Kolekar Vipul U, Sindgikar Seema P, Uppoor Raghuraj, Shetty Km Dhrithiman, Shenoy Vijaya
Department of Paediatrics, K.S. Hegde Medical Academy, Nitte (Deemed to be University), Mangaluru, Karnataka, India.
Department of Radiodiagnosis, K.S. Hegde Medical Academy, Nitte (Deemed to be University), Mangaluru, Karnataka, India.
J Pediatr Neurosci. 2021 Apr-Jun;16(2):131-136. doi: 10.4103/jpn.JPN_84_20. Epub 2021 Jul 2.
Common first-line antiepileptic drugs (AEDs) used in children are valproate, phenytoin, and levetiracetam. Many side effects for these AEDs are reported including obesity, atherosclerosis, and metabolic syndrome. The aim of our study was to evaluate changes in carotid artery intima-media thickness (CIMT) in epileptic children and to correlate with lipid profile of those who are on long-term antiepileptic therapy.
This case-control study was done over 18 months in department of pediatrics. Sample size was 84 with equal number of cases and controls. Epileptic children between 1 and 18 years of age receiving monotherapy with valproate, phenytoin, or levetiracetam for at least 6 months were included in the study. Measurement of CIMT was done by B mode ultrasonography. Lipid profile was analyzed. Statistical analysis was performed using one-way analysis of variance (ANOVA) test and Pearson correlation.
Among 42 cases of epilepsy, 30 were on valproate, 9 on phenytoin, and 3 on levetiracetam monotherapy. No significant difference was noted in body mass index (BMI) among children receiving AED compared with that of controls ( = 0.82). Mean value for CIMT was significantly higher among valproate (0.43 ± 0.04, ≤ 0.001), phenytoin (0.44 ± 0.04, 0.001), and levetiracetam group (0.43 ± 0.03, = 0.01) compared to controls (0.39 ± 0.01). Significant correlation was noted between CIMT and total cholesterol ( = 0.034), triglyceride ( = 0.011), low-density lipoprotein ( = 0.008), and very low-density lipoprotein ( = 0.011).
Children on long-term monotherapy with valproate, phenytoin, and levetiracetam have significantly abnormal CIMT. This might be associated with atherosclerotic changes, and these children may require close follow-up to prevent cardiovascular and cerebrovascular risks.
儿童常用的一线抗癫痫药物（AEDs）有丙戊酸盐、苯妥英和左乙拉西坦。据报道，这些AEDs有许多副作用，包括肥胖、动脉粥样硬化和代谢综合征。我们研究的目的是评估癫痫患儿颈动脉内膜中层厚度（CIMT）的变化，并将其与长期接受抗癫痫治疗患儿的血脂水平相关联。
本病例对照研究在儿科进行了18个月。样本量为84例，病例组和对照组数量相等。研究纳入了1至18岁接受丙戊酸盐、苯妥英或左乙拉西坦单药治疗至少6个月的癫痫患儿。通过B型超声测量CIMT。分析血脂水平。采用单因素方差分析（ANOVA）和Pearson相关性分析进行统计分析。
在42例癫痫患儿中，30例接受丙戊酸盐单药治疗，9例接受苯妥英单药治疗，3例接受左乙拉西坦单药治疗。与对照组相比，接受AEDs治疗的患儿体重指数（BMI）无显著差异（P = 0.82）。与对照组（0.39±0.01）相比，丙戊酸盐组（0.43±0.04，P≤0.001）、苯妥英组（0.44±0.04，P = 0.001）和左乙拉西坦组（0.43±0.03，P = 0.01）的CIMT平均值显著更高。CIMT与总胆固醇（P = 0.034）、甘油三酯（P = 0.011）、低密度脂蛋白（P = 0.008）和极低密度脂蛋白（P = 0.011）之间存在显著相关性。
长期接受丙戊酸盐、苯妥英和左乙拉西坦单药治疗的患儿CIMT显著异常。这可能与动脉粥样硬化改变有关，这些患儿可能需要密切随访以预防心血管和脑血管疾病风险。
