Antiepileptic drugs influences on body weight in people with epilepsy

Abstract

Data from clinical trials, retrospective and cross-sectional studies have quantified the metabolic changes associated with long-term use of antiepileptic drugs (AEDs). AEDs can be associated with weight gain or weight loss, although most are weight neutral. Weight gain is not only a cosmetic problem but also a risk for obesity-related vascular disorders. Weight loss may compromise growth in children/adolescents. This review discusses the possible contribution of peripheral and central hormones/neuropeptides (as leptin, insulin, adiponectin, neuropeptide-Y, ghrelin and galanin) and pathways that influence energy balance in the pathogenesis of weight changes with AEDs. As AEDs may influence weight, physicians have to properly select and characterize the suitable AED as an initial step or modify the existing AED if it compromises patient’s health.

Keywords:

• antiepileptic drugs
• metabolic adverse effects
• weight
• obesity
• insulin
• leptin
• neuropeptide-Y
• adiponectin
• ghrelin
• galanin

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Epilepsy is a dynamic medical illness and its treatment is often for years or lifelong. Chronic use of antiepileptic drugs (AEDs) may be associated with adverse metabolic consequences, among them are weight changes. Weight gain has been reported with valproate, carbamazepine, gabapentin, vigabatrin and pregabalin. Weight loss has been reported with topiramate, felbamate, zonisamide, rufinamide and lacosamide. No weight changes (weight-neutral) have been reported with phenytoin, oxcarbazepine, lamotrigine, tiagabine and levetiracetam.

• Weight gain is not only a cosmetic problem, but also a risk for disorders associated with obesity as dyslipidemia, hypertension, diabetes mellitus and atherosclerosis, whereas weight loss may compromise growth particularly in children and adolescents.

• The metabolic or endocrinologic consequences of AEDs on peripheral and/or central processes, which regulate glucose metabolism, food intake and energy expenditure, are highly incriminated in the pathogenesis of weight changes with AEDs.

• Physicians should be aware of the metabolic and endocrinological changes associated with AEDs through proper selection and characterization of suitable AED as an initial step, monitoring of weight and modification of an AED during management and follow-up of patients.

Notes