Antiepileptic Drugs and Risk Factors of Vascular Diseases
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Epilepsy is one of the most common neurological diseases, affecting approximately 50 million people worldwide. The most common treatment for epilepsy involves long-term use of antiepileptic drugs. Some older antiepileptic drugs like carbamazepine, phenobarbital, and phenytoin may increase levels of homocysteine and asymmetric dimethylarginine in patients by inducing liver enzymes, and long-term use of these drugs can also impair folic acid absorption, potentially leading to an increased risk of cardiovascular issues.
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Pathological changes of the adrenal glands (including adrenal atrophy) are combined with fatigue, hypotension, weight loss and hyper skin pigmentation (Mitchell & Pearce, 2012). The steroidogenic enzymes in the adrenal cortex of the patient with Addison’s disease become targets for the immune system to attack (Mitchell & Pearce, 2012). The presence of circulating steroid 21-hydroxylase antibodies is a reliable predictor of Addison’s Disease, this is normally located on the smooth endoplasmic reticulum of intact cells (Mitchell & Pearce, 2012). This can lead to other autoimmune responses in the body, metastatic malignancy, amyloidosis, hemorrhage, infections, adrenoleuko dystrophy, or sarcoidosis. Other clinical manifestations include low levels of cortisol in serum and urine tests, increased ACTH levels, BUN increases (due to dehydration), Eosinophil and lymphocyte elevations, hyperkalemia and mild alkalosis (Huether & McCance, 2017). Treatment involves glucocorticoid and mineralocorticoid replacement for life as well as increases in sodium intake if patient experiences excessive sweating and diarrhea.
References
Huether, S. E., & McCance, K. L. (2017).
Understanding Pathophysiology
(6th ed.). St. Louis,
MO: Mosby.
Mitchell, A. L., & Pearce, S. H. S. (2012). Autoimmune Addison disease: pathophysiology and
genetic complexity. Nature Reviews. Endocrinology, 8(5), 306–316.
https://doi-
org.ezp.waldenulibrary.org/10.1038/nrendo.2011.245
.
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- 1. Ade Wijaya, MD –February 2022
- 2. One of the most common neurological diseases Approximately 50 million people worldwide suffer from epilepsy The most common treatment of epilepsy is based on long-term use of antiepileptic drugs (AEDs) Dorszewska J, Lagan-Jedrzejczyk U, Kowalska M, Wize K, Kozubski W. Antiepileptic drugs and risk factors of vascular diseases. EPILEPTOLOGY. 2016 Oct 12;21:195.
- 3. Brodie MJ, Sills GJ. Combining antiepileptic drugs—rational polytherapy?. Seizure. 2011 Jun 1;20(5):369-75.
- 4. Nicholas, J.M., Ridsdale, L., Richardson, M.P., Grieve, A.P., & Gulliford, M.C. (2013). Fracture risk with use of liver enzyme inducing antiepileptic drugs in people with active epilepsy: Cohort study using the General Practice Research Database. Seizure, 22, 37-42.
- 5. Dorszewska J, Lagan-Jedrzejczyk U, Kowalska M, Wize K, Kozubski W. Antiepileptic drugs and risk factors of vascular diseases. EPILEPTOLOGY. 2016 Oct 12;21:195.
- 6. Polymorphism of the ABCB1/MDR1 genes Dorszewska J, Lagan-Jedrzejczyk U, Kowalska M, Wize K, Kozubski W. Antiepileptic drugs and risk factors of vascular diseases. EPILEPTOLOGY. 2016 Oct 12;21:195.
- 7. AEDs especially the older generation, including CBZ, PB, and PHT may lead to increased plasma Hcy concentrations and changes in the level of plasma ADMA in patients with epilepsy, by inducing liver enzyme Longer duration of the use of AEDs associated with impaired intestinal absorption of FA (CBZ, PB, and PHT) leads to an increase in incidents of myocardial infarction involving elevated levels of Hcy and/or ADMA or by other mechanisms of vascular lesions