Thyroid function and volume in epileptic children using carbamazepine, oxcarbazepine and valproate

Department of Pediatric Endocrinology, Gazi University, Engüri, Ankara, Turkey
Pediatrics International (Impact Factor: 0.73). 12/2007; 49(6):822-6. DOI: 10.1111/j.1442-200X.2007.02456.x
Source: PubMed


The aim of the present study was to investigate the effects of carbamazepine (CBZ), oxcarbazepine (OXC), and valproic acid (VPA) on thyroid function and volume in epileptic children.
Fifty-three epileptic children (age, 3-17 years) treated with OXC (n = 10), CBZ (n = 12), or VPA (n = 31) at least for 1 year were evaluated in terms of thyroid hormones, thyroid-stimulating hormone (TSH) levels, response to thyrotropin-releasing hormone (TRH) stimulation test, and thyroid volumes.
The patients in the OXC and CBZ groups had similar total thyroxin (TT4) and free T4 (fT4) median levels that were significantly lower than those of the VPA group (P < 0.016). Total tri-iodothyrosin median levels were lower in the CBZ group compared to the VPA group (P < 0.016). Basal TSH levels and thyroid volumes were similar in all groups (P > 0.016). One child from the OXC group (10%), one from the CBZ group (%8.3), and six from the VPA group (19.3%) had hypothyroidic status according to the TRH stimulation test. No statistically significant correlations were found between thyroid gland volume and thyroid function variables and between anti-epileptic drug receiving time and thyroid function or thyroid volume, respectively, in any of the groups (P > 0.05).
Thyroid function should be evaluated periodically in children using CBZ, OXC or VPA. The children taking VPA seems to be at greater risk compared to children onr CBZ or OXC therapy. Except for the basal TSH values in the VPA group, the parameters predictive for the subclinical hypothyroid status remain to be evaluated in further studies.

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    • "Additionally, an examination of the side effect profile may be warranted on patients on other psychotropics (eg, antidepressants or antipsychotic medications) or cardiovascular agents that may accentuate the AE profile of eslicarbazepine. Finally, a study of endocrinologic effects of ESL may be warranted as changes in thyroid function36,37 and vitamin D levels38,39 have been observed in adults and children on oxcarbazepine and decreased bone mineral density has been observed in pediatric patients receiving oxcarbazepine.39 "
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    ABSTRACT: Eslicarbazepine is a new dibenzazepine antiepileptic agent. It is a high affinity antagonist of the voltage-gated sodium channel. It is closely related to both carbamazepine and oxcarbazepine. Eslicarbazepine has similar affinity to inactivated sodium channels (channels in just activated neurons) as carbamazepine, and greater efficacy in animal models of seizure than oxcarbazepine. In human placebo-controlled trials of a single daily dose of eslicarbazepine added to other anti-epileptic agents, significant seizure reductions occurred with 800 and 1200 mg daily, with nearly half of the patients experiencing a greater than 50% reduction in seizure frequency. Adverse events (AEs) occurred in over 50% of patients receiving therapeutic doses of eslicarbazepine (compared to 31.4%-44.7% of placebo-treated subjects), but were generally mild or moderate. Eight to 19.6% of eslicarbazepine treated patients discontinued due to AEs (compared to 3.9%-8.5% of placebo-treated subjects). In these patients receiving combination anticonvulsant therapy, the most common AEs were dizziness, nausea and vomiting, somnolence, and diplopia. Eslicarbazepine is an effective and reasonably well-tolerated adjunct in patients with suboptimal control of their partial seizures.
    Therapeutics and Clinical Risk Management 04/2010; 6(1):103-9. · 1.47 Impact Factor
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    • "Amiodarone hydrochloride Barbesino (2010), Gassanov et al. (2010), Martino et al. (2001) Antacids: aluminum hydroxide, calcium carbonate Mazokopakis et al. (2008) Anticoagulant agents Gasse et al. (2005) Anticonvulsives: Carbamazepine, diphenylhydantoin, valproic acid Castro-Gago et al. (2007), Hirfanoglu et al. (2007), Simko and Horacek (2007) Antidepressants Kaplan et al. (1971) Antidiabetic drugs Isidro et al. (2007), Capelli et al. (2009) Beta sympatholytics Barbesino (2010), Gassanov et al. (2010) Rifampicin Nolan et al. (1999) Furosemide Stockigt et al. (1985) Digoxin Siegmund et al. (2002) Estrogens Tahboub and Arafah (2009) Ferrous sulfate Shakir et al. (2000), Campbell et al. (1992) Iodine contrast medium Barbesino (2010), Gassanov et al. (2010) Phosphate Sachmechi et al. (2007) Propylthiouracilo Barbesino (2010), Gassanov et al. (2010) Proton pump inhibitors Sachmechi et al. (2007) Salicylates Samuels et al. (2003), Wang et al. (1999) Ritonavir Touzot M et al. 2006 the prescription pattern of drugs for the treatment of concomitant pathologies in children with hypothyroidisms who are receiving levothyroxine, so as to identify drugs with possible interaction risk and avoid the production of events with adverse effects. MATERIALS AND METHODS We performed an observational, descriptive, transversal and retrospective study of 475 medical records of pediatric patients diagnosed with congenital hypothyroidism treated with levothyroxine, Service of Endocrinology, National Institute of Pediatrics in Mexico City from December 1999 to December 2009. "
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    ABSTRACT: The aim of this work was to know the prescription pattern of drugs for the treatment of concomitant pathologies in children with hypothyroidism, who were receiving levothyroxine, so as to identify drugs with possible interaction risk and avoid the production of adverse effects. An analysis of treatments in children diagnosed of hypothyroidism treated with levothyroxine and medicines added for the treatment of concomitant pathologies in an endocrinology service from December 1999 to December 2009 was carried out. For capturing the information, a form for information gathering was used and the Naranjo causality algorithm was used. 475 clinical files corresponding to 292 (61.47%) females and 183 (38.53%) males were reviewed. The concomitant pathologies most frequently seen were gastrointestinal (60.47%) and respiratory diseases with 55.58%. The number of drugs simultaneously administered with levothyroxine was from 1 to 7. Applying the Naranjo algorithm, 38.5% were adverse drug reactions (ADRs) definite, 23% ADRs probable, 23% ADRs possible and 4% doubtful. In conclusion, the prescription of drugs co-administered simultaneously with levothyroxine should be done in a rational form because there are drugs as anticonvulsant, diuretics or gastrointestinal that can interact between them as with levothyroxine, principally with drugs administered in a chronic form.
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    ABSTRACT: The antiepileptic drugs (AED) have been widely used for a great deal of people - in the treat- ment of epilepsy and other diseases - throughout the world. Continuous and prolonged use of AED may be associated with adverse effects in different systems, including a variety of en- docrine and metabolic abnormalities. In this review, the relationship of AED with alterations in bone mineral metabolism, energy balance and body weight, gonadal function and thyroid metabolism was revised, as well as their clinical utility in the treatment of diabetic neuropathy.
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