Department of Neurology, University Hospital Zurich, Switzerland.
Ann Neurol. 2011 Feb;69(2):352-9. doi: 10.1002/ana.22229. Epub 2011 Jan 19.
Antiepileptic drugs (AEDs) are important for the treatment of epilepsy, psychiatric diseases, and pain syndromes. Small studies have suggested that AED treatment reduces serum levels of folate and vitamin B12.
This prospective monocenter study aimed at testing the hypothesis that AED treatment is associated with folate and vitamin B12 serum levels in a large population. A total of 2730 AED-treated and 170 untreated patients with epilepsy and 200 healthy individuals were enrolled.
Treatment with carbamazepine, gabapentin, oxcarbazepine, phenytoin, primidone, or valproate was associated with lower mean serum folate levels or with a higher frequency of folate levels below the reference range in comparison with the entire group of patients, untreated patients, or controls. Treatment with phenobarbital, pregabalin, primidone, or topiramate was associated with lower vitamin B12 levels compared with the entire group of patients. Vitamin B12 serum levels were higher in patients treated with valproate compared with the entire group of patients, untreated patients, and healthy controls. Folate or vitamin B12 levels below the reference range were associated with higher mean corpuscular volume (MCV) and higher homocysteine plasma levels. Vitamin substitution for 3 months in 141 patients with folate or vitamin B12 levels below the reference range yielded normal vitamin levels in 95% of the supplemented patients and reduced MCV and homocysteine plasma levels.
Treatment with most of the commonly used AEDs is associated with reduced folate or vitamin B12 serum levels and is a risk factor for hyperhomocysteinemia. Oral substitution is effective to restore vitamin, MCV, and homocysteine levels.
抗癫痫药物（AEDs）对于癫痫、精神疾病和疼痛综合征的治疗非常重要。一些小型研究表明，AED 治疗会降低血清叶酸和维生素 B12 水平。
本前瞻性单中心研究旨在检验一个假设，即 AED 治疗与大人群中叶酸和维生素 B12 的血清水平有关。共纳入了 2730 名接受 AED 治疗的癫痫患者、170 名未接受治疗的癫痫患者和 200 名健康个体。
与整个患者群体、未接受治疗的患者或对照组相比，卡马西平、加巴喷丁、奥卡西平、苯妥英钠、苯巴比妥、丙戊酸钠治疗与平均血清叶酸水平较低或叶酸水平低于参考范围的频率较高相关。与整个患者群体相比，苯妥英钠、普瑞巴林、苯巴比妥或托吡酯治疗与较低的维生素 B12 水平相关。与整个患者群体、未接受治疗的患者和健康对照组相比，丙戊酸钠治疗的患者维生素 B12 血清水平较高。低于参考范围的叶酸或维生素 B12 水平与平均红细胞体积（MCV）较高和同型半胱氨酸血浆水平较高相关。在 141 名叶酸或维生素 B12 水平低于参考范围的患者中进行了 3 个月的维生素替代治疗，95%的补充患者的维生素水平恢复正常，并降低了 MCV 和同型半胱氨酸血浆水平。
大多数常用 AED 的治疗与降低的叶酸或维生素 B12 血清水平相关，并且是高同型半胱氨酸血症的一个危险因素。口服替代治疗可有效恢复维生素、MCV 和同型半胱氨酸水平。
