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Fasting and Post-Methionine Loading Concentrations of Homocysteine, Vitamin B₂, and Vitamin B₆ in Patients on Antiepileptic Drugs

Departments of
¹ Internal Medicine and
² Medical Biochemistry and
³ Stavanger Neurological Unit, Rogaland Central Hospital, Armauer Hansens vei 20, 4011 Stavanger, Norway
⁴ Northern Ireland Center for Diet and Health, School of Biomedical Sciences, University of Ulster, Coleraine BT52 1SA, Northern Ireland

^aauthor for correspondence: fax 47-51519906, e-mail apeland@online.no

The first 300 words of the full text of this article appear below.

Patients on antiepileptic drugs (AEDs) frequently have low serum folate and high plasma total homocysteine (tHcy) (1)(2)(3)(4). This metabolic disturbance has been implicated in an increased rate of cardiovascular disease, fetal malformations, dementia, and neuropsychiatric symptoms among patients on AEDs (5)(6)(7). Homocysteine metabolism is dependent on four B vitamins as cofactors: The methylation of homocysteine to methionine requires folate and vitamin B₁₂, and the irreversible transsulfuration to cysteine requires vitamin B₆ (8). The recycling of folate cofactors is dependent on vitamin B₆ and B₂, and vitamin B₂ is necessary for activating vitamin B₆ to pyridoxal 5'-phosphate (PLP) (9). Vitamin B₂ and B₆ status thus may have an impact on tHcy concentrations in patients taking AEDs, but few studies have reported on this matter (3)(4)(10)(11). The methionine loading test detects individuals with impaired homocysteine metabolism not detected by fasting Hcy concentrations alone and is often considered primarily a test of the transsulfuration pathway (1)(8)(12). We therefore determined the fasting and 6 h post-methionine loading (postload) plasma concentrations of thiols and B vitamins in patients taking AEDs.

We recruited 101 patients with symptomatic, cryptogenic, or primary generalized epilepsy from our outpatient clinic. None of them had epilepsy secondary to ischemic stroke or other conditions considered to be associated with high tHcy, and none were on prescribed vitamin supplements. We recruited 101 controls among blood donors and hospital employees. All participants gave written informed consent before entering the study, and The Regional Ethics Committee (University of Bergen, Norway) approved the study. The number of male patients and controls was identical (n = 53), as was the mean (SD) age . . . [Full Text of this Article]

The following articles in journals at HighWire Press have cited this article:

				P. I. Holm, P. M. Ueland, S. E. Vollset, O. Midttun, H. J. Blom, M. B.A.J. Keijzer, and M. den Heijer Betaine and Folate Status as Cooperative Determinants of Plasma Homocysteine in Humans Arterioscler. Thromb. Vasc. Biol., February 1, 2005; 25(2): 379 - 385. [Abstract] [Full Text] [PDF]