RESUMO
Prolonged antiepileptic drugs treatment can result in secondary carnitine deficiency. Clinical studies indicate a decrease in free and total carnitine in children treated with old-generation antiepileptic drugs [especially valproate]. Some studies on valproic acid [VPA]-induced hepatotoxicity showed decreased free serum carnitine, but some did not. A number of studies on the effect of VPA and/or other antiepileptic drugs on carnitine concentrations yielded contradictory results. The effect of new antiepileptic drugs as oxcarbazepine and lamotrigine on carnitine metabolism has not been reported previously. The aim of this study was performed to evaluate the plasma carnitine level in children with idiopathic epilepsy treated with old antiepileptic drugs [valproic acid and carbamazepine] and new antiepileptic drugs [lamotrigine and oxcarbazepine]. This study was carried out in Tanta University Hospital Pediatric Department, Neurology Unit. Fifty children with newly diagnosed idiopathic epilepsy were selected from those attending the pediatric neurology out-patient clinic. Thirty four [34] males and sixteen [16] females were enrolled in the study with the age range was 1-12 years with the mean age was [6.8 +/- 3 years]. Patients were grouped according to their antiepileptic treatment into: Group 1, twenty patients received valproic acid as monotherapy without any antiepileptic drugs treatment before. Group 2 ten patients received valproic acid as polytherapy after three months treatment with carbamazepine. Group 3, ten patients received lamotrigine as monotherapy, and group 4, ten patients received oxcarbazepine as monotherapy. Twenty healthy children served as control group with the age range was, 2-12 years with the mean age was [8 +/- 2 years]. Estimation of the plasma carnitine levels were done for all the studied groups. Group 1 and group 2 epileptic children, treated with valproic acid monotherapy and polytherapy had significantly lower plasma carnitine levels than the control group [P<0.05]. There was significant correlation between the age and the plasma carnitine in group 1 and group 2 epileptic children, the younger the age the more reduction in the plasma carnitine level Patients treated with valproic acid polytherapy had significantly lower plasma carnitine than patients treated with valproic acid monotherapy [P<0.05] .There was no significant difference between the plasma carnitine in children with epilepsy treated with oxcarbazepine and lamotrigine and the control group [P>0.05]. In conclusion, 1-Carnitine deficiency is not uncommon among children with epilepsy and is mainly linked to valproate therapy. 2-valproate may induce carnitine deficiency, but most cases are asymptomatic. 3-In contrast new-generation antiepileptic drugs probably do not cause carnitine deficiency. 4-These findings suggest a need to monitor serum carnitine levels in children treated with any of these drugs