간질환아에서 항경련제 투여가 혈청 및 적혈구 엽산농도에 미치는 영향

The Effects of Antiepileptic Drugs on Serum and Red Cell Folate Levels in Epileptic Children

To assess the effect of antiepileptic drugs(AEDs) on blood folate, we evaluated the serum and red cell folate levels by means of competitive radioassay as well as the peripheral blood findings in epileptic children treated with various AEDs. This study included a control group of 24 children(13 males, 11 females : 6-16 years of age) and 56epileptic patients(32 males, 24 females : 6-20 years of age) who were divided into four AED-treated groups : phenobarbital(PB) monotherapy (n=9), carbamazepine(CBZ) monotherapy(n=22), valproic acid(VPA) monotherapy(N=11) and CBZ polytherapy(N=14). The results were as follows: 1. The red cell folate levels were significantly reduced in the patient group compared with the control group, but serum folate levels were statistically insignificant. 2. The number of patients whose red cell folate level reduced by up to 2SD below the mean of control group was 11 of 56 patients in AED-treated group : 3 of 9 in PB monotherapy(33.3%), 6 of 22 in CBZ monotherapy(27.3%), 1 of 11 in VPA monotherapy(9.1%) and 1 of 14 CBZ polytherapy(7.1%) 3. From the peripheral blood studies, only the value of mean corpuscular volume(MCV) was significantly increased in the patient group compared with the control group. 4. The number of patients whose MCV value increased by up to 2 SD above the mean of control group was 13 of 56 patients in AED-treated group : 4 of 9 in PB monotherapy(44.4%), 3 of 22 in CBZ monotherapy(13.6%), 1 of 11 in VPA monotherapy(9.1%), and 5 of 14 in CBZ polytherapy(35.7%). 5. The reduced levels of red cell folate and the increased values of MCV were observed in PB monotherapy, CBZ monotherapym and CBZpolytherapy, but not in VPA monotherapy group. 6. There was neither correlation between the reduced levels of red cell folate and the increased values of MCV nor between the duration of AEDs therapy and the reduced levels of red cell folate or the increased values of MCV. It is suggested that the reduction of red cell folate levels should be considered in epileptic patients treated with PB or CBZ, although the clinical symptoms of folate deficiency were not Found in patients of this study, and that the measurement of red cell folate may be a useful parameter to detect the disturbance of folic acid metabolism in its early stage.