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Plasma total homocysteine concentrations in epileptic patients taking anticonvulsants
1Department of Pediatrics, Hiroshima University School of Medicine, Hiroshima, Japan.
Insights
Measuring serum folate (FA) and plasma total homocysteine (tHcy) can help prevent thrombosis in epileptic patients on long-term anticonvulsant therapy. Low FA levels correlate with high tHcy, especially in older patients.
Area of Science:
- Clinical Chemistry
- Neurology
- Nutritional Biochemistry
Background:
- Epileptic patients on anticonvulsant drugs often exhibit altered homocysteine and folate levels.
- Hyperhomocysteinemia is a risk factor for thrombosis.
- Anticonvulsant medications can interfere with folate metabolism.
Purpose of the Study:
- To investigate the relationship between serum folate (FA) and plasma total homocysteine (tHcy) in epileptic patients on anticonvulsant therapy.
- To assess the clinical significance of FA deficiency and hyperhomocysteinemia in this patient group.
Main Methods:
- Cross-sectional study involving 130 epileptic patients treated with anticonvulsants.
- Measurement of plasma total homocysteine (tHcy) and serum folate (FA) concentrations.
- Comparison of tHcy levels with control subjects and correlation analysis between FA and tHcy.
Main Results:
- A significant inverse correlation was observed between FA and tHcy concentrations, more pronounced in older patients (≥15 years).
- Four patients (3.1%) were identified as folate-deficient, all with long-term (>7 years) multiple anticonvulsant treatment and elevated tHcy levels.
- Two patients with extremely high tHcy and subnormal methionine normalized after folate therapy, with tHcy decreasing to control levels.
Conclusions:
- Monitoring FA and tHcy levels is valuable for preventing thrombosis in epileptic patients on anticonvulsants.
- Long-term treatment with multiple anticonvulsants increases the risk of folate deficiency and hyperhomocysteinemia.
- Early detection and intervention with folate therapy can mitigate hyperhomocysteinemia-associated risks.
Abstract:
Plasma total homocysteine (tHcy) and serum folate (FA) concentrations were measured in 130 epileptic patients taking anticonvulsant drugs. A significant inverse correlation was found between FA and tHcy. This was greater in the older group (> or = 15 years) than in the younger group (1 to 14 years). There were four FA-deficient patients (FA concentration < 3 ng/mL regardless of symptoms), including three patients in the older group and one in the younger group. All FA-deficient patients had received long-term treatment (> 7 years) with multiple anticonvulsants. Their tHcy levels were higher than the 90th percentile of those in control subjects. Two patients showed extremely high levels of tHcy (57.9 and 29.1 mumol/L) and subnormal plasma methionine levels. After FA therapy, their tHcy decreased to levels the same as or less than those of control subjects and FA increased to above the normal range. Based on these findings, we conclude that measuring FA and tHcy concentrations may be useful for preventing thrombosis due to hyperhomocysteinemia in epileptic patients taking anticonvulsants, particularly those who receive long-term treatment with multiple agents.