Carbamazepine-Induced Hematological and Immunological Alterations in Egyptian Children with Idiopathic Generalized Seizures

Abstract

Carbamazepine (CBZ) is one of the oldest antiepileptic drugs (AEDs) that is still used for the treatment of tonic-clonic seizures in children. Long-term use of AEDs induces potential toxic effects that may remain undetermined for a long time. Earlier studies have revealed a wide spectrum of hematological toxicities associated with CBZ. This study was conducted to unveil the toxic effects of carbamazepine as an antiepileptic monotherapy on hematological and immunological parameters in a group of Egyptian pediatric patients using it for different durations. Fifty pediatric epileptics of either sex were enrolled; 38 were taking CBZ as antiepileptic monotherapy for ≥ 6 months and 12 were newly diagnosed untreated patients. Hematological and immunological parameters studied were compared with their age and sex-matched 15 controls and among groups. CBZ was found more toxic for total leukocyte count, lymphocyte count, serum IgA and IgM levels (p < 0.001, 0.001, < 0.001, < 0.001, respectively). Hemoglobin level, platelets count, serum C4 level and IgA were negatively correlated with serum CBZ level (Spearman's rho = – 0.62, – 0.42, – 0.34, – 0.13; p < 0.001, 0.008, 0.04, 0.44, respectively). CBZ treatment duration associated inversely with platelets, lymphocyte, and eosinophil counts (p < 0.001, 0.03, 0.01, respectively). Epileptic children on CBZ monotherapy had their hematologic and immunologic systems affected, which mandates routine monitoring of these children.

Associations between Antiepileptic Use and Hypogammaglobulinaemia: Findings from a Population-Based Case-Control Study Using Data Linkage

“…A further 15% had sub-normal IgA levels. El-Shimi and colleagues found that IgA and IgM were lower than in 50 children with epilepsy treated with carbamazepine than in 15 controls [37]. In one longitudinal study of 19 patients with epilepsy, zonisamide was unlikely to affect immunoglobulin levels, but this study had low power [38].…”

“…Only one study has previously reported an exposure-response relationship between AED exposure and HGG. El-Shimi and colleagues found that IgG levels (but not IgA or IgM levels) were lower in children treated for longer with carbamazepine, but this analysis was hindered by a low sample size (only 50 children) [37].…”