الفهرس 
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Abstract
Summary and Conclusion
he aim of this study is to uncover the relationship between the levels of homocysteine and the cofactors involved in its metabolism as folic acid and vitamin B12 with anti-epileptic drugs in epileptic patients and their role in epilepsy control before and after supplementation of 5mg folic acid daily in the morning for three months.
This study was conducted in Ain Shams University hospitals, Pediatric Neurology Clinic, on 8o epileptic children with idiopathic epilepsy that were divided into 4 groups:
Group 1: 20 patients receiving valproic acid.
Group 2: 20 patients receiving carbamazepin.
Group 3: 20 patients receiving single new antiepileptic drug (levetiracetam).
Group 4: 20 patients receiving polytherapy.
Controls: 20 non-epileptic healthy children of the same mean age and sex of the patients.
All children were subjected to full history taking, complete clinical examination and investigations as CBC, determination of serum levels of folic acid, vitamin B12 and Hcy, EEG and neuroimaging. There were no significant differences in age, gender, mean age of onset, duration of seizures and weight between the four groups of patients administering antiepileptic drugs compared to each other and compared to controls. All
patients were supplemented with 5mg folate each morning for 90 days. Serum level of homocystine, folic acid and antiepileptic drugs were measured one day before treatment and after 90 days post treatment.
The results of this study revealed:
Homocysteine was significantly increased in serum of epileptic patients receiving valproic acid, Polytherapy and carbamazepin compared to controls. In Levetiracetam receiving patients, homocysteine was non-significantly increased compared to controls.
Folic acid was significantly decreased in epileptic patients receiving Valporate, polytherapy and Carbazepine compared to controls. Except for Levetiracetam, where folic acid showed no significant differences in serum of patients compared to controls.
There was no significant difference in mean and SD of serum vitamin B12 among epileptic patients receiving antiepileptic drugs compared to controls.
Folic acid supplementation for 3 months significantly decrease level of homocysteine among patients receiving Valproic acid, Polytherapy and Carbamazepin compared to controls. In Levetiracetam receiving patients, homocysteine was non significant increased compared to controls.
Folic acid supplementation significantly increased serum folic acid in epileptic patients receiving Valproic acid, polytherapy and carbamazepine. It also shows non significant increase folic acid in epileptic patients receiving Levetiracetam.
Folic acid supplementation increase serum level of vitamin B12 among epileptic patients compared to their level before supplementation except for those receiving valproic acid.
A significant increase in the level of homocysteine in blood of epileptic patients receiving polytherapy compared to those receiving monotherapy.
A significant increase in the level of homocysteine in blood of epileptic patients receiving old single antiepileptic drug compiared to those receiving a single new one.
Positive correlation btween mean srum level of homocysteine and duration of treatment.
negative correlation btween mean serum level of folic acid and duration of treatment. No significant correlation between man serum levels of vitamin B12with duration of treatment.
3 months treatment with folic acid enough period to decrease serum level of homocysteine and increase serum level of folic acid.
Asignificant negative correlation between severity of convulsions and serum folic acid among epileptic patients administering Valproic acid, polytherapy, Carbamazepine and Levetiracetam before and after folic acid supplementation.
It can be concluded that AEDs play a major role in hyperhomocysteinemia development in patients with epilepsy. Adding folate AED therapy is a safe and inexpensive way to reduce the risk of hyperhomocysteinemia. Also, in AED-treated patients, reduced folate play important roles in the development of hyperhomocysteinemia, while vitamin B12 does not. Levetiracetam has a minimal effect on homocystiene.Receiving polytherapy (two or more) AEDs increase serum level of homocystiene more than monotherapy do