Antiepileptic drug use for treatment of epilepsy and dyslipidemia: Systematic review

Vyas, Manav V.; Davidson, Benjamin Andrew; Escalaya, Leonardo; Chen, John; Saposnik, Gustavo; Burneo, Jorge G.

doi:10.1016/j.eplepsyres.2015.03.002

Cited by 55 publications

(43 citation statements)

References 54 publications

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“…A recent systematic review (Vyas et al., 2015) found that the three drugs mostly related to changes in lipid profile are PHT, CBZ, and VPA. In our case, EIAEDs—as a group—were associated with dyslipidemia diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Although we cannot discard the possibility that CBZ might have caused changes in cholesterol levels, the clinical significance is questionable, as any changes that occurred did not exceed the dyslipidemia definition threshold (De Backer et al., 2003). We consider this an important finding, as a systematic review (Vyas et al., 2015) reported changes in lipid profile (i.e., an increase in total cholesterol from 180 to 190 mg/dl) that did not necessarily result in a dyslipidemia diagnosis, making it difficult to assess prevalence of this CRF, and there was no consistency in association between VPA and total cholesterol levels. In our study, patients under VPA therapy were less affected by dyslipidemia than the rest of the population.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of cardiovascular risk factors in people with epilepsy

et al. 2016

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ObjectivesEpilepsy has been associated with cardiovascular comorbidity. This study aimed to assess the potential association between cardiovascular risk factors (CRFs), antiepileptic drugs (AEDs), and etiology.Material and MethodsA single‐center retrospective epilepsy cohort from the decade of 2004–2013 was assessed. Poisson regression models with robust variance were estimated to obtain CRF prevalence ratios (PR) according to AED prescription and etiology.ResultsAfter excluding patients in the monotherapy group with vascular etiology or previous cardiovascular events, in the remaining 400 patients, enzyme‐inducer AEDs (EIAEDs), especially phenytoin (PHT), were associated with higher prevalence of dyslipidemia (PRa 1.77, p < .05), compared to valproic acid. No etiology was associated with higher prevalence of any CRF.ConclusionsPatients treated with EIAEDs, especially PHT, had higher prevalence of dyslipidemia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prevalence of cardiovascular risk factors in people with epilepsy

et al. 2016

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“…The literature on the effect of AEDs per se on lipids is not unequivocal. Negative effects seems larger for older AEDs, but this may reflect publication bias or lack of data, as noted in a recent systematic review whose authors recommend vigilance regarding vascular risk-factor modification in patients on AEDs [Vyas et al 2015]. As a rule, treatment with AEDs in elderly patients combines the described challenges of drug-drug interactions and cardiovascular risk with age-related changes in pharmacokinetics and increased susceptibility to cognitive side effects in particular [Siniscalchi, 2012].…”

Section: Aed Treatmentmentioning

confidence: 99%

“…More research is needed on the importance of stroke prophylaxis in elderly patients with newly diagnosed epilepsy. Such information is especially needed given the potentially negative impact on vascular risk exerted by AEDs [Katsiki et al 2014;Vyas et al 2015].…”

Section: Prestroke Epilepsymentioning

confidence: 99%

“…The combination of strong enzyme inducers, exemplified by CBZ and PHT, with new anticoagulants like apixaban or dabigatran is discouraged in the prescription information. CBZ lowers the exposure to concomitant simvastatin, as do newer generation AEDs with enzyme-inducing properties like ESL [Falcao et al 2013;Vyas et al 2015]. Regarding vascular risk, AEDs can, for instance, impact serum lipids, weight and risk of cardiac arrhythmias [Katsiki et al 2014].…”

Section: Aed Treatmentmentioning

confidence: 99%

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Poststroke epilepsy: update and future directions

Zelano

2016

Ther Adv Neurol Disord

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Stroke is among the most common causes of epilepsy after middle age. Patients with poststroke epilepsy (PSE) differ in several respects from patients with other forms of structural-metabolic epilepsy; not least in age, age-related sensitivity to side effects of antiepileptic drugs (AEDs), and specific drug-drug interaction issues related to secondarystroke prophylaxis. Encouragingly, there has lately been remarkable activity in the study of PSE. Three developments in PSE research deserve particular focus. First, large prospective trials have established the incidence and risk factors of PSE in the setting of modern stroke care. Stroke severity, cortical location, young age, and haemorrhage remain the most important risk factors. Second, although more studies are needed, epidemiological data indicate that the risk of PSE may be influenced, for instance, by statin treatment. Third, studies are emerging regarding the treatment and prognosis of PSE. Levetiracetam and lamotrigine may be well tolerated treatment options and seizure freedom is achieved in at least a similar proportion of patients as in other epilepsies. Furthermore, new animal models such as photothrombotic stroke gives hope of a more clear understanding of PSE epileptogenesis in the near future. In summary, PSE shows indications of maturing into an independent epilepsy research field. This review summarizes recent advances in our understanding of PSE and provides an update on management issues such as diagnosis, AED selection, and prognosis. Finally, future research challenges in the field are outlined.

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Association Between Antiseizure Drug Monotherapy and Mortality for Patients With Poststroke Epilepsy

et al. 2022

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The relationship between epilepsy and stroke is complicated. While stroke is a major cause of epilepsy after middle age, there is also evidence that the risk of stroke is increased in persons with epilepsy. The overall aim of this dissertation is to elaborate on the prognosis and treatment of epilepsy in older adults and its association to stroke. It is based on four studies which have been conducted using information from linked national registers, which offer unique opportunities to follow thousands of patients over a long period of time.The results from Papers I-II indicate that a significant proportion of all newonset seizures after middle age will herald a subsequent stroke. Using incidence data and population statistics, we estimated the 10-year risk of stroke to be between 5-20%, depending on age group. In relative terms, the risk appears to be almost two-fold (odds ratio [OR] 1.77; 95% confidence interval [95%CI] 1.65-1.89) compared with age-matched controls from the general population -and highest during the first year after seizure onset (OR 2.21; 95 % CI 1.79-2.72).The studies described in Papers III-IV examined prognostic aspects of antiseizure medication (ASM) therapy in poststroke epilepsy. Paper III found the 5-year retention rate to be highest for lamotrigine (0.75, 95%CI 0.70-0.79) and levetiracetam (0.69, 95%CI 0.63-0.74), suggesting these drugs are well tolerated in this patient group. Paper IV used a similar methodology but investigated if mortality varied with different ASMs in monotherapy. Patients treated with lamotrigine had lower mortality (hazard ratio [HR] 0.72, 95%CI 0.60-0.86) than the reference group treated with carbamazepine, while patients treated with valproic acid had higher mortality (HR 1.40, 95%CI 1.23-1.59). Treatment with levetiracetam was associated with a reduced risk of cardiovascular death compared to carbamazepine (HR 0.77, 95%CI 0.60-0.99).In conclusion, this thesis supports a tailored management approach in adults with new-onset seizures late in life, particularly in those with a history of stroke. Persons with late-onset seizures have high vascular risk, potentially warranting screening and treatment for vascular risk factors. Moreover, the association between ASM selection and mortality raises concerns about clinically relevant drug-drug or drug-disease interactions that may modify vascular risk. Overall, lamotrigine and levetiracetam seem sensible initial treatment options in this patient group.

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Antiepileptic drug use for treatment of epilepsy and dyslipidemia: Systematic review

Cited by 55 publications

References 54 publications

Prevalence of cardiovascular risk factors in people with epilepsy

Prevalence of cardiovascular risk factors in people with epilepsy

Poststroke epilepsy: update and future directions

Association Between Antiseizure Drug Monotherapy and Mortality for Patients With Poststroke Epilepsy

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