Purpose: Severe cytopenia and liver dysfunction are characterized as antiepileptic drug (AED) adverse effects dependent upon an idiosyncrasy. However, in clinical practice, we often find hemato-logical and biochemical changes during AED treatment with causes other than an idiosyncrasy. This study aims to investigate the effect of antiepileptic monotherapy on hematological and biochemical parameters.
Methods: We retrospectively recruited 480 patients untreated with AED at baseline. Changes in hematological and biochemical parameters before and after initiation of medication were investigated, and correlation with plasma concentrations of AED was analyzed.
Results: Sixty-six of 480 patients treated with carbamazepine (CBZ: n = 27), sodium valproate (VPA: n = 19) or levetiracetam (LEV: n = 20) monotherapy were eventually selected for analysis. After CBZ treatment, decreased white blood cell (WBC) count and increased gamma-glutamyltransferase (GGT) and alkaline phosphatase (ALP) activities were recorded at high frequencies. Decreased WBC count tended to correlate with elevated serum CBZ level. Elevated GGT activity was observed in all patients treated with CBZ. In patients treated with VPA, platelet (PLT) counts decreased. In patients treated with LEV, there were no significant differences in the measured parameters before and after medication.
Discussion: We considered that the reduction in WBC count might be dose-dependently related to AEDs. Elevated GGT activity was observed in all patients treated with CBZ, but the average increase in GGT activity was 35.19 ± 33.08 U/L. In patients undergoing VPA treatment, decreased PLT counts were also observed at high frequency. Thus, hematological and biochemical parameters should be closely monitored in patients receiving AED, especially in patients treated with high doses of AEDs.
Musicogenic epilepsy is an extremely rare type of reflex epilepsy triggered by listening to music. A 27-year-old woman began to recognize auras of déjà-vu approximately once a month when listening to a ballad since she was 23 years of age. She experienced a total of 5 episodes of aura followed by tonic-clonic seizure, and was referred to our department. We strongly suspected the patient as having musicogenic epilepsy based on electroencephalography findings and symptomatological features, although there were no obviously abnormal findings on cephalic magnetic resonance imaging performed during the interval between seizures. The seizures were controlled by antiepileptic drug. Type 1 diabetes mellitus with a high level of anti-glutamic acid decarboxylase antibodies (GAD-ab) developed approximately 3 years after epilepsy onset, which resulted in triggering of the aura without listening to music.
To investigate the linearity and nonlinearity of EEGs before and after psychosis in patients with epilepsy, continuous EEGs before and after psychosis of five patients who developed epileptic psychosis were examined. The continuous EEGs of eight patients without psychosis were used as controls. EEGs were analyzed by Fourier transform for the frequency bands of delta, theta, alpha, and beta as linear indices and by Sample entropy (SampEn) as a nonlinear index. Significant changes were seen in SampEn before vs after psychosis at bilateral frontal and frontal-anterior temporal regions. Significant differences in SampEn between the before psychosis group and the control group were found at the right frontal and frontal-anterior temporal regions. In patients with epilepsy, SampEn may not only decrease in the right frontal and frontal-anterior temporal regions before psychosis, but it may also increase in the frontal and frontal-temporal regions during psychosis. EEG complexity may be useful to investigate the pathophysiological association between epilepsy and psychosis.