysteinemia in Children Treated With Antiepileptic Drugs Is Normalized By Folic Acid Supplementation." Epilepsia, vol. 46, no. 10, 2005, pp. 1677-83.
    Huemer M, Ausserer B, Graninger G, et al. Hyperhomocysteinemia in children treated with antiepileptic drugs is normalized by folic acid supplementation. Epilepsia. 2005;46(10):1677-83.
    Huemer, M., Ausserer, B., Graninger, G., Hubmann, M., Huemer, C., Schlachter, K., ... Simma, B. (2005). Hyperhomocysteinemia in children treated with antiepileptic drugs is normalized by folic acid supplementation. Epilepsia, 46(10), pp. 1677-83.
    Huemer M, et al. Hyperhomocysteinemia in Children Treated With Antiepileptic Drugs Is Normalized By Folic Acid Supplementation. Epilepsia. 2005;46(10):1677-83. PubMed PMID: 16190942.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Hyperhomocysteinemia in children treated with antiepileptic drugs is normalized by folic acid supplementation. AU - Huemer,Martina, AU - Ausserer,Bernd, AU - Graninger,Gunther, AU - Hubmann,Michael, AU - Huemer,Christian, AU - Schlachter,Kurt, AU - Tscharre,Arthur, AU - Ulmer,Hanno, AU - Simma,Burkhard, PY - 2005/9/30/pubmed PY - 2005/11/1/medline PY - 2005/9/30/entrez SP - 1677 EP - 83 JF - Epilepsia JO - Epilepsia VL - 46 IS - 10 N2 - PURPOSE: To assess the prevalence of hyperhomocysteinemia in pediatric patients treated with antiepileptic drugs (AEDs) and to evaluate the effect of folic acid supplementation on plasma total homocysteine (tHcy) concentrations in hyperhomocysteinemic patients. METHODS: 123 patients from three regional hospitals participated in the study. Patients with hyperhomocysteinemia were included in a 3-month double-blind randomized trial testing oral folic acid supplementation (1 mg/day) versus placebo. RESULTS: Hyperhomocysteinemia (tHcy >10.4 micromol/L) was present in 19 of 123 patients. Patients with hyperhomocysteinemia were older (13.7 +/- 4 vs. 11.0 +/- 3.9 years) and had significantly lower folate and cobalamin concentrations. Multidrug (two or more) AED treatment and duration of therapy correlated significantly with elevated total homocysteine (tHcy) and low folate. In contrast, polymorphisms in the methylene tetrahydrofolate reductase gene (MTHFR 677 C-->T, 1298 A-->C, 1793 G-->A) had no significant impact on tHcy. Nine of 19 patients with hyperhomocysteinemia were randomized to placebo, whereas the remaining 10 patients received folic acid supplementation. Folic acid supplementation resulted in a significant increase of folate and decrease of tHcy, whereas both parameters remained unchanged in the placebo group. CONCLUSIONS: Hyperhomocysteinemia is present in 15.5% of children receiving long-term AED treatment. Multidrug treatment and long duration of therapy enhance the risk for hyperhomocysteinemia. Folic acid supplementation significantly reduces tHcy. We recommend assessment of serum folate and plasma tHcy in children receiving AEDs. SN - 0013-9580 UR - https://www.unboundmedicine.com/medline/citation/16190942/Hyperhomocysteinemia_in_children_treated_with_antiepileptic_drugs_is_normalized_by_folic_acid_supplementation_ L2 - https://doi.org/10.1111/j.1528-1167.2005.00264.x DB - PRIME DP - Unbound Medicine ER -