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Published on: May 16, 2019
Impact of Antiseizure Medications on Appetite and Weight in Children
Ersida Buraniqi1, Hicham Dabaja1, Elaine C Wirrell2
1Division of Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, 200 First St., SW, Rochester, MN, 55905, USA.
Insights
Antiseizure medications (ASMs) can impact children's growth by affecting appetite and weight. Some ASMs cause weight loss, while others, like valproic acid, promote weight gain, influencing treatment adherence and health outcomes.
Area of Science:
- Pediatric Neurology
- Pharmacology
- Child Growth and Development
Background:
- Epilepsy and its treatment can significantly affect a child's growth, particularly concerning appetite and weight.
- Antiseizure medications (ASMs) are known to have various adverse effects, including potential impacts on appetite and weight, which are crucial for normal development.
Purpose of the Study:
- To systematically review the impact of epilepsy and ASMs on appetite and weight in children.
- To identify specific ASMs associated with decreased appetite/weight loss and those linked to increased appetite/weight gain in pediatric populations.
Main Methods:
- A systematic literature review was conducted using Medline database.
- Included studies were randomized controlled trials and open-label studies involving pediatric patients (0-18 years).
- Studies were classified using the American Academy of Neurology (AAN) Classification of Evidence and graded for impact on appetite and weight.
Main Results:
- ASMs linked to decreased appetite/weight loss: fenfluramine, topiramate, zonisamide, felbamate, rufinamide, stiripentol, cannabidiol, brivaracetam, ethosuximide.
- ASMs with minimal impact: oxcarbazepine, eslicarbazepine, lamotrigine, levetiracetam, lacosamide, carbamazepine, vigabatrin, clobazam.
- ASM most associated with increased appetite/weight gain: valproic acid; pregabalin and perampanel may also cause modest weight gain.
Conclusions:
- ASMs have a variable impact on pediatric appetite and weight, ranging from weight loss to weight gain.
- Understanding these effects is critical for managing children with epilepsy, as they can influence treatment adherence and overall morbidity.
- Clinical evaluation of appetite and weight is essential for all children with epilepsy experiencing such concerns.
Abstract:
There are numerous potential factors that may affect growth in children with epilepsy, and these must be evaluated in any child with appetite and weight concerns. Antiseizure medications (ASMs) have potential adverse effects, and many may affect appetite, thus impacting normal growth and weight gain. The aim of this review is to focus on the impact of both epilepsy and ASMs on appetite and weight in children. We systematically reviewed studies using Medline assessing the impact of ASMs on appetite and weight in children. Eligible studies included randomized controlled trials and open-label studies (open-label extension and interventional) that targeted or included the pediatric population (0-18 years of age). Each study was classified using the American Academy of Neurology (AAN) Classification of Evidence for Therapeutic Studies, and the level of evidence for impact on appetite and weight in children was graded. ASMs associated with decreased appetite and/or weight loss include fenfluramine, topiramate, zonisamide, felbamate, rufinamide, stiripentol, cannabidiol, brivaracetam and ethosuximide; ASMs with minimal impact on weight and appetite in children include oxcarbazepine, eslicarbazepine, lamotrigine, levetiracetam, lacosamide, carbamazepine, vigabatrin and clobazam. The ASM most robustly associated with increased appetite and/or weight gain is valproic acid; however, both pregabalin and perampanel may also lead to modest weight gain or increased appetite in children. Certain ASMs may impact both appetite and weight, which may lead to increased morbidity of the underlying disease and impaired adherence to the treatment regimen.
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