Plasma Homocysteine Level in Children under Treatment with Antiepileptic Drugs and its Relation to Intelligence Quotient

Background: Epilepsy is one of the most common neurological disorders in children. It often requires long-term antiepileptic drug (AED) therapy. AEDs are frequently associated with cognitive and behavioral dysfunctions. Also, there is a relationship between AEDs use and homocysteine levels. Elevated homocysteine has been associated with cognitive dysfunction. However, such effect among epileptic children has not been well-studied. Aim of the work: To study plasma homocysteine level in children under treatment with AEDs and its relation to intelligence quotient (IQ). Patients and Methods: A case control study included 56 epileptic children on AED therapy for at least 6 months, and 36 healthy children (Controls). Study was conducted at Al-Azhar University Hospital (Damietta) from June 2016 to June 2018. Plasma homocysteine was measured using Enzymatic Recycling (Biotecnica Instruments SpA). IQ testing was conducted using Stanford-Binet Intelligence Scales, Fifth Edition. Results: Epileptic children exhibited significant elevation of Homocysteine level (P=0.005), and significant affection of all IQ parameters. There was significant negative correlation between homocysteine level with total working memory, total verbal IQ and total IQ. Multivariate regression analysis revealed that homocysteine showed a significant and independent association with total working memory, total verbal IQ and total IQ. None of the other studied factors revealed such association. Conclusion: Homocysteine was a significant and independent risk factor for low total working memory score, low total Verbal IQ and low total IQ scores. Further studies are required to confirm these results, and to evaluate the effect of homocysteine-lowering treatment on cognitive function in epileptic children.