Serum folate levels in children on long-term anti-seizure medication in a Nigerian tertiary center—Implications for practice and public health

Abstract

Background: Epilepsy is the most common childhood neurological disorder in Nigeria. Treatment of epilepsy is long-term and sometimes lifelong with anti-seizure medications. There are conflicting reports on the effect of anti-seizure medications on serum folate. There is therefore a need to determine the effect of a commonly used anti-seizure medication's on serum folate levels of children. This would provide an evidence-based consideration for folic acid supplementation in children on anti-seizure medication as has been suggested by some studies. Study objectives: To determine whether serum folate levels were lower in children taking long-term carbamazepine or sodium valproate, compared to a control group. Methods: Serum folic acid levels were measured from well-nourished children between the ages of 1–17 years on carbamazepine and sodium valproate monotherapy and their age/sex-matched controls, using spectrophotometry. Results: The mean serum folate levels of patients on carbamazepine (43) and sodium valproate (22) were 0.032 mg/l ± 0.009 and 0.028 mg/l ± 0.008, respectively. The mean folate levels of the controls were 0.046 mg/l ± 0.03 ( p = 0 001). No statistically significant difference was observed between the serum folate levels of children on the two anti-seizure medications, that is, carbamazepine and valproate. Conclusion: The children on treatment with carbamazepine and sodium valproate for more than 6 months had statistically significantly lower serum levels of folic acid compared to the standard reference range and controls. The serum folate levels of children on carbamazepine were not statistically different from those on sodium valproate.

Hubungan Durasi Terapi Asam Valproat dengan Kadar Asam Folat Darah pada Epilepsi Anak

“…2 Tidak adanya hubungan antara durasi terapi dan kadar asam folat pada penelitian ini, baik pada seluruh subjek maupun berdasarkan kendali kejang, sejalan dengan penelitian terdahulu di Nigeria yang menekankan hipotesis bahwa efek asam valproat menurun seiring durasi terapi sehingga lama terapi tidak mempengaruhi kadar asam folat. 12 Meskipun penelitian lain dengan durasi terapi yang lebih panjang menunjukkan hubungan negatif yang signifikan dengan kadar asam folat. 2 Oleh sebab itu, pemeriksaan serial perlu dilakukan, seperti yang ditunjukkan penelitian terdahulu ketika terdapat penurunan kadar asam folat setelah 1 tahun pengobatan.…”

“…Namun, pemeriksaan kadar asam folat dapat dipertimbangkan jika onset epilepsi dan onset terapi asam valproate dimulai pada usia yang lebih besar atau ditemukan klinis defisiensi asam folat. 12,2…”