Effects Of VPA,OXC And LEV On Lipid Metabolism In Epilepsy Patients In Northern Shaanxi

Background: Epilepsy is a chronic brain disorder characterized by repeated seizures,with a persistent tendency to produce spontaneous seizures,and with numerous neurobiological,cognitive,and psychosocial consequences.It affects more than 70 million people worldwide,and nearly 80% of people with epilepsy live in low-and middle-income countries.Among them,in my country,there are about 10 million epilepsy patients,and the number of cases is increasing at a rate of 650,000-700,000 cases per year,and the annual economic burden is heavy.At present,there are many treatment methods for epilepsy,among which antiepileptic drugs（AEDs）treatment is the mainstream method of epilepsy treatment,in addition to some other non-drug treatment methods,such as diet therapy（such as ketogenic diet）,surgery therapy,nerve stimulation therapy,etc.Surgery is divided into curative surgery and palliative surgery.Curative surgery is mainly to remove epileptogenic foci,including focal resection and hemisphere resection.The main purpose of palliative surgery is to reduce the intensity of seizures and the severity of certain seizure types.Attack frequency,the main surgical methods are corpus callotomy and multiple subpial transections.Neurostimulation is a new technique,mainly including vagus nerve stimulation（VNS）and deep brain stimulation（DBS）,which is a complementary treatment to surgical treatment.As the understanding of epilepsy development,epigenetic determinants,and pharmacogenomics improves,better,disease-modifying,and effective pharmacological and non-pharmacological treatments are expected.Long-term regular use of AEDs is currently the most commonly used treatment method for most epilepsy patients,but long-term oral AEDs can significantly increase the adverse reactions of drugs,and can also cause some drug interactions,neuropsychiatric symptoms such as fatigue.,dizziness,instability and irritability are the most common side effects,but AEDs can affect every organ system,AEDs with enzyme-inducing properties may also cause folic acid deficiency,endocrine,metabolic disorders or affect bone health,recent studies have reported,AEDs also have effects on lipid health,which are often insidious and may not receive sufficient attention.AEDs include traditional AEDs and new AEDs.Traditional AEDs include phenobarbital（PB）,carbamazepine（CBZ）,phenytoin（PHT）,ethosuximide,primidone,and sodium valproate（VPA）.Newer AEDs are oxcarbazepine（OXC）,zonisamide,ethene,lamotrigine（LTG）,felbamate,topiramate（TPM）,gabapentin（GBP）,tigabine,pregabalin（PGB）,stiripentol,lacosamide,rufinamide,eslicarbazepine,and levetiracetam（LEV）,etc.Studies have shown that VPA can affect lipid metabolism in patients,such as increasing triacylglycerol（TG）levels.The mechanism of its influence on lipid metabolism may be through the down-regulation of peroxisome proliferator-activated receptor γ（PPARγ）m RNA expression in the nucleus,resulting in weight gain and changes in lipid metabolism indicators in children taking the drug.New types of AEDs,such as OXC and LEV,are widely used in clinical practice,have few interactions with other drugs,and have relatively few side effects.However,there are few research reports on their effects on blood lipid metabolism,and the research results have not been consistent,and they are mostly limited to children with epilepsy.Objective: To study the effects of antiepileptic drugs VPA,OXC and LEV on lipid metabolism of epileptic patients treated with antiepileptic drugs for the first time in northern Shaanxi.The possible mechanism of AEDs in epileptic patients was further discussed to provide some reference for the selection of AEDs in epileptic patients,and to further improve the quality of life of epileptic patients.Methods: A total of 149 patients with epilepsy in northern Shaanxi who were treated with AEDs for the first time in the Department of Neurology,Yan’an University Affiliated Hospital from 2020.09 to 2021.09 were collected,and 135 patients were followed up.There were 45 cases in the VPA group,40 cases in the OXC group,and 50 cases in the LEV group.Before taking the medicine and after taking the medicine for 6 months,the lipid metabolism indexes of the patients were detected: total cholesterol（TC）,high-density lipoprotein cholesterol（HDL-C）,TG,lipoprotein a（LPa）,apolipoprotein A1（Apo A1）,Low-density lipoprotein cholesterol（LDL-C）and apolipoprotein B（Apo B）.SPSS 25.0statistical analysis software was used for statistical processing and analysis,and the effects of VPA,OXC and LEV on lipid metabolism in epilepsy patients were compared.Results: 1.There was no significant difference in age,BMI and gender among the three groups（P>0.05）.There was no significant difference in blood lipid indexes TC,TG,LPa,HDL-C,LDL-C,Apo A1 and Apo B before VPA,OXC and LEV monotherapy in patients（P>0.05）.2.Compared with before taking VPA,after taking VPA for 6 months,the levels of TC,LDL-C,TG and Apo B were all increased（P<0.05）,while the levels of HDL-C,Apo A1 and LPa had no significant changes（P<0.05）.P>0.05);compared with before taking OXC,after taking OXC for 6 months,the levels of TG,LDL-C,TC,LPa and Apo B were all increased（P<0.05）,while the levels of HDL-C and Apo A1 were not higher than those before taking OXC.Significant changes（P>0.05）;compared with before taking LEV,the level of LDL-C increased（P<0.05）after taking LEV for 6 months,while the levels of TC,TG,HDL-C,LPa,Apo A1 and Apo B were higher than those taking LEV.There was no significant change before（P>0.05）.3.After 6 months of drug treatment in VPA group,OXC group and LEV group,there were significant differences in blood lipid indexes TC,TG,LDL-C and Apo B（P<0.05）,while Apo A1,LPa and HDL-C in the three groups The difference was not statistically significant（P>0.05）.Bonfronni’s multiple comparisons were used,and the results showed that the VPA group increased the level of TC more significantly than the LEV group（P<0.05）,and the VPA group increased the levels of TG,LDL-C and Apo B significantly compared with the OXC group and the LEV group（P<0.05）.Conclusions: 1.The VPA group could increase TC,TG,LDL-C and Apo B in epilepsy patients in northern Shaanxi after taking the drug for 6 months.2.OXC group could increase TC,TG,LDL-C,LPa and Apo B in epilepsy patients in northern Shaanxi after taking the drug for 6 months.3.LEV group only increased LDL-C in epilepsy patients in northern Shaanxi after taking the drug for 6 months,and had little effect on blood lipids.4.Pairwise comparison between the VPA group,OXC group and LEV group after taking the drug,the VPA group increased the level of TC more significantly than the LEV group（P<0.05）,and the VPA group increased the levels of TG,LDL-C and Apo B compared with the OXC group and the LEV group（P<0.05）.Significant difference in LEV group（P<0.05）.