Early detection of atherosclerotic changes associated with long use of antiepileptic drugs in epileptic patients

Objective
Doppler ultrasound changes in the common carotid artery intima-media thickness (CCA IMT) and estimation of serum thiobarbituric acid reactive substances (TBARS) as predictors to the atherosclerotic complications of long use of antiepileptic drugs (AEDs).


Patients and methods
The study was done on 45 epileptic patients and 15 healthy individuals as a control group. All patients have been selected from the outpatient clinic of Neurology Department of Al-Zahraa University Hospital from period July 2018 to July 2020. They have been treated by monotherapy AEDs for at least 2 years. No other risk factors for atherosclerosis had been considered in these patients. They have been investigated for serum level of TBARS and Doppler ultrasound for assessment of CCA IMT. The patient group was also subdivided into three groups according to their type of treatment.


Results
The risk of carotid atherosclerosis in patients with epilepsy is linked with long use of older generation AEDs, namely carbamazepine and valproic acid, rather than levetiracetam which have no effect in vascular risk or CCA IMT changes.


Conclusion
The choice of AED therapy for long-term use should be guided with serum level of TBARS and CCA IMT as their mechanism of action as enzyme inducer might be a leading cause of vascular changes in epileptic patients.