[Latar Belakang. Penggunaan obat antiepilepsi (OAE) generasi lama (karbamazepin,
fenitoin, fenobarbital dan asam valproat) mendominasi tatalaksana epilepsi di Indonesia.
OAE tersebut berpotensi menimbulkan efek samping obesitas, peningkatan fraksi lipid
aterogenik, peningkatan homosistein, resistensi insulin dan stres oksidatif yang merupakan
faktor risiko ateroksklerosis dan penyakit kardiovaskular. Oleh karena itu diperlukan
penilaian risiko global kejadian kardiovaskular dan aterosklerosis pada orang dengan epilepsi
(ODE) yang menggunakan OAE generasi lama, yaitu dengan mengukur kadar hs-CRP
plasma. Molekul hs-CRP merupakan penanda biologis inflamasi tingkat rendah dan penyebab
langsung aterosklerosis.
Metode. Desain penelitian adalah potong lintang yang membandingkan kelompok studi
(ODE yang menggunakan OAE generasi lama) dan kelompok orang normal yang usia dan
jenis kelaminnya disesuaikan. Subjek kelompok studi didapatkan dari populasi ODE yang
kontrol di Poliklinik Saraf RS Cipto Mangunkusumo dan Yayasan Epilepsi Indonesia.
Dilakukan wawancara, pemeriksaan fisik, dan pemeriksaan laboratorium pada semua subjek.
Hasil. Didapatkan masing-masing 44 subjek kelompok studi dan kontrol. Kadar hs-CRP pada
kelompok studi (1,19 (0,27-9,13) mg/L) lebih tinggi secara signifikan dibandingkan
kelompok kontrol (0,745 (0,13-4,9) mg/L). Tidak terdapat hubungan signifikan antara usia,
jenis kelamin, tipe bangkitan terakhir, jenis dan jumlah OAE dengan kadar hs-CRP. Kadar
hs-CRP cenderung lebih tinggi pada ODE yang menggunakan OAE generasi lama
penginduksi ekstensif enzim CYP (fenitoin, karbamazepin dan fenobarbital) dibandingkan
asam valproat (1,785 (0,27-9,13) vs 0,77 + 0,36 mg/L). Kadar hs-CRP kelompok OAE
penginduksi enzim CYP lebih tinggi secara bermakna dibandingkan kontrol, sedangkan
rerata kadar hs-CRP kelompok asam valproat tidak berbeda dengan kontrol. Kadar hs-CRP
juga cenderung lebih tinggi pada kelompok politerapi (2,255 (0,43-8,67) mg/L) dibandingkan
monoterapi (1,105 (0,27-9,13) mg/L). Nilai median kadar hs-CRP kelompok politerapi
penginduksi-penginduksi enzim CYP lebih tinggi (3,11 (1,80-8,67) mg/L) dibandingkan
kelompok politerapi penginduksi-bukan penginduksi enzim (0,96 (0,43-4,59) mg/L). Pada
analisis multivariat, interaksi antara jumlah dan jenis OAE berhubungan dengan kadar hs-
CRP secara bermakna.
Simpulan. Kadar hs-CRP pada ODE yang menggunakan OAE generasi lama lebih tinggi
dibandingkan kelompok kontrol. Kadar hs-CRP cenderung lebih tinggi pada ODE yang
menggunakan OAE generasi lama penginduksi ekstensif enzim CYP dan menggunakan OAE
politerapi. Terdapat peningkatan risiko mengalami kejadian kardiovaskular dan aterokslerosis
yang lebih tinggi pada ODE yang menggunakan OAE generasi lama penginduksi ekstensif
enzim CYP baik monoterapi maupun politerapi.;Background. Old generation antiepileptic drugs (AED), including carbamazepine,
phenytoin, phenobarbital and valproic acid are still utilized extensively in treating epilepsy
patients (EP) in Indonesia. Those drugs are potencial causing obesity, higher atherogenic
lipid fraction, higher homocysteine, insulin resistance and oxidative stress which are
atherosclerosis risk factor and cardiovascular events. Therefore, atherosclerosis and
cardiovascular global risk assesment is required in epilepsy patients treated with those AED
by measuring high sensitivity C-reactive Protein (hs-CRP). Hs-CRP is well-known biomarker
of chronic low level inflammatory and direct etiology of atherosclerosis.
Method. This is a cross sectional study comparing study group (EP treated with old
generation AED) and control group (healthy subjects), age and sex are matched. Subjects of
study group are selected from EP who are visiting neurology outpatient clinic in Cipto
Mangunkusumo Hospital and Indonesia Epilepsy Foundation. All subjects underwent
interview, physical examination and laboratory investigations.
Result. Forty four patients are selected for each group. Hs-CRP level of study group (1.19
(0.27-9.13) mg/L) is significantly higher compared to control group (0.745 (0.13-4.9) mg/L).
No significant correlation between age, sex, last epileptic seizure type, AED type and
duration with hs-CRP level. Hs-CRP level in EP treated with extensive CYP-inducer AED
tend to be higher than valproic acid-treated patients (1.785 (0.27-9.13) vs 0.77 + 0.36 mg/L).
Hs-CRP level in EP treated with extensive CYP-inducer AED is significantly higher
compared to their control group, whereas no difference in valproic acid group compared to
their control. Polytherapy group (2.255 (0.43-8.67) mg/L) tends to have higher hs-CRP level
compared to monotherapy group (1.105 (0.27-9.13) mg/L). Median of hs-CRP in extensive
CYP-inducer polytherapy (3.11 (1.80-8.67) mg/L) is higher than polytherapy with
combination AED (0.96 (0.43-4.59) mg/L). In multivariat analysis, interaction between
number and type of AED is significantly related to hs-CRP level.
Conclusion. Level of hs-CRP in EP treated with old generation AED is significantly higher
than control. Hs-CRP level tends to be higher in EP treated with CYP inducer AED and
polytherapy although not reaching significant point. Therefore, there is increased
cardiovascular events and atherosclerosis risk in EP treated with extensive CYP-inducer AED
in monotherapy and polytherapy manner.;Background. Old generation antiepileptic drugs (AED), including carbamazepine,
phenytoin, phenobarbital and valproic acid are still utilized extensively in treating epilepsy
patients (EP) in Indonesia. Those drugs are potencial causing obesity, higher atherogenic
lipid fraction, higher homocysteine, insulin resistance and oxidative stress which are
atherosclerosis risk factor and cardiovascular events. Therefore, atherosclerosis and
cardiovascular global risk assesment is required in epilepsy patients treated with those AED
by measuring high sensitivity C-reactive Protein (hs-CRP). Hs-CRP is well-known biomarker
of chronic low level inflammatory and direct etiology of atherosclerosis.
Method. This is a cross sectional study comparing study group (EP treated with old
generation AED) and control group (healthy subjects), age and sex are matched. Subjects of
study group are selected from EP who are visiting neurology outpatient clinic in Cipto
Mangunkusumo Hospital and Indonesia Epilepsy Foundation. All subjects underwent
interview, physical examination and laboratory investigations.
Result. Forty four patients are selected for each group. Hs-CRP level of study group (1.19
(0.27-9.13) mg/L) is significantly higher compared to control group (0.745 (0.13-4.9) mg/L).
No significant correlation between age, sex, last epileptic seizure type, AED type and
duration with hs-CRP level. Hs-CRP level in EP treated with extensive CYP-inducer AED
tend to be higher than valproic acid-treated patients (1.785 (0.27-9.13) vs 0.77 + 0.36 mg/L).
Hs-CRP level in EP treated with extensive CYP-inducer AED is significantly higher
compared to their control group, whereas no difference in valproic acid group compared to
their control. Polytherapy group (2.255 (0.43-8.67) mg/L) tends to have higher hs-CRP level
compared to monotherapy group (1.105 (0.27-9.13) mg/L). Median of hs-CRP in extensive
CYP-inducer polytherapy (3.11 (1.80-8.67) mg/L) is higher than polytherapy with
combination AED (0.96 (0.43-4.59) mg/L). In multivariat analysis, interaction between
number and type of AED is significantly related to hs-CRP level.
Conclusion. Level of hs-CRP in EP treated with old generation AED is significantly higher
than control. Hs-CRP level tends to be higher in EP treated with CYP inducer AED and
polytherapy although not reaching significant point. Therefore, there is increased
cardiovascular events and atherosclerosis risk in EP treated with extensive CYP-inducer AED
in monotherapy and polytherapy manner.;Background. Old generation antiepileptic drugs (AED), including carbamazepine,
phenytoin, phenobarbital and valproic acid are still utilized extensively in treating epilepsy
patients (EP) in Indonesia. Those drugs are potencial causing obesity, higher atherogenic
lipid fraction, higher homocysteine, insulin resistance and oxidative stress which are
atherosclerosis risk factor and cardiovascular events. Therefore, atherosclerosis and
cardiovascular global risk assesment is required in epilepsy patients treated with those AED
by measuring high sensitivity C-reactive Protein (hs-CRP). Hs-CRP is well-known biomarker
of chronic low level inflammatory and direct etiology of atherosclerosis.
Method. This is a cross sectional study comparing study group (EP treated with old
generation AED) and control group (healthy subjects), age and sex are matched. Subjects of
study group are selected from EP who are visiting neurology outpatient clinic in Cipto
Mangunkusumo Hospital and Indonesia Epilepsy Foundation. All subjects underwent
interview, physical examination and laboratory investigations.
Result. Forty four patients are selected for each group. Hs-CRP level of study group (1.19
(0.27-9.13) mg/L) is significantly higher compared to control group (0.745 (0.13-4.9) mg/L).
No significant correlation between age, sex, last epileptic seizure type, AED type and
duration with hs-CRP level. Hs-CRP level in EP treated with extensive CYP-inducer AED
tend to be higher than valproic acid-treated patients (1.785 (0.27-9.13) vs 0.77 + 0.36 mg/L).
Hs-CRP level in EP treated with extensive CYP-inducer AED is significantly higher
compared to their control group, whereas no difference in valproic acid group compared to
their control. Polytherapy group (2.255 (0.43-8.67) mg/L) tends to have higher hs-CRP level
compared to monotherapy group (1.105 (0.27-9.13) mg/L). Median of hs-CRP in extensive
CYP-inducer polytherapy (3.11 (1.80-8.67) mg/L) is higher than polytherapy with
combination AED (0.96 (0.43-4.59) mg/L). In multivariat analysis, interaction between
number and type of AED is significantly related to hs-CRP level.
Conclusion. Level of hs-CRP in EP treated with old generation AED is significantly higher
than control. Hs-CRP level tends to be higher in EP treated with CYP inducer AED and
polytherapy although not reaching significant point. Therefore, there is increased
cardiovascular events and atherosclerosis risk in EP treated with extensive CYP-inducer AED
in monotherapy and polytherapy manner., Background. Old generation antiepileptic drugs (AED), including carbamazepine,
phenytoin, phenobarbital and valproic acid are still utilized extensively in treating epilepsy
patients (EP) in Indonesia. Those drugs are potencial causing obesity, higher atherogenic
lipid fraction, higher homocysteine, insulin resistance and oxidative stress which are
atherosclerosis risk factor and cardiovascular events. Therefore, atherosclerosis and
cardiovascular global risk assesment is required in epilepsy patients treated with those AED
by measuring high sensitivity C-reactive Protein (hs-CRP). Hs-CRP is well-known biomarker
of chronic low level inflammatory and direct etiology of atherosclerosis.
Method. This is a cross sectional study comparing study group (EP treated with old
generation AED) and control group (healthy subjects), age and sex are matched. Subjects of
study group are selected from EP who are visiting neurology outpatient clinic in Cipto
Mangunkusumo Hospital and Indonesia Epilepsy Foundation. All subjects underwent
interview, physical examination and laboratory investigations.
Result. Forty four patients are selected for each group. Hs-CRP level of study group (1.19
(0.27-9.13) mg/L) is significantly higher compared to control group (0.745 (0.13-4.9) mg/L).
No significant correlation between age, sex, last epileptic seizure type, AED type and
duration with hs-CRP level. Hs-CRP level in EP treated with extensive CYP-inducer AED
tend to be higher than valproic acid-treated patients (1.785 (0.27-9.13) vs 0.77 + 0.36 mg/L).
Hs-CRP level in EP treated with extensive CYP-inducer AED is significantly higher
compared to their control group, whereas no difference in valproic acid group compared to
their control. Polytherapy group (2.255 (0.43-8.67) mg/L) tends to have higher hs-CRP level
compared to monotherapy group (1.105 (0.27-9.13) mg/L). Median of hs-CRP in extensive
CYP-inducer polytherapy (3.11 (1.80-8.67) mg/L) is higher than polytherapy with
combination AED (0.96 (0.43-4.59) mg/L). In multivariat analysis, interaction between
number and type of AED is significantly related to hs-CRP level.
Conclusion. Level of hs-CRP in EP treated with old generation AED is significantly higher
than control. Hs-CRP level tends to be higher in EP treated with CYP inducer AED and
polytherapy although not reaching significant point. Therefore, there is increased
cardiovascular events and atherosclerosis risk in EP treated with extensive CYP-inducer AED
in monotherapy and polytherapy manner.]
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