FOLATE DEFICIENCY INDUCED BY ANTIEPILEPTICS: A CASE SERIES

Abstract

Antiepileptic drugs are widely used for seizure management, but their long-term use
has been associated with various side effects like osteoporosis, vitamin D deficiency,
dysphagia, nephrotoxicity, depression and hepatotoxicity. It also causes
hematological abnormalities which includes anemia, thrombocytopenia and folate
deficiency. Folate plays a crucial role in neural function, DNA synthesis and
erythropoiesis. Its depletion can lead to anemia, thrombocytopenia, and neurological
complications. Long-term use of antiepileptics like sodium valproate, phenytoin,
carbamazepine, and levetiracetam have been implicated in affecting folate
metabolism through mechanisms such as enzyme induction, increased folate
breakdown, impaired absorption, and competitive inhibition at folate receptor sites.
This case series highlights the incidence of folate deficiency, anemia and
thrombocytopenia in patients on treatment with anti-epileptics. Thus, awareness
regarding antiepileptic-induced folate deficiency and monitoring hematological
parameters, particularly folate level in patients taking antiepileptics can be
helpful in early detection and prevention of complications. Intervention through
folate supplementation can improve patient outcome and quality of life.