Effects of long term antiepileptic therapy on serum trace element levels in epileptic children

Conventional anticonvulsants including valproate (VPA) and phenytoin (PHT) have been shown to influence the trace element homeostasis in patients with epilepsy. Even though the newer agents such as levetiracetam (LEV) are considerebetter tolerability profile, given the lack of long-term data this confidence is somewhat guarded. In this study, we evaluated the trace element profiles of epileptic children receiving conventional agents i.e., PHT and VPA and newer agent – LEV and compared them with healthy controls. The study groups based on drug treatment were as follows: Group-I (n=35) children received PHT, Group-II (n=30) received VPA, Group-III (n=27) were treated with VPA plus LEV while Group-IV (n=28) included healthy children. Serum levels of zinc, copper, selenium, strontium, magnesium, manganese, and iron were estimated using inductively coupled plasma-atomic emission spectrometry (ICP-AES). As compared to healthy controls, monotherapy with phenytoin was associated with increased serum levels of copper (1568.8 vs. 1053.6 ng/ml; p=0.002) as well as strontium (37.0 vs. 30.7 ng/ml; p=0.014). On the contrary, epileptic children treated with valproate monotherapy had decreased serum selenium (67.0 vs. 84.7 ng/ml; p=0.02) and zinc (1010.5 vs. 1242.9 ng/ml; p=0.003) concentrations. However, in the valproate plus levetiracetam therapy group, no significant alterations in the trace element status were observed. Our findings suggest a potential association between treatment with PHT and VPA and trace element changes in children diagnosed with epilepsy. However, newer agent LEV when used with VPA was not associated with these alterations. Further prospective studies are warranted to confirm our findings and to assess the impact of drug treatment on trace element homeostasis in epileptic children.