Abstracts

Rationale: Treatment of epilepsy frequently lasts for years, so minor metabolic derangements have the potential to become a concern because of cumulative adverse effects. While it is well documented that long-term therapy with older generation antiepileptic drugs (AEDs) can cause metabolic consequences that lead to an increase in risk of atherosclerosis, there is only limited information on the metabolic effect of newer generation AEDs. We performed a multi-center, open-label observational study to assess the metabolic effects of newer generation AEDs in newly diagnosed epilepsy patients. Methods: We recruited adult epilepsy patients who began to receive monotherapy with one of the newer generation AEDs, including levetiracetam (LEV), oxcarbazepine (OXC) and topiramate (TPM). We excluded patients from the analysis when the patients were under AED polytherapy or co-administration of lipid-lowering agents. Circulatory markers of vascular risk including lipid battery, homocysteine, apolipoprotein B, and apolipoprotein B/apolipoprotein A1 ratio were measured before and after six months' AED treatment. Results: A total of 133 patients were included. Fifty-nine patients received LEV, and OXC and TPM were administered in 45 and 29 patients respectively. Six months' treatment of newer-generation AEDs caused significant increase in the circulatory markers of vascular risk including total cholesterol, low-density lipoprotein (LDL), homocysteine, apolipoprotein B, and apolipoprotein B/apolipoprotein A1 ratio (p < 0.001 by paired T test), while there was no significant change in the levels of folate and vitamin B12. There was no remarkable difference in the circulatory markers of vascular risk among the three AED groups (p > 0.05 by one way ANOVA). Conclusions: Our study shows that monotherapy with newer generation AEDs can also exhibited altered circulatory markers of vascular risk that may contribute to the acceleration of the atherosclerotic process. Therefore, our study suggests that the long-term metabolic effects should be considered even in epilepsy patients with newer generation AEDs.