Can J Clin Pharmacol Vol 17 (1) Winter 2010:e5-e46; January 4, 2010
Relationship between Antiepileptic Drugs and Biological Markers Affecting Long-Term Cardiovascular Function in Children and Adolescents
Original Research
Laura S Cheng, Asuri N Prasad, Michael J Rieder

Background
Epilepsy is a neurological disorder, relatively common in the paediatric population. These children are often treated with antiepileptic drugs (AEDs) for several years. The consequence of such long-term exposure may lead to variations in plasma homocysteine and serum lipoprotein concentrations. 

Objective(s)
To review the cardiovascular effects of anticonvulsant therapy and their use in childhood epilepsy with special reference to homocysteine and lipoprotein.

Methods
A literature search was conducted on PubMed (1966-May 2009) and MEDLINE (1966-May 2009). Key terms included antiepileptic drugs, epilepsy, homocysteine, cardiovascular events, and children.

Results
Certain AEDs including carbamazepine, phenobarbital, phenytoin and valproic acid, as well as the presence of a homozygous 5-methylenetetrahydrofolate reductase polymorphism in the genotype, are potential causes of elevation in plasma homocysteine and serum lipoprotein concentrations.

Conclusions
Persistent elevation in these biochemical markers has shown to be associated with the development of long-term sequelae such as cardiovascular diseases, prompting concerns about the long-term implications of chronic AED use in children and cardiovascular risk. Further research is needed to assess the relationship between specific chronic AED use, homocysteine and lipoprotein concentrations, the influence of genotype, as well as the risk of long-term sequelae in the paediatric population.

Key Words: Anticonvulsant/antiepileptic drugs; epilepsy; homocysteine; cardiovascular events; children

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