A COMPARATIVE STUDY ON RISK OF OSTEOPOROSIS ASSOCIATED WITH THE USE OF VALPROATE VERSES LEVETIRACETAM IN EPILEPTIC PATIENTS ANDITS RELATIONSHIP WITH MTHFR GENOTYPES
BACKGROUND: Hyperhomocysteinemia is an uncommon source for the occurrence of both epilepsy and osteoporosis. The imbalance of MTHFR activity, either due to C677T mutation or drugs like Antiepileptics (AEDs) causes elevated levels of circulating homocysteine which results in alteration in the bone formation and deteriorates bone health. Thus, the added effect of AEDs and MTHFR polymorphism (T allele variants) in epileptic patients predisposes them for early onset of Osteoporosis. The objective of our study is to assess and compare the intensity of the effect of Valproate and Levetiracetam on the bone mass in epileptic patients, to distinguish their MTHFR genotypes and correlate MTHFR polymorphism & AEDs usage with the risk of development of osteoporosis
METHOD: The study design was a comparative, prospective, observational study. It was conducted for a duration of 6 months within which patients were recruited from outpatient department of Neurology, Princess Esra Hospital (PEH), Hyderabad with their Bone Mineral Density (BMD) testing and genotype testing being carried out at Orthopaedic department (PEH) and Salar-e- Millat Research lab (PEH) respectively. The consent was obtained from total 70 subjects, divided into 3 groups:
GROUP 1: 18 patients receiving Sodium Valproate monotherapy.
GROUP 2: 17 patients receiving Levetiracetam monotherapy.
GROUP 3: 35 healthy control subjects from general population.
Patients of either gender within age group of 15-40 years, experiencing GTCS or Focal seizures, receiving either the monotherapy of Sodium Valproate or Levetiracetam for a prolonged duration of time (≥ 2 years) were included in the study.
RESULT: The results of our study showed significant correlation between the AEDs treatment and MTHFR Polymorphism in predisposing osteoporosis.
CONCLUSION: The variants of MTHFR gene (C677T) are prone to develop increased levels of homocysteine as a result of decreased activity of the enzyme in their bodies which is further increased in patients receiving AEDs. Monitoring of homocysteine levels in epileptic patients especially in the mutants of MTHFR gene along with their periodic testing of BMD levels is recommended. Treatment for low folate and calcium levels is recommended in these patients to correct their deficiencies and avoid further problems in future.
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