title: Effect of antiepileptic therapy on trace elements status in Indian population in a tertiary care hospital from northern India: a cross sectional study.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  REF/2013/03/004819.
authors.affiliation: Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sudhir Chandra
authors.initials: SC
authors.lastname: Sarangi
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Manjari
authors.initials: M
authors.lastname: Tripathi
authors.affiliation: Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ashish Kumar
authors.initials: AK
authors.lastname: Kakkar
authors.affiliation: Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: yk.ykgupta@gmail.com.
authors.forename: Yogendra Kumar
authors.initials: YK
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000494:pharmacology*; D001774:Blood Chemical Analysis; D003430:Cross-Sectional Studies; D004573:Electrolytes / Q000097:blood; D004827:Epilepsy / Q000097:blood* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D062606:Tertiary Care Centers; D014131:Trace Elements / Q000097:blood*
chemical_list: D000927:Anticonvulsants; D004573:Electrolytes; D014131:Trace Elements
keywords: Antiepileptic drugs; Copper; Levetiracetam; Trace elements; Valproic acid; Zinc