Differential Effects of Anti-Seizure Medications on Sarcopenia in Patients With Epilepsy

Epilepsy is a chronic neurological disorder that often requires long-term use of anti-seizure medications (ASMs). While ASMs are known to affect bone health, their impact on muscle mass and the development of sarcopenia has not been well studied. This study investigated the association between ASM use and sarcopenia in patients with epilepsy and identified specific medications associated with increased risk.

This cross-sectional study was conducted from March to September 2022. Adult epilepsy patients were recruited from a neurology outpatient clinic. Information on current and past ASM use was obtained from electronic medical records and patient interviews. ASMs were categorized into 4 groups: enzyme-inhibiting ASM (Valproate), enzyme-inducing ASMs (EIASMs), weak EIASMs, and non-EIASMs. Sarcopenia was defined using standard criteria based on muscle mass, strength, and physical performance. Statistical analyses included descriptive statistics and logistic regression using IBM SPSS Statistics Version 26.0.

A total of 200 patients were included. Univariate analysis showed significant differences in current EIASM use, duration of EIASM use, and phenytoin use between sarcopenia and non-sarcopenia groups (P = 0.030, P = 0.029, and P = 0.045, respectively). Logistic regression identified age (P = 0.030; OR = 1.045), body mass index (P = 0.001; OR = 0.672), and EIASM use (P = 0.023; OR = 5.091) as independent factors associated with sarcopenia.

Enzyme-inducing ASMs, particularly phenytoin, are associated with sarcopenia diagnosis in epilepsy patients. Older age and lower BMI were also associated with sarcopenia. Individualized ASM selection and early screening are recommended.