Antiepileptic Drugs and Risk Factors of Vascular Diseases

Abstract

Epilepsy is one of the most common neurological diseases, afecting approximately % of the population. It is a chronic disease and increased incidence falls in the period up to year and years of age. Most patients require long-term antiepileptic drugs AEDs therapy. In addition, approximately % of patients with epilepsy do not obtain satisfactory seizure control, which is deined as drug-resistant epilepsy. It is postulated that one of the causes of drug resistance can be polymorphisms of ABCB1/MDR1 gene, tested particularly in tumors. It is believed that the old generation of AEDs, e.g. CBZ, VPA, may change plasma Hcy, asymmetric dimethylarginine ADMA levels, disturb lipid levels, C-reactive protein, vitamins, markers of oxidative stress, which are risk factors for vascular and neurodegenerative diseases. Changes in the level of risk factors for vascular disease caused by enzymes inducing AEDs, CBZ, PB, and PHT lead to a small increase in the risk of myocardial infarction. Alteration of Hcy and ADMA levels are also linked to genetic factors, e.g. genetic variants of MTHFR, MTR, MTHFD1, CBS, DDAH1, eNOS genes. Individualization of treatment with AEDs and prevention against cardiovascular disease in patients with epilepsy may bring the best therapeutic efects in these patients.

Influence of Different Antiseizure Medications on Vascular Risk Factors in Children with Epilepsy

“…It is a byproduct in the normal metabolism of the amino acid methionine to cysteine [ 3 ]. Many studies have demonstrated that the prolonged use of certain ASMs raises homocysteine levels, which is related to vascular endothelial damage and, therefore, raises the chances of atherosclerosis and cardiovascular diseases [ 4 ]. Elevated serum homocysteine levels increase oxidative stress, thus, cause vascular inflammation, increase platelet aggregation, induce thrombosis and coagulation disorders, and consequently, produce endothelial damage.…”