Mohankumar Shivaprasad, Rameshkumar Ramachandran, Selvan Tamil, Nandeesha Hanumanthappa, Cg Delhikumar
Department of Pediatrics, Mediclinic City Hospital, Mohammed Bin Rashid University of Medicine & Health Sciences, Dubai, UAE.
Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Sultan Qaboos Univ Med J. 2024 Nov;24(4):528-533. doi: 10.18295/squmj.11.2024.075. Epub 2024 Nov 27.
This study aimed to explore the effect of antiseizure medications (ASM) on thyroid function in children with epilepsy.
A prospective study involving children between 6 months and 12 years of age with new-onset seizures who took ASM within 2 months was conducted in the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India, between August 2019 to March 2022. Thyroid function tests-free T3, free T4 and thyroid stimulating hormone (TSH)-were done at baseline and after completing 3 months by competitive immunoassay using direct chemiluminescent technology. The primary outcome was the proportion of patients diagnosed with thyroid dysfunction (subclinical or overt hypothyroidism).
In total, 126 patients were enrolled. Median (interquartile range [IQR]) age and follow-up months were 10 years (7-12) and 6 months (4-8), respectively. Most patients (n = 103, 81.7%) had generalised seizures, while the remaining (n = 23, 18.3%) had focal seizures. There was a significant difference noted in median (IQR) TSH (micro-IU/mL) at baseline (2.08 [1.41-3.31]) and follow-up (2.56 [1.65-4.14]; ≤0.001). Thyroid dysfunction (subclinical hypothyroidism) was noted in 7 patients. Among the 7 children with subclinical hypothyroidism, 6 (4.8%) were on sodium valproate either as monotherapy (n = 3, 2.4%) or polytherapy (n = 3, 2.4%), while the remaining child was on phenytoin. No difference was noted between the monotherapy and polytherapy groups (4% versus 11.5%; = 0.15).
The incidence of thyroid dysfunction (subclinical hypothyroidism) was 5.6% in children taking ASM with a median follow-up period of 6 months. A longer follow-up period and larger sample size study is warranted in the future.
本研究旨在探讨抗癫痫药物（ASM）对癫痫患儿甲状腺功能的影响。
2019年8月至2022年3月期间，在印度本地治里的贾瓦哈拉尔·尼赫鲁研究生医学教育与研究学院（JIPMER）开展了一项前瞻性研究，纳入6个月至12岁新发癫痫且在2个月内服用ASM的儿童。采用直接化学发光技术通过竞争性免疫测定法在基线和完成3个月治疗后进行甲状腺功能测试——游离T3、游离T4和促甲状腺激素（TSH）。主要结局是被诊断为甲状腺功能障碍（亚临床或显性甲状腺功能减退）的患者比例。
共纳入126例患者。年龄中位数（四分位间距[IQR]）和随访月数分别为10岁（7 - 12岁）和6个月（4 - 8个月）。大多数患者（n = 103，81.7%）为全身性癫痫发作，其余患者（n = 23，18.3%）为局灶性癫痫发作。基线时TSH中位数（IQR）（微国际单位/毫升）为2.08[1.41 - 3.31]，随访时为2.56[1.65 - 4.14]，差异有统计学意义（P≤0.001）。7例患者出现甲状腺功能障碍（亚临床甲状腺功能减退）。在7例亚临床甲状腺功能减退患儿中，6例（4.8%）接受丙戊酸钠单药治疗（n = 3，2.4%）或联合治疗（n = 3，2.4%），其余1例患儿接受苯妥英治疗。单药治疗组和联合治疗组之间未观察到差异（4%对11.5%；P = 0.15）。
在中位随访期为6个月的服用ASM的儿童中，甲状腺功能障碍（亚临床甲状腺功能减退）的发生率为5.6%。未来有必要进行更长随访期和更大样本量的研究。
