TO EVALUATE THE IMPACT OF LONG-TERM ANTIEPILEPTIC DRUG (AED) THERAPY ON LIVER FUNCTION AMONG PEDIATRIC PATIENTS AGED 6 TO 14 YEARS ATTENDING A TERTIARY CARE HOSPITAL.

Abstract

Introduction

Epilepsy is a common neurological condition that often begins in childhood and can significantly affect a child's development, education, and overall quality of life. While antiepileptic drugs (AEDs) are essential for controlling seizures, their long-term use can lead to side effects, particularly related to liver function. These side effects are well-documented in adults, but there is limited research on their impact in children. Given the importance of safe and effective lsong-term treatment in pediatric epilepsy, it is crucial to understand how commonly prescribed AEDs affect liver enzymes. This study focuses on children aged 6 to 14 years undergoing treatment at a tertiary care hospital.

Aims and Objectives

To evaluate the effects of long-term antiepileptic drug therapy on liver function in pediatric patients aged 6 to 14 years. To assess and compare the effects of phenytoin, valproate, and levetiracetam on  liver function markers (serum bilirubin, SGPT, SGOT, ALP) in children, in order to evaluate differences in their metabolic and hepatic safety profiles.

Materials & Methods

This cross-sectional study was conducted over 12 months (May 2023 – May 2024) at Sree Balaji Medical College and Hospital, Chennai. The study involved children aged 6–14 years diagnosed with partial or generalized seizures who had been on monotherapy with either phenytoin, valproate, or levetiracetam for more than 4 weeks. A total of 105 participants were enrolled using purposive sampling, with 35 children in each drug group based on sample size calculations. Participants were selected according to strict inclusion and exclusion criteria to eliminate confounding factors such as metabolic disorders, polytherapy, or other medications known to affect liver metabolism. Data were entered in Microsoft Excel and analyzed using SPSS version 27. Descriptive statistics were presented as Mean ± SD. Pearson correlation, linear regression, and chi-square tests were used to explore associations between variables. A p-value < 0.05 was considered statistically significant.

Results

This cross-sectional study evaluated the effects of phenytoin, sodium valproate, and levetiracetam on liver function in children aged 6–14 years over a 12-month period. Among 105 participants (35 per group), phenytoin was associated with the highest elevations in liver enzymes (SGOT, SGPT, ALP), with values worsening over longer treatment durations. Sodium valproate showed moderate elevations in liver markers, particularly after 12 months of therapy. Levetiracetam had the least hepatic and metabolic impact, with minimal changes in liver enzymes

Discussion

Phenytoin and sodium valproate demonstrated significant hepatic metabolic disturbances, especially with longer treatment durations. This reinforces their known enzyme-inducing and hepatotoxic potentials. Levetiracetam was comparatively safer, with minimal liver enzyme alterations. These findings are consistent with existing literature and underscore the time-dependent nature of adverse effects, particularly with phenytoin and sodium valproate.

Conclusion

Phenytoin and sodium valproate are associated with time-dependent liver dysfunction, warranting regular monitoring. Levetiracetam exhibited the most favorable safety profile and may be preferred in patients with hepatic or metabolic risk factors.