Noninvasive screening for preclinical atherosclerosis in children on phenytoin or carbamazepine monotherapy: A cross sectional study

摘要

Purpose: This study was carried out to compare the carotid Intimal Media Thickness (IMT), and endothelial function using brachial flow mediated dilatation (FMD), in Epileptic children (6-12 years) on phenytoin (PHT) or carbamazepine (CBZ) monotherapy for ≥18 months with a control group of children. Methods: In this cross-sectional study 30 children (aged 6-12 years) on PHT monotherapy and 28 children on CBZ monotherapy were compared with an equal number of apparently healthy age and sex matched children unexposed to antiepileptics. Fasting lipids, sugar, Hs-CRP levels and ultrasonographic assessment of carotid IMT and endothelial function using brachial FMD were conducted. Results: The age (years) of the children in the CBZ group (9.1. ±. 2), PHT group (9.4. ±. 2) and the controls (9.3. ±. 2) was comparable. The duration of CBZ therapy was 30.8. ±. 13.2 months and that of PHT therapy was 29.5. ±. 13.6 months. The mean dose of CBZ was 18.18. ±. 8.5. mg/kg and that of PHT was 5.5. ±. 2.3. mg/kg body weight. The time since last seizure was 15.6. ±. 8.4 months in the CBZ group and 17.3. ±. 10.4 months in the PHT group. The fasting blood sugar was below 110. mg/dl in all children.The height, weight, waist and hip measurements, waist hip ratio and blood pressures were similar in the groups. The total cholesterol levels (161.7. ±. 24.8 vs 140.2. ±. 20.8. mg/dl, p= 0.001), HDL (53.8. ±. 10.5 vs 47.1. ±. 8.8. mg/dl, p= 0.017) and LDL (85. ±. 21.1 vs 70.9. ±. 19.4. mg/dl, p= 0.01) were significantly higher in the CBZ group compared to the control group. The HDL levels (54.6. ±. 9.4 vs 45.8. ±. 7.7. mg/dl, p<. 0.0001) were significantly higher in the PHT group compared to the control group. The right carotid (0.374. ±. 0.04 vs 0.339. ±. 0.05. mm, p=0.012), left carotid (0.382. ±. 0.05 vs 0.351. ±. 0.05. mm, p=0.044) and the overall average carotid intima media thickness (0.378. ±.048 vs 0.345. ±. 052. mm, p= 0.018) of the children on CBZ was significantly higher than the carotid IMT in control group children. The right carotid (0.370. ±. 0.04 vs 0.342. ±. 0.05. mm, p= 0.032) and the overall average carotid IMT (0.374. ±. 0.04 vs 0.348. ±. 0.05. mm, p= 0.035) of the children on PHT was significantly higher than the carotid IMT in controls. The FMD were comparable in the children on CBZ or PHT and the control group. Conclusions: The results are preliminary but could signal the increased vulnerability of epileptic children on long term antiepileptics to have subclinical atherosclerosis.