Effect of antiepileptic drugs on plasma fibrinogen level

Background: Childhood epilepsy is one of the most common neurological disorders in pediatrics . The prevalence of active epilepsy is 5–8 per 1000 population in developed countries and 10 per 1000 population in developing nations . There is a significant relationship between epilepsy and cognitive deficits. Aim of study: prospective study to evaluate the effect of the most commonly used anti-epileptics drugs on plasma fibrinogen level. Patient and methods 100 newly diagnosed patients (2months to 15 years old) selected from Outpatient Clinic of Neurology attending Mansoura University Children’s Hospital for plasma fibrinogen level evaluation by taking basal sample and second sample after six months after the basal one. Results: This study showed that, significant positive correlation between plasma fibrinogen level and the use of antiepileptic drugs. Conclusion: epileptic patient should be closely monitored during Antiepileptic drugs treatment and prior to surgical procedures as they can affect plasma fibrinogen level and coagulation profile. INTRODUCTION Epilepsy is a common illness worldwide. It is estimated that 0.5-1% of all children have epilepsy, with the majority presenting during infancy or early childhood (1). Epileptic seizures result from abnormal, excessive or hypersynchronous neuronal activity in the brain. About 50 million people worldwide have epilepsy, and nearly 80% of epilepsy occurs in developing countries(2 ). Antiepileptic drugs (AED) have been associated with adverse effects on the coagulation system. Carbamazepine, phenytoin and valproic acid can cause thrombocytopenia , Additionally, valproic acid and gabapentin have been associated with acquired von Willebrand disease type 1, hypofibrinogenemia ,decreased factorXIII and abnormal platelet function. (3). Coagulopathies were reported in children treated with VPA (>4%), but this is likely to be significantly underestimated. These children were reported with platelet dysfunction, thrombocytopenia, hypofibrinogenemia, acquired Von Wilbrand disease, Factor XIII deficiency and vitamin K-dependent factor deficiency (4). Little is known about the hematological side effects of the newer antiepileptic drugs (AEDs), but recent case reports have raised concerns regarding the possibility of altered coagulation profile, thrombocyte counts or function in some patients during levetiracetam (LEV) treatment. ( 5) Carbmazepines have been reported to be associated with clotting defects including: elevated prothrombin time, elevated partial thromboplastin time, though the exact mechanism is not known yet (6). PATIENT AND METHODS In this Observational Prospective Study, One hundred newly diagnosed patients will be included. They will be selected from the patients attended to Mansoura University Children Hospital at Outpatient Clinic of Neurology. This study was conducted on One hundred newly diagnosed patients with age ranging from 2 months to 15 years. In This study, we search for plasma fibrinogen level and coagulation profile. We do a basal sample then another follow up sample after six months of starting treatment with antiepileptic therapy. Inclusion criteria: 1. Newly diagnosed Epileptic children by criteria of epilepsy , At least two unprovoked (or reflex) seizures occurring greater than 24 hours apart. A cc ep te d P ap er One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years. 2. All patients to be in good health, free of a history of bleeding or thrombosis. 3. Patients will receive antiepileptic drugs. Exclusion criteria: • Hematological problems affecting fibrinogen [disseminated intravascular coagulation, hemolytic uremic syndrome]. • Patients known to have renal or hepatic diseases. • Patients receiving other drugs that affect coagulation profile (salicylate or anticoagulants).