title: Comparison of the metabolic syndrome risk in valproate-treated patients with epilepsy and the general population in Estonia.
abstract: BACKGROUND
  No study has explored the risk of metabolic syndrome (MS) in patients with epilepsy treated with valproate (VPA) at the population level. The aim of this study was to compare the risk of MS in VPA-treated patients in Estonia to the risk in the general population.
  
  
  METHODS
  This study involved 118 patients with epilepsy (63 men, 55 women) who received VPA monotherapy. MS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Data were compared with the results of a population-based study of the prevalence of MS in the same geographic region (N = 493; 213 men, 280 women).
  
  
  RESULTS
  In the multiple logistic regression analysis, after adjustment for age and sex, the risk of MS in VPA-treated patients was not increased compared to the control subjects (odds ratio [OR] = 1.00; 95% confidence interval [CI], 0.59-1.68). VPA-treated patients had higher serum insulin concentrations than control subjects, independent of body mass index (BMI). A positive association was found between MS development and BMI (OR = 1.47; 95% CI, 1.25-1.73) in VPA-treated patients, but there were no associations with the VPA dosage or the homeostasis model assessment-estimated insulin resistance (HOMA-IR) index. In control subjects, BMI and HOMA-IR had similar predictive abilities for MS occurrence. In VPA-treated patients, the predictive ability of the HOMA-IR index was significantly lower than that of BMI, with areas under the receiver operating characteristic curves of 0.808 and 0.897 (P = 0.05), respectively.
  
  
  CONCLUSIONS
  The risk of MS is not increased among VPA-treated patients with epilepsy in Estonia compared to the general population. The HOMA-IR index likely has a lower predictive ability for MS in VPA-treated patients compared to its predictive ability in the general population.
authors: Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia; Neurology Clinic, Tartu University Hospital, Tartu, Estonia.
authors: Aleksei
authors: A
authors: Rakitin
authors: Department of Internal Medicine, University of Tartu, Tartu, Estonia; Internal Medicine Clinic, Tartu University Hospital, Tartu, Estonia.
authors: Triin
authors: T
authors: Eglit
authors: Department of Pathophysiology, University of Tartu, Tartu, Estonia; Centre of Translational Medicine, University of Tartu, Tartu, Estonia.
authors: Sulev
authors: S
authors: Kõks
authors: Department of Internal Medicine, University of Tartu, Tartu, Estonia; Internal Medicine Clinic, Tartu University Hospital, Tartu, Estonia.
authors: Margus
authors: M
authors: Lember
authors: Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia; Neurology Clinic, Tartu University Hospital, Tartu, Estonia.
authors: Sulev
authors: S
authors: Haldre
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D004827:Epilepsy / Q000188:drug therapy*; D004957:Estonia; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000139:chemically induced*; D008875:Middle Aged; D012372:ROC Curve; D012307:Risk Factors; D014635:Valproic Acid / Q000009:adverse effects* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid