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Effects of sodium valproate and levetiracetam on posterior segment parameters in children with epilepsy
Asena Keles Sahin1, Sevgi Cirakli2
1Department of Ophthalmology, Training and Research Hospital, Ordu University, 52000, Ordu, Turkey. asina_86@hotmail.com.
Insights
Sodium valproate treatment in pediatric epilepsy patients was associated with reduced retinal nerve fiber layer thickness. Levetiracetam appears safer for ocular health, but long-term monitoring is advised for both medications.
Area of Science:
- Ophthalmology and Neurology
- Pediatric Epilepsy Management
- Neuro-ophthalmic Complications
Background:
- Epilepsy affects children, necessitating long-term treatment with antiepileptic drugs.
- Ocular side effects of antiepileptic drugs require thorough investigation, particularly in pediatric populations.
- Understanding the impact of specific medications like sodium valproate and levetiracetam on posterior segment parameters is crucial for patient safety.
Purpose of the Study:
- To evaluate changes in posterior segment parameters, specifically retinal nerve fiber layer (RNFL) and macular ganglion cell layer-inner plexiform layer (mGCIPL) thicknesses.
- To compare these changes in pediatric epilepsy patients on monotherapy with sodium valproate versus levetiracetam for at least 12 months.
- To assess the safety profile of these antiepileptic drugs concerning ocular structures in children.
Main Methods:
- A study involving 45 children (6-17 years) with generalized epilepsy and 32 healthy controls.
- Patients were divided into three groups: sodium valproate monotherapy, levetiracetam monotherapy, and healthy controls.
- Spectral-domain optical coherence tomography (OCT) was used to measure peripapillary RNFL and mGCIPL thicknesses.
Main Results:
- Patients on sodium valproate monotherapy showed significantly thinner RNFL values compared to both levetiracetam and control groups.
- No significant differences in OCT parameters were observed between the levetiracetam group and the healthy controls.
- A negative correlation was found between sodium valproate dose and average mGCIPL thickness, suggesting a dose-dependent effect.
Conclusions:
- Sodium valproate treatment is associated with a reduction in RNFL thickness in pediatric epilepsy patients.
- Levetiracetam appears to be a safer alternative regarding RNFL and mGCIPL thickness in this population.
- Caution is advised with long-term, high-dose sodium valproate use due to potential ocular side effects.
Purpose:
To evaluate changes in posterior segment parameters in pediatric patients with epilepsy using sodium valproate or levetiracetam monotherapy for at least 12 months.
Methods:
This study included 45 children with generalized epilepsy aged 6-17 years and 32 age- and gender-matched healthy subjects. The patients were assigned to three groups: Group 1 included patients using valproate monotherapy at a dose of 20-40 mg/kg/day, group 2 included patients using levetiracetam monotherapy at a dose of 20-40 mg/kg/day, and group 3 consisted of healthy controls. Peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell layer-inner plexiform layer (mGCIPL) thicknesses were measured using spectral-domain optical coherence tomography (OCT).
Results:
No significant differences were noted between the groups regarding age, gender distribution, visual acuity, spherical equivalent, and intraocular pressure (p > 0.05). The average and temporal, nasal, and superior quadrants RNFL values were significantly thinner in group 1 than in group 2 (p = 0.001, p = 0.023, p = 0.011, and p = 0.001, respectively) and group 3 (p < 0.001, p = 0.032, p < 0.001, and p = 0.001, respectively). The OCT parameters were similar in groups 2 and 3 (p > 0.05). A negative correlation was observed in group 1 between only the average mGCIPL and the treatment dose (r = - 0.501). In group 2, no significant correlation was found between OCT parameters and the duration of epilepsy treatment, dose of treatment, and age at treatment onset values (p > 0.05).
Conclusion:
These findings support that there is an association between sodium valproate treatment and the reduction of RNFL thickness in epilepsy. Levetiracetam treatment appears to be a safe option, but care should be taken regarding ocular side effects that may occur with long-term and high-dose use of sodium valproate.
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