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Homocysteine Metabolism and Hematological Parameters in Early Stage of Phenytoin Treated Epileptic Children

Tarun K Sharma, S K Vardey, S Sitaraman

    Clinical Laboratory
    |August 10, 2017
    PubMed

    Insights

    Phenytoin monotherapy in epileptic children significantly increases homocysteine and decreases folate and vitamin B12 levels early in treatment. Monitoring these metabolic changes is crucial for preventing cardiovascular complications.

    Area of Science:

    • Neurology
    • Clinical Chemistry
    • Pediatric Medicine

    Background:

    • Antiepileptic drug (AED) therapy, particularly long-term use, is linked to metabolic issues and increased atherosclerosis risk in epilepsy patients.
    • Conflicting prior research exists on hematological parameters, homocysteine, folate, and vitamin B12 levels in epilepsy patients on phenytoin monotherapy.

    Purpose of the Study:

    • To evaluate homocysteine metabolism and hematological parameters in epileptic children during the early stages of phenytoin monotherapy.

    Main Methods:

    • Enrolled 64 newly diagnosed epileptic children; 50 completed the 3-month follow-up.
    • Measured serum homocysteine via enzyme immunoassay and serum folate/vitamin B12 via competitive chemiluminescent enzyme immunoassay.
    • Analyzed hematological parameters using a Sysmex XT-1800i automated hematology analyzer.

    Main Results:

    • No significant changes in anthropometric or hematological parameters were observed post-phenytoin therapy compared to baseline.
    • Significantly increased serum homocysteine levels were detected after phenytoin monotherapy.
    • Highly significant decreases in serum folate and vitamin B12 levels were observed post-phenytoin monotherapy.

    Conclusions:

    • Phenytoin monotherapy can rapidly increase serum homocysteine and decrease serum folate and vitamin B12 in epileptic children.
    • These early metabolic alterations may contribute to a higher incidence of cardiovascular events in pediatric epilepsy patients on phenytoin.
    • Early screening and management of elevated homocysteine, alongside regular monitoring of hematological parameters, are recommended for children on phenytoin to prevent atherosclerosis.
    Abstract

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