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Comparison of the metabolic syndrome risk in valproate-treated patients with epilepsy and the general population in Estonia.

Rakitin A, Eglit T, Kõks S, Lember M, Haldre S - PLoS ONE (2014)

Bottom Line: Data were compared with the results of a population-based study of the prevalence of MS in the same geographic region (N = 493; 213 men, 280 women).In VPA-treated patients, the predictive ability of the HOMA-IR index was significantly lower than that of BMI, with areas under the receiver operating characteristic curves of 0.808 and 0.897 (P = 0.05), respectively.The HOMA-IR index likely has a lower predictive ability for MS in VPA-treated patients compared to its predictive ability in the general population.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia; Neurology Clinic, Tartu University Hospital, Tartu, Estonia.

ABSTRACT

Background: No study has explored the risk of metabolic syndrome (MS) in patients with epilepsy treated with valproate (VPA) at the population level. The aim of this study was to compare the risk of MS in VPA-treated patients in Estonia to the risk in the general population.

Methods: This study involved 118 patients with epilepsy (63 men, 55 women) who received VPA monotherapy. MS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Data were compared with the results of a population-based study of the prevalence of MS in the same geographic region (N = 493; 213 men, 280 women).

Results: In the multiple logistic regression analysis, after adjustment for age and sex, the risk of MS in VPA-treated patients was not increased compared to the control subjects (odds ratio [OR] = 1.00; 95% confidence interval [CI], 0.59-1.68). VPA-treated patients had higher serum insulin concentrations than control subjects, independent of body mass index (BMI). A positive association was found between MS development and BMI (OR = 1.47; 95% CI, 1.25-1.73) in VPA-treated patients, but there were no associations with the VPA dosage or the homeostasis model assessment-estimated insulin resistance (HOMA-IR) index. In control subjects, BMI and HOMA-IR had similar predictive abilities for MS occurrence. In VPA-treated patients, the predictive ability of the HOMA-IR index was significantly lower than that of BMI, with areas under the receiver operating characteristic curves of 0.808 and 0.897 (P = 0.05), respectively.

Conclusions: The risk of MS is not increased among VPA-treated patients with epilepsy in Estonia compared to the general population. The HOMA-IR index likely has a lower predictive ability for MS in VPA-treated patients compared to its predictive ability in the general population.

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Flowchart for the inclusion of valproate-treated patients with epilepsy.
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pone-0103856-g001: Flowchart for the inclusion of valproate-treated patients with epilepsy.

Mentions: A total of 384 patients (206 men, 178 women) with epilepsy diagnoses who had received VPA treatment were identified. Employing the data collection methods described above, 122 patients (64 men, 58 women) who met the inclusion criteria and agreed to participate were included in the study. Subsequently, four patients were excluded because of low serum VPA levels measured during the evaluation visit (Figure 1). The final study sample comprised 118 adult patients with epilepsy (63 men, 55 women) and 493 control subjects (213 men, 280 women). Median ages of the patients and control subjects were 32 years (IQR, 24–45 years) and 47 years (IQR, 35–59 years), respectively. In recently published studies, the mean reported increase of BMI after initiation of VPA treatment in adults was around 2.5 kg/m2[17]–[22]. The power of the present study for detecting a BMI difference of 2.5 kg/m2 with a SD of 5 is >90%. The clinical characteristics of the patients are given in Table 1.


Comparison of the metabolic syndrome risk in valproate-treated patients with epilepsy and the general population in Estonia.

Rakitin A, Eglit T, Kõks S, Lember M, Haldre S - PLoS ONE (2014)

Flowchart for the inclusion of valproate-treated patients with epilepsy.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4117573&req=5

pone-0103856-g001: Flowchart for the inclusion of valproate-treated patients with epilepsy.
Mentions: A total of 384 patients (206 men, 178 women) with epilepsy diagnoses who had received VPA treatment were identified. Employing the data collection methods described above, 122 patients (64 men, 58 women) who met the inclusion criteria and agreed to participate were included in the study. Subsequently, four patients were excluded because of low serum VPA levels measured during the evaluation visit (Figure 1). The final study sample comprised 118 adult patients with epilepsy (63 men, 55 women) and 493 control subjects (213 men, 280 women). Median ages of the patients and control subjects were 32 years (IQR, 24–45 years) and 47 years (IQR, 35–59 years), respectively. In recently published studies, the mean reported increase of BMI after initiation of VPA treatment in adults was around 2.5 kg/m2[17]–[22]. The power of the present study for detecting a BMI difference of 2.5 kg/m2 with a SD of 5 is >90%. The clinical characteristics of the patients are given in Table 1.

Bottom Line: Data were compared with the results of a population-based study of the prevalence of MS in the same geographic region (N = 493; 213 men, 280 women).In VPA-treated patients, the predictive ability of the HOMA-IR index was significantly lower than that of BMI, with areas under the receiver operating characteristic curves of 0.808 and 0.897 (P = 0.05), respectively.The HOMA-IR index likely has a lower predictive ability for MS in VPA-treated patients compared to its predictive ability in the general population.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia; Neurology Clinic, Tartu University Hospital, Tartu, Estonia.

ABSTRACT

Background: No study has explored the risk of metabolic syndrome (MS) in patients with epilepsy treated with valproate (VPA) at the population level. The aim of this study was to compare the risk of MS in VPA-treated patients in Estonia to the risk in the general population.

Methods: This study involved 118 patients with epilepsy (63 men, 55 women) who received VPA monotherapy. MS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Data were compared with the results of a population-based study of the prevalence of MS in the same geographic region (N = 493; 213 men, 280 women).

Results: In the multiple logistic regression analysis, after adjustment for age and sex, the risk of MS in VPA-treated patients was not increased compared to the control subjects (odds ratio [OR] = 1.00; 95% confidence interval [CI], 0.59-1.68). VPA-treated patients had higher serum insulin concentrations than control subjects, independent of body mass index (BMI). A positive association was found between MS development and BMI (OR = 1.47; 95% CI, 1.25-1.73) in VPA-treated patients, but there were no associations with the VPA dosage or the homeostasis model assessment-estimated insulin resistance (HOMA-IR) index. In control subjects, BMI and HOMA-IR had similar predictive abilities for MS occurrence. In VPA-treated patients, the predictive ability of the HOMA-IR index was significantly lower than that of BMI, with areas under the receiver operating characteristic curves of 0.808 and 0.897 (P = 0.05), respectively.

Conclusions: The risk of MS is not increased among VPA-treated patients with epilepsy in Estonia compared to the general population. The HOMA-IR index likely has a lower predictive ability for MS in VPA-treated patients compared to its predictive ability in the general population.

Show MeSH
Related in: MedlinePlus