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

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±8.5mg/kg and that of PHT was 5.5±2.3mg/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 110mg/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±20.8mg/dl, p=0.001), HDL (53.8±10.5 vs 47.1±8.8mg/dl, p=0.017) and LDL (85±21.1 vs 70.9±19.4mg/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±7.7mg/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±0.05mm, p=0.012), left carotid (0.382±0.05 vs 0.351±0.05mm, p=0.044) and the overall average carotid intima media thickness (0.378±.048 vs 0.345±.052mm, 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±0.05mm, p=0.032) and the overall average carotid IMT (0.374±0.04 vs 0.348±0.05mm, 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.