Characteristics of Epileptic Patients with Hyper-homocysteinaemia (Initial Experience)

Souhrn

Homocysteine (Hcy) is an important product of the intermediary metabolism. Even a mild increase isa risk factor of vascular damage, in particular of peripheral, cerebral and coronary arteries. Its markedneurogenic excitatory effect is also known and it is used as an epileptogenic agent in experimentalmodels of epilepsy. Metabolic disorders leading to a general rise of total plasma homocysteine (tHcy)are closely associated with deficiency of B vitamins - folate, vitamin B 12, pyridoxine. The authors submitresults of assessment of plasma tHcy and vitamins in a group of 82 patients treated by classicalantiepileptics (AE). In a group of 35 patients with elevated values of tHcy - above 10.3 in women and12.5 m mol/l in men, statistically significantly lower folate values were found (on account of the group ofmen), of vitamin B12 (equally in men and women) and of pyridoxine (in women) as compared witha group of 47 with lower values of tHcy. In the mentioned group of 35 patients only slightly elevatedvalues of tHcy predominated. In those instances it may be assumed that there is an association withvitamin deficiency due to AE therapy. The finding of medium elevated tHcy was recorded in three men,suspected deficiency of the MTHFR enzyme (methylenetetrahydrofolate reductase) within the frame-work of the metabolic deviation with autosomal recessive heredity was confirmed so far in one patient.The EEG and clinical follow up of the influence of medium grade hyperhomocysteinaemia (HHcy) inpatients after an acute methionine loading test did not provide evidence of a direct e pileptogenic effect(in 7 patients). Despite this it may be assumed that a metabotropic effect on neurogenic mechanismscannot be ruled out during long-term latent action in particular in non-treated patients. The findingsof interrelated HHcy and deficiency of the vitamin B group in epileptology may be important from theaspect of the course, etiology and coincidence with vascular damage. As substitution of deficientvitamins led to normalization of tHcy levels, their aimed administration may be recommended.

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