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Homocysteine Metabolism and Hematological Parameters in Early Stage of Phenytoin Treated Epileptic Children.
Clin Lab 2017; 63(7):1089-1097CL

Abstract

BACKGROUND

Long-term antiepileptic drug (AED) therapy has been associated with metabolic consequences that lead to an increase in risk of atherosclerosis in patients with epilepsy. Earlier published studies showed conflicting results about the levels of hematological parameters, serum homocysteine, folate, and vitamin B12, in epileptics treated with phenytoin monotherapy. Therefore, we evaluated homocysteine metabolism and hematological parameters in early stage of phenytoin treated epileptic children.

METHODS

A total of 64 newly diagnosed epileptic children with mean age 10.09 ± 2.56 years were enrolled at the start of study. However, after 3 months follow up, the final total sample size was only 50 epileptic children. Fourteen children dropped out of study due to poor follow up. Serum homocysteine levels were measured by enzyme immunoassay method. Serum folate and vitamin B12 levels were estimated by Competitive Chemiluminescent Enzyme Immunoassay method. Hematological parameters were analysed by an automated hematology analyzer (Cell counter), Sysmex XT-1800i, using commercially available reagents.

RESULTS

In our study the anthropometric and hematological parameters did not show any significant difference after phenytoin monotherapy as compared to before therapy in epileptic children. The serum homocysteine level in epileptic children was found to be significantly increased after phenytoin (PHT) monotherapy as compared to before therapy. Moreover, a highly significant decrease was observed in the serum folate and vitamin B12 levels after phenytoin monotherapy as compared to before therapy in epileptic children.

CONCLUSIONS

Phenytoin monotherapy may cause a significant increase in the levels of serum homocysteine and a significant decrease in the serum folate and vitamin B12 levels in children with epilepsy, and the significant changes in above mentioned parameters occur early in the course of treatment. This could be responsible for a higher prevalence of cardiovascular incidents in epileptic children taking phenytoin monotherapy. Therefore, it may be useful to do early screening and treatment of increased serum homocysteine levels in epileptic children under phenytoin monotherapy to prevent atherosclerosis and its complications. Hematological parameters should also be strictly monitored regularly in individuals administered with PHT monotherapy. If there are persistent alterations, the administration of the drugs should be discontinued.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28792705

Citation

Sharma, Tarun K., et al. "Homocysteine Metabolism and Hematological Parameters in Early Stage of Phenytoin Treated Epileptic Children." Clinical Laboratory, vol. 63, no. 7, 2017, pp. 1089-1097.
Sharma TK, Vardey SK, Sitaraman S. Homocysteine Metabolism and Hematological Parameters in Early Stage of Phenytoin Treated Epileptic Children. Clin Lab. 2017;63(7):1089-1097.
Sharma, T. K., Vardey, S. K., & Sitaraman, S. (2017). Homocysteine Metabolism and Hematological Parameters in Early Stage of Phenytoin Treated Epileptic Children. Clinical Laboratory, 63(7), pp. 1089-1097. doi:10.7754/Clin.Lab.2017.161205.
Sharma TK, Vardey SK, Sitaraman S. Homocysteine Metabolism and Hematological Parameters in Early Stage of Phenytoin Treated Epileptic Children. Clin Lab. 2017 Jul 1;63(7):1089-1097. PubMed PMID: 28792705.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Homocysteine Metabolism and Hematological Parameters in Early Stage of Phenytoin Treated Epileptic Children. AU - Sharma,Tarun K, AU - Vardey,S K, AU - Sitaraman,S, PY - 2017/8/10/entrez PY - 2017/8/10/pubmed PY - 2018/7/24/medline SP - 1089 EP - 1097 JF - Clinical laboratory JO - Clin. Lab. VL - 63 IS - 7 N2 - BACKGROUND: Long-term antiepileptic drug (AED) therapy has been associated with metabolic consequences that lead to an increase in risk of atherosclerosis in patients with epilepsy. Earlier published studies showed conflicting results about the levels of hematological parameters, serum homocysteine, folate, and vitamin B12, in epileptics treated with phenytoin monotherapy. Therefore, we evaluated homocysteine metabolism and hematological parameters in early stage of phenytoin treated epileptic children. METHODS: A total of 64 newly diagnosed epileptic children with mean age 10.09 ± 2.56 years were enrolled at the start of study. However, after 3 months follow up, the final total sample size was only 50 epileptic children. Fourteen children dropped out of study due to poor follow up. Serum homocysteine levels were measured by enzyme immunoassay method. Serum folate and vitamin B12 levels were estimated by Competitive Chemiluminescent Enzyme Immunoassay method. Hematological parameters were analysed by an automated hematology analyzer (Cell counter), Sysmex XT-1800i, using commercially available reagents. RESULTS: In our study the anthropometric and hematological parameters did not show any significant difference after phenytoin monotherapy as compared to before therapy in epileptic children. The serum homocysteine level in epileptic children was found to be significantly increased after phenytoin (PHT) monotherapy as compared to before therapy. Moreover, a highly significant decrease was observed in the serum folate and vitamin B12 levels after phenytoin monotherapy as compared to before therapy in epileptic children. CONCLUSIONS: Phenytoin monotherapy may cause a significant increase in the levels of serum homocysteine and a significant decrease in the serum folate and vitamin B12 levels in children with epilepsy, and the significant changes in above mentioned parameters occur early in the course of treatment. This could be responsible for a higher prevalence of cardiovascular incidents in epileptic children taking phenytoin monotherapy. Therefore, it may be useful to do early screening and treatment of increased serum homocysteine levels in epileptic children under phenytoin monotherapy to prevent atherosclerosis and its complications. Hematological parameters should also be strictly monitored regularly in individuals administered with PHT monotherapy. If there are persistent alterations, the administration of the drugs should be discontinued. SN - 1433-6510 UR - https://www.unboundmedicine.com/medline/citation/28792705/Homocysteine_Metabolism_and_Hematological_Parameters_in_Early_Stage_of_Phenytoin_Treated_Epileptic_Children_ L2 - https://doi.org/10.7754/Clin.Lab.2017.161205 DB - PRIME DP - Unbound Medicine ER -