Vascular risk linked to long-term antiepileptic drug therapy

November 15, 2011

New research reveals that patients with epilepsy who were treated for extended periods with older generation antiepileptic drugs (AEDs) may be at increased risk for developing atherosclerosis, a common disorder known as hardening of the arteries. According to the findings now available in Epilepsia, the journal of the International League Against Epilepsy (ILAE), the vascular risk is significantly associated with the duration of AED monotherapy.

While the majority of have good results with treatment, more than 30% of patients continue to have seizures even with AED therapy. In these cases of refractory epilepsy, long-term or lifelong AED therapy is needed. Prolonged treatment can lead to diabetes, thyroid issues, psychiatric problems and . Prior studies suggest that older-generation AEDs such as phenytoin, carbamazepine, phenobarbital, and may alter , contributing to increased vascular risks.

Lead author, Dr. Yao-Chung Chuang from Kaohsiung Chang Gung Memorial Hospital in Taiwan, and colleagues compared the long-term impact of different categories of AED monotherapy on atherosclerosis development. The team recruited 160 with epilepsy who had received AED for more than 2 years, along with 60 healthy controls. Ultrasonography was used to measure participants' common carotid artery (CCA) intima media thickness (IMT) -- a measurement used to assess the extent of atherosclerosis.

"Our study found patients with epilepsy who were under long-term monotherpy with phenytoin, carbamazepine and valproic acid displayed significantly increased CCA IMT measurements," said Dr. Chuang. "These altered circulatory markers from prolonged AED therapy may accelerate the atherosclerotic process." Analysis showed that CCA IMT is positively correlated with the duration of AED therapy.

Researchers also investigated specific associated with the type of AED therapy. Epilepsy patients taking carbamazepine or phenytoin for long periods exhibited increased levels of cholesterol and of the amino acid, total homocysteine (tHcy), and lower levels of folate, all of which increase risk of adverse cardiovascular and cerebrovascular events. Patients who were treated with valproic acid displayed elevated levels of uric acid, tHcy, and thiobarbituric acid reactive substances (TBARS), increasing atherosclerosis risk which the authors believe is based on oxidative mechanisms.

The authors argue that drug choice should be carefully selected for epilepsy patients requiring long-term AED treatment, particularly in elderly or individuals at high-risk of vascular events. Dr. Chuang concluded, "Our findings suggest that newer AEDs, such as lamotrigine, may minimize metabolic disturbances, and therefore reduce the risk of atherosclerosis brought on by long-term AED therapy."

Explore further: Adjunctive antiepileptic drug treatment can lower risk of dying from a sudden unexpected death

More information: "Effects of Long-Term Antiepileptic Drug Monotherapy on Vascular Risk Factors and Atherosclerosis." Yao-Chung Chuang, Hung-Yi Chuang, Tsu-Kung Lin, Chiung-Chih Chang, Cheng-Hsien Lu, Wen-Neng Chang, Shang-Der Chen, Teng-Yeow Tan, Chi-Ren Huang, and Samuel H.H. Chan. Epilepsia; November 15, 2011 (DOI: 10.1111/j.1528-1167.2011.03316.x).

Related Stories

Adjunctive antiepileptic drug treatment can lower risk of dying from a sudden unexpected death

September 18, 2011
New research published Online First in The Lancet Neurology, has found that epilepsy patients who receive additional treatment with antiepileptic drugs (AEDs) have about a seven times lower risk of dying from a sudden unexpected ...

Recommended for you

Five vascular diseases linked to one common genetic variant

July 27, 2017
Genome-wide association studies have implicated a common genetic variant in chromosome 6p24 in coronary artery disease, as well as four other vascular diseases: migraine headache, cervical artery dissection, fibromuscular ...

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.