الفهرس | Only 14 pages are availabe for public view |
Abstract SUMMARY Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate seizures and by the neurobiologic, cognitive, psychologic and social consequences of this condition. Epilepsy is the most common serious neurologic disorder that often requires lifelong treatment. The aim of epilepsy management is complete seizures cessation and maintenance of a good quality of life, which is affected not only by the epileptic attacks but also by adverse effect of the drug. This concern is more in case of developing brain of children. However, selection of antiepileptic drug is a challenging task. Prolonged antiepileptic drugs treatment can result in secondary carnitine deficiency. Clinical studies indicate a decrease in total and free plasma carnitine level in children treated with old antiepileptic drugs especially valproate. The effect of valproic acid on carnitine metabolism was age dependent with more evidence on children younger than 10 years old. This may be in line with the observation that valproate induced hepatotoxicity is more common in young children. Carnitine is an essential metabolite, which has a number of indispensable roles in intermediary metabolism. It has an important role in the transport of activated long-chain fatty acids from the cytosol to the mitochondrial matrix, where β-oxidation takes place. Also carnitine is involved in the transfer of the products of peroxisomal β-oxidation, including acetyl-CoA, to the mitochondria for oxidation to CO2 and H2O in the Krebs cycle. Other functions of carnitine include storage of energy as acetylcarnitine and the modulation of toxic effects of poorly metabolized acyl groups by excreting them as carnitine esters. In this study, patients were assessed by measuring plasma carnitine level before and one year after treatment with old antiepileptic drugs (valproate and carbamazepine) and new antiepileptic drugs (leviteracetam and oxcarbazepine) and compairing it by the plasma carnitine level in control children. This study was carried out in Tanta University Hospital Pediatric Department, Neurology Unit. Fifty children with newly diagnosed idiopathic epilepsy selected from those attending the pediatric neurology outpatient clinic and enrolled in the study with patients classified into four groups according to their antiepileptic drug treatment into: group 1, 20 patients received valproic acid as momotherapy without any antiepileptic drug treatment before. group 2, 10 patients treated with carbamazepine. group 3, 10 patients treated with leviteracetam as monotherapy. group 4, 10 patients treated with oxcarbazepine as monotherapy, duration of treatment one year. Twenty healthy children served as control group with the same age range. Patients with idiopathic epilepsy with normal brain magnetic resonance imaging (MRI) were included. Patients with symptomatic epilepsy, liver or renal diseases, hypotonia or progressive weakness were excluded. In the present study, there was no significant difference between mean plasma level of carnitine in children treated with (valproate, carbamazepine, leviteracetam and oxcarbazepine) and the controls before receiving treatment.This study showed significant difference between mean plasma level of carnitine in children treated with valproate before and after treatment. Also, showed inverse correlation between the duration of treatment with valproate and the mean plasma carnitine level. The longer the duration of treatment, the more significant decrease in mean plasma carnitine level. Also, there was inverse relation between the level of valproate and the mean plasma carnitine level. The higher the level of valproic acid, the more significant decrease in the mean plasma carnitine level. from this study we conclude that, valproic acid was the only antiepileptic drug reported to cause carnitine deficiency and carnitine supplementation may reduces the adverse reactions caused by VPA. |