Effect of antiepileptic therapy on trace elements status in Indian population in a tertiary care hospital from northern India: a cross sectional study

Aim: Conventional antiepileptics (AEDs) have been shown to alter the homeostasis of copper, zinc, and selenium in persons with epilepsy (PWE). The effects of newer AEDs on trace elements have not been addressed yet. This cross-sectional study evaluated trace elements and electrolytes status in PWE on conventional and newer AEDs treatment.

Methods: A total of 307 adult persons with epilepsy and 42 healthy controls were recruited. Panels of ten trace elements estimated by inductively coupled plasma-atomic emission spectrometry, electrolytes, liver and renal function status were compared among subjects grouped according to the monotherapy of AEDs and type of conventional and newer AEDs.

Results: Out of the total 307 PWE, 171 were on monotherapy [valproic acid (VPA) (n=50), carbamazepine (n=47), phenytoin (n=49), levetiracetam (n=21), lamotrigine (n=4)]. AEDs monotherapy groups had no significant difference in the trace element levels, except higher nickel level in levetiracetam group and low iron level in lamotrigine group compared to VPA group. Compared to control [zinc level 698.0 (367.8-3084.4)ng/ml], levetiracetam group had higher zinc [1293.1 (997.7-2419.7)ng/ml, p<0.0001], selenium, copper, iron, aluminium, cadmium, cobalt, and nickel levels; similar manganese and lead levels. Other monotherapy groups were having similar metal levels as that of levetiracetam group except nickel, iron, lead, and selenium levels.

Conclusion: Trace element status was significantly altered with both conventional and newer antiepileptic drugs as compared to control; however, there was not much difference in between conventional and new drug treated groups. Prospective studies will address its impact on treatment response and adverse effect profile.

Ctri registration number: REF/2013/03/004819.