https://orcid.org/0000-0002-7687-0227
Abstract
Background
Epilepsy is a treatable disease, but unfortunately a treatment gap exists in epileptic patients, especially in developing countries, due to adverse effects of antiepileptic drugs and polymorphisms in genes. Carbamazepine is the most commonly used medication in epilepsy, but is related to some serious and rare adverse effects. The aim of the study was to investigate the effect of folate metabolizing genes (MTHFR and DHFR) polymorphisms on different parameters of complete blood count in patients who were treated with carbamazepine and valproic acid.
Materials and methods
Blood samples from 267 epileptic patients were collected on consent and surrogate consent forms. The blood was analyzed for changes in different parameters in complete blood count through a blood analyzer. The MTHFR gene was genotyped using the RFLP method. The data were analyzed using GraphPad Prism 6.
Results
The homozygous mutant genotype (677CT) of the methylenetetrahydrofolate reductase enzyme (MTHFR C677T) gene significantly affects the level of hemoglobin (P=0.12), hematocrit (P=0.008) and mean corpuscular hemoglobin (P=0.01) compared to the homozygous wild genotype (677CC) and heterozygous mutant genotype (677CT) of the MTHFR (C677T) gene. However, the heterozygous genotype (1298AC) of MTHFR (A1298C) gene affect the total leukocyte count (P=0.037) level significantly.
Conclusion
Changes in different parameters of complete blood count were statistically significant but clinically insubstantial decreases in different parameters of complete blood count indexes.
Acknowledgments
The authors are very thankful to the Directorate of Science and Technology, Khyber Pakhtunkhwa for funding this project. We are also very thankful to Professor Dr. Adnan Gul Khan, Dr. Shabeer, and Dr. Bakht Jan who helped us during our research in the Neurology Department of Lady Reading Hospital Peshawar.
Abbreviations
AEDs, Antiepileptic drugs; CBZ, Carbamazepine; Hb, Hemoglobin; TLC, Total leucocyte count; Plts, Platelets; HCT, Hematocrit; MCV, Mean corpuscular volume; MCH, Mean corpuscular hemoglobin; MCHC, Mean corpuscular hemoglobin concentration; pg, Picograms; fl, Femtoliters; MTHFR, Methylenetetrahydrofolate reductase enzyme; DHFR, Dihydrofolate reductase.
Recommendations
It is recommended that epileptic patients of different cohorts should be followed for at least 5 years and their complete blood count should be monitored at different intervals of time. Patients should be focused on who are on a high dose of carbamazepine and it is advisable to genotype the MTHFR gene for possible variants.
Disclosure
The authors report no conflicts of interest in this work.