[Hematologic alterations and reduction in serum folate in epileptics treated with anticonvulsants]

A prospective study of the incidence of toxic hematologic effects of antiepileptic drugs was carried out in a series of 104 epileptic patients treated with phenytoin alone or combined with other drugs, and in 30 patients treated with other anticonvulsants. A slight decrease in hemoglobin values and a slight increase in mean corpuscular volume and mean corpuscular hemoglobin was observed in both groups. These changes are typical of the hyperchromatic megaloblastic anemias, although a statistically significant relationship between folates and hemoglobin could not be established. Moreover, we found leukopenia and lymphopenia in the group treated with hydantoins, and moderate eosinophilia in both groups. Changes in metabolism of vitamin B12 and folate were frequent, with decreased values in more than 30% of patients. A significant inverse correlation was observed between serum levels of folates and phenytoin, which suggests a direct toxic effect of the drug. No major dyscrasias were noticed.