Impact of long-term antiseizure medications on serum vitamin B12 and folate levels in children with epilepsy in central India

Objectives This study investigates the impact of long-term antiseizure medication (ASM) therapy on serum folate and vitamin B12 levels in pediatric epilepsy patients in the Bundelkhand region of Central India. Given the region’s socioeconomic challenges and the critical role of these vitamins in neurological development, the research aims to inform comprehensive treatment strategies that address both seizure control and nutritional well-being. Material and Methods A comparative cross-sectional study was conducted at Maharani Laxmi Bai Medical College, Jhansi, from May to December 2024. The study included 100 children aged 5-18 years with epilepsy on ASM therapy for over 1 year and 100 age- and sex-matched healthy controls. Participants were categorized into monotherapy (phenytoin-PHY, sodium valproate-SV, or levetiracetam-LEV) and polytherapy groups. Exclusion criteria encompassed factors like body mass index (BMI) below the 3 rd percentile, current vitamin supplementation, systemic illnesses, and malabsorption syndromes. Serum folate and vitamin B12 levels were measured using chemiluminescent microparticle immunoassay (CMIA). Data were analyzed using SPSS version 23, employing t-tests, Chi-square tests, and logistic regression. Results The mean age of participants was 10.48 ± 3.89 years, with 59% being male and 63% from rural areas. Among epilepsy patients, 34 and 66 were on monotherapy and polytherapy, respectively. Vitamin deficiencies were observed in 36% of cases versus 22% of controls. Folate deficiency was present in 24% of cases and 2% of controls, while vitamin B12 deficiency was more prevalent in the polytherapy group (53%) compared to the monotherapy group (29%). Within monotherapy, deficiency rates were highest in PHY users (39%), followed by SV (29%) and LEV (17%). All patients on a triple combination of PHY, SV, and LEV exhibited deficiencies in both vitamins. Longer treatment duration and polytherapy were significantly associated with lower serum vitamin levels. Conclusion The study highlights a significant association between long-term ASM therapy and deficiencies in vitamin B12 and folate among pediatric epilepsy patients. PHY and SV were particularly implicated in these deficiencies. The findings align with existing literature indicating that certain ASMs can impair the absorption and metabolism of these essential vitamins, leading to potential neurological and hematological complications. The higher deficiency rates in the Bundelkhand region may also reflect broader nutritional challenges prevalent in resource-constrained settings. Long-term ASM therapy, especially polytherapy and PHY monotherapy, is associated with increased deficiencies in vitamin B12 and folate among children with epilepsy. Regular monitoring and potential supplementation of these vitamins should be considered integral to epilepsy management, particularly in regions with underlying nutritional vulnerabilities. Incorporating nutritional assessments into routine care can mitigate adverse outcomes and enhance the overall well-being of pediatric epilepsy patients.