الفهرس 
EpilepsyOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Epilepsy is a disorder of the brain characterized by an enduring
predisposition to generate seizures and by the neurobiologic, cognitive,
psychologic and social consequences of this condition. Epilepsy is the
most common serious neurologic disorder that often requires lifelong
treatment.
The aim of epilepsy management is complete seizures cessation
and maintenance of a good quality of life, which is affected not only by
the epileptic attacks but also by adverse effect of the drug. This concern
is more in case of developing brain of children. However, selection of
antiepileptic drug is a challenging task.
Prolonged antiepileptic drugs treatment can result in secondary
carnitine deficiency. Clinical studies indicate a decrease in total and free
plasma carnitine level in children treated with old antiepileptic drugs
especially valproate.
The effect of valproic acid on carnitine metabolism was age
dependent with more evidence on children younger than 10 years old.
This may be in line with the observation that valproate induced
hepatotoxicity is more common in young children.
Carnitine is an essential metabolite, which has a number of
indispensable roles in intermediary metabolism. It has an important role
in the transport of activated long-chain fatty acids from the cytosol to the
mitochondrial matrix, where β-oxidation takes place. Also carnitine is
involved in the transfer of the products of peroxisomal β-oxidation,
including acetyl-CoA, to the mitochondria for oxidation to CO2 and H2O
in the Krebs cycle. Other functions of carnitine include storage of energy as acetylcarnitine and the modulation of toxic effects of poorly
metabolized acyl groups by excreting them as carnitine esters.
In this study, patients were assessed by measuring plasma
carnitine level before and one year after treatment with old antiepileptic
drugs (valproate and carbamazepine) and new antiepileptic drugs
(leviteracetam and oxcarbazepine) and compairing it by the plasma
carnitine level in control children.
This study was carried out in Tanta University Hospital Pediatric
Department, Neurology Unit. Fifty children with newly diagnosed
idiopathic epilepsy selected from those attending the pediatric neurology
outpatient clinic and enrolled in the study with patients classified into
four groups according to their antiepileptic drug treatment into: group 1,
20 patients received valproic acid as momotherapy without any
antiepileptic drug treatment before. group 2, 10 patients treated with
carbamazepine. group 3, 10 patients treated with leviteracetam as
monotherapy. group 4, 10 patients treated with oxcarbazepine as
monotherapy, duration of treatment one year. Twenty healthy children
served as control group with the same age range.
Patients with idiopathic epilepsy with normal brain magnetic
resonance imaging (MRI) were included.
Patients with symptomatic epilepsy, liver or renal diseases,
hypotonia or progressive weakness were excluded.
In the present study, there was no significant difference between
mean plasma level of carnitine in children treated with (valproate,
carbamazepine, leviteracetam and oxcarbazepine) and the controls
before receiving treatment.This study showed significant difference between mean plasma
level of carnitine in children treated with valproate before and after
treatment.
Also, showed inverse correlation between the duration of
treatment with valproate and the mean plasma carnitine level. The longer
the duration of treatment, the more significant decrease in mean plasma
carnitine level.
Also, there was inverse relation between the level of valproate
and the mean plasma carnitine level. The higher the level of valproic
acid, the more significant decrease in the mean plasma carnitine level.
from this study we conclude that, valproic acid was the only
antiepileptic drug reported to cause carnitine deficiency and carnitine
supplementation may reduces the adverse reactions caused by VPA.