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Year : 2022  |  Volume : 54  |  Issue : 1  |  Page : 24--32

Antiepileptic-drug tapering and seizure recurrence: Correlation with serum drug levels and biomarkers in persons with epilepsy

Sudhir C Sarangi1, Sachin Kumar1, Manjari Tripathi2, Thomas Kaleekal1, Surender Singh1, Yogendra K Gupta3 
1 Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
3 Department of Pharmacology, All India Institute of Medical Sciences, New Delhi; President, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

Correspondence Address:
Dr. Sudhir C Sarangi
Department of Pharmacology, All India Institute of Medical Sciences, New Delhi
India

OBJECTIVES: Antiepileptic-drug (AED) serum level and inflammatory biomarkers are primarily monitored/assessed during epilepsy treatment for effective seizure control; however, their correlation with seizure recurrence (SR) following AED-tapering has not been established, and this is being investigated in this study. MATERIALS AND METHODS: This prospective observational study enrolled persons with epilepsy (PWE) on AED monotherapy and going to start tapering after being seizure-free for ≥2 years. Data regarding seizure episodes, AED-treatment, and adverse events (using Liverpool Adverse Event profile [LAEP]-score) were recorded. Serum AED levels using high-performance liquid chromatography and biomarkers levels through enzyme-linked immunosorbent assay kits were estimated at AED-tapering commencement and at 6 months/SR time. RESULTS: Among 129 enrolled PWE (levetiracetam [n = 52], valproate [n = 34], carbamazepine [n = 29], and phenytoin [n = 14]), SR occurred in 23.3% during follow-up (range 12–44 months). PWE with subtherapeutic serum AED level at the onset of tapering had higher SR (P = 0.004) than those with therapeutic or higher levels. Levetiracetam-treated PWEs with SR have significantly low AED levels than PWE with no-SR (P < 0.001). PWE had significantly raised inflammatory biomarkers (interleukin [IL]-1 β, tumor necrosis factor [TNF]-α, IL-6, and high-mobility group box protein 1) and decreased IL-10 than healthy control subjects. SR and no-SR groups did not differ significantly in inflammatory markers except for higher IL-1 β and TNF-α levels in SR group (P = 0.001, 0.02, respectively). Improvement in LAEP score was observed in follow-up visits without any difference between SR and no-SR groups. CONCLUSION: Low serum AED levels (especially levetiracetam) and raised levels of TNF-α and IL-1 β during tapering commencement had a higher association with SR following AED-tapering.


How to cite this article:
Sarangi SC, Kumar S, Tripathi M, Kaleekal T, Singh S, Gupta YK. Antiepileptic-drug tapering and seizure recurrence: Correlation with serum drug levels and biomarkers in persons with epilepsy.Indian J Pharmacol 2022;54:24-32


How to cite this URL:
Sarangi SC, Kumar S, Tripathi M, Kaleekal T, Singh S, Gupta YK. Antiepileptic-drug tapering and seizure recurrence: Correlation with serum drug levels and biomarkers in persons with epilepsy. Indian J Pharmacol [serial online] 2022 [cited 2023 Feb 6 ];54:24-32
Available from: https://www.ijp-online.com/article.asp?issn=0253-7613;year=2022;volume=54;issue=1;spage=24;epage=32;aulast=Sarangi;type=0