EFFECT OF VALPROATE AND OXCARBAZEPINE THERAPY ON ASYMMETRIC DIMETHYL ARGININE (ADMA) AND HOMOCYSTEINE LEVELS IN NEWLY DIAGNOSED EPILEPTIC CHILDREN
Journal Title: Journal of Advanced Medical and Dental Sciences Research - Year 2017, Vol 5, Issue 7
Abstract
Aim: The aim of our study was to evaluate the effect of valproate and oxcarbazepine therapy in children newly diagnosed with epilepsy. Changes in serum asymmetric dimethyl arginine (ADMA), homocysteine, folate and B12 levels were assessed as possible markers of cardiovascular risk and correlation between homocysteine and ADMA levels was ascertained. Materials and Methods: Drug naïve patients newly diagnosed with epilepsy of age 7-17 years (n= 62), with no known cause of hyperhomocysteinemia, were enrolled for the study. A pre treatment analysis of homocysteine, folate and B12 was done using chemiluminescent competitive immunoassay. Serum ADMA levels were measured by ELISA. Thereafter, treatment of 34 children was started on valproate and 28 were prescribed oxcarbazepine. After six months of continuous treatment, the analysis was repeated. Results: Sixty two newly diagnosed, drug naïve patients of epilepsy were recruited for the study. After initial assessment of biochemical parameters, treatment was initiated. Valproate was started on 34 patients and 28 were given oxcarbazepine. No significant variations were observed in age, gender and seizure type. There was a significant increase in ADMA and Hcy levels in both the groups after six months of therapy (p < 0.05). A decrease in folate levels was registered in both the groups, but the change was significant only in the group on OXC treatment (p = 0.003). A significant increase in B12 concentration was observed in the group on VPA (p = 0.002) and a decrease was registered in children on OXC treatment (p = 0.026). . Differences between the groups were significant in ADMA, Hcy and B12 levels (p = 0.000, 0.000 and 0.003 respectively). 41.1% (14/34) children on valproate therapy and 21.4% (6/28) patients on oxcarbazepine had hyperhomocysteinemia after six months of therapy. No correlation was observed between ADMA and Hcy changes in both the groups. In subjects on valproate, at follow up, ADMA levels exhibited a positive correlation with B12 (r= 0.389; p= 0.023) and Hcy levels correlated negatively with folate (r= -0.444; p= 0.008). In patients on OXC therapy, ADMA correlated negatively with B12 at recruitment(r= -0.503; p= 0.006). After six months of therapy, Hcy and folate levels had a significant negative correlation (r= -0.427; p= 0.024). Conclusion: Anti-epileptic therapy can affect ADMA, Hcy and related vitamins but increase in ADMA may be independent of Hhcy. Further studies are needed to understand the etiology of ADMA increase
Authors and Affiliations
Namrata Khanna, Sajjan Lal Verma, Pradeep K Maurya, Vandana Tiwari, Dinkar Kulshreshtha
Keywords
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