Plasma homocysteine and asymmetric dimethylarginine (ADMA) and serum nitric oxide (NO) levels in children receiving antiepileptics

Today, morbidity and mortality from atherosclerotic heart disease is the major health problem in our country as well as across world. Although clinical manifestations of atherosclerosis occur in middle age, the atherosclerotic process begins early in life. Detection and prevention of risk factors at an early stage will avail us to reduce the potential complications that may develop in the future.Many studies conducted recently have proposed that long term antiepileptic drug treatment in children may result in early atherosclerosis development. In order to evaluate atherosclerosis risk, some special laboratory markers such as homocysteine, asymmetric dimethyl arginine and nitric oxide are increasingly coming into use. In this study asymmetric dimethyl arginine and nitric oxide for the first time and homocysteine were studied in children receiving antiepileptic drugs so as to assess the risk of early onset atherosclerosis.This study was conducted among 53 children that were followed in Gazi University department of neurology with the diagnosis of epilepsy and receiving antiepileptic monotherapy (26 valproate, 27 oxcarbazepine). Twenty-four healthy sex- and age-matched children served as controls. Participants were aged between 7 and 16 years. All the subjects underwent physical examination and their venous blood samples were obtained for determining homocysteine, asymmetric dimethyl arginine and nitric oxide levels.The plasma homocysteine, asymmetric dimethyl arginine and serum nitric oxide levels did not differ significantly among the three groups (valproate, oxcarbazepine and control). However a statistically significant positive correlation was found between duration of drug use and plasma homocysteine level. In oppose to valproate and oxcarbazepine groups, there wasn?t any subject in the control group having plasma homocysteine level greater than the cut-off level of 13,1 µM/L.Homocysteine, trigger of atherosclerotic cascade and independent risk factor for atherosclerosis was measured higher as the duration of drug use lengthened. The last two findings support the increased risk of atherosclerosis in epileptic children receiving antiepileptic drugs.In conclusion serum homocysteine level should be measured periodically in children receiving long-standing antiepileptic drug. When we compare the patient groups with the control group they did not differ from each other in plasma asymmetric dimethyl arginine and serum nitric oxide levels. However during their long term follow-up may be we would observe expected plasma ADMA increase and NO decrease owing to inducing effect of hyperhomocysteinemia. Therefore in order to throw light on this argument, large scale prospective studies should be conducted.