Adverse Metabolic Effects of Antiepileptic Drug Treatment

Active epilepsy with recurrent seizures is associated with a range of well-documented unfavourable consequences. Nevertheless, adverse metabolic effects of antiepileptic drug (AED) treatments have only recently received attention. Such effects may be subtle, insidious, take many years to become clinically apparent, and may have a negative impact on general health for many decades. Unfortunately, many neurologists are unaware of such AED-related side-effects. The relationship between epilepsy and metabolic disorders is multi-factorial. Metabolic encephalopathies, including mitochondrial disorders and some of the progressive myoclonic epilepsies, are important causes of seizures in childhood. Acute metabolic disturbances associated with diseases affecting the kidneys, liver, or pancreas may give rise to seizures. Furthermore, alcoholor drug-withdrawal may also be associated with seizures. From the other perspective, seizures themselves, in particular prolonged seizures such as in convulsive status epilepticus, may lead to a variety of metabolic abnormalities. In this chapter I will summarize our current knowledge about the adverse metabolic effects of AED treatment and discuss whether these side-effects are so severe that a reconsideration of our prescribing habits would be beneficial.