A new study suggests that antiepileptic drugs are associated with an increased risk of Parkinson’s disease (PD).
Using data from the UK Biobank, the researchers compared more than 1,400 individuals diagnosed with PD to matched controls, finding that those who took antiepileptic drugs (AEDs) were more likely to be on the sidelines than those who did not. They found a significantly higher risk of developing PD compared to humans. There was a trend to associate more AED prescriptions with multiple AEDs, which was associated with higher risk of PD.
“Using data from the UK Biobank, we observed an association between the most commonly prescribed antiepileptic drugs in the UK and Parkinson’s disease,” said lead author Dr. Alastair Noyce, Professor of Neurology and Neuroepidemiology. , Emeritus Consultant Neurologist, Queen Mary University London, UK, said Medscape Medical News.
“This is the first comprehensive study of the association between AEDs and PD,” said Noyce.
He added that the findings do not have direct clinical implications. [as] This is an interesting observation made in a research setting. ”
The study was published online on December 27. JAMA Neurology.
Plausible but unclear links
In a recent observational study,
It is associated with the development of epilepsy and PD, but the mechanisms underlying this association are “unknown,” the authors wrote.
Although it is “plausible” that AEDs “may explain some or all of the apparent associations between epilepsy and PD” and that movement disorders are a potential side effect of AEDs, Since the association between PD is ‘understudied’, it remains ‘unclear’ whether AEDs play a role in the association.
“We have previously reported an association between epilepsy and PD in several different datasets. Here, we wanted to see if it could be explained by an association with medications used to treat epilepsy rather than epilepsy itself. I wanted to,” Noyce explained.
Is the AED the culprit?
The researchers used data from the UK Biobank, a longitudinal cohort study of over 500,000 participants, and linked primary care medication data to conduct a nested case-control study to support this study. Investigated potential relevance. Participants were recruited between 2006 and 2010, he ranged in age from 40 to 69 years.
The researchers compared 1433 individuals diagnosed with PD and their age, gender, race, ethnicity, and socioeconomic status (median [interquartile range] 71 years old [65 – 75] years; 60.9% male; 97.5% white).
Among PD patients, 4.3% were prescribed an AED before being diagnosed with PD, compared with 2.5% in the control group. 4.4% had a diagnosis of epilepsy, compared with 1% in the control group.
The strongest evidence was the association of lamotrigine, levetiracetam, and sodium valproate with PD. All AEDs were associated with a higher risk of PD, although there was ‘weaker evidence’ for carbamazepine.
| AEDs | or (95% CI) | P. worth |
|---|---|---|
| Any | 1.80 (1.35 – 2.40) | 6.93×10−5 |
| carbamazepine | 1.43 (0.97 – 2.11) | .07 |
| Lamotrigine | 2.83 (1.53 – 5.25) | 9.29×10−4 |
| Levetiracetam | 3.02 (1.51 – 6.05) | 1.85×10−3 |
| sodium valproate | 3.82 (2.41 – 6.05) | 1.17×10−8 |
The odds of developing PD were higher in those who were prescribed one or more AEDs and in those who were issued more prescriptions, the authors report.
It’s possible that it’s the epilepsy itself, not the drugs, that is associated with the risk of PD, “which likely explains some of the associations we’re seeing,” Noyce said.
“The bottom line is that more research is needed on epilepsy and the relationship between drugs used to treat epilepsy and PD,” he said.
Furthermore, “time will tell whether the findings hold real clinical relevance,” he added.
another explanation
comments on the research of Medscape Medical News“Studies to date have established a link between epilepsy and PD,” said Rebecca Gilbert, MD, PhD, chief scientific officer of the American Parkinson’s Association. The current study “shows that being prescribed one of four antiepileptic drugs was associated with a subsequent diagnosis of PD.”
One possible conclusion is that AEDs themselves increase the risk of developing PD, but “there seems to be other explanations for why people who are prescribed an AED are at increased risk of being diagnosed with PD.” says Gilbert. Associate Professor of Neurology at Bellevue Hospital Center in New York City, not involved in current research.
For example, pre-exercise brain changes in Parkinson’s disease patients “may increase the risk of needing an AED by potentially increasing the risk of having a seizure,” Changes in the brain that affect the brain increase the risk of PD.”
In addition, Gilbert suggested that psychiatric changes associated with PD may have led to AED prescriptions, as at least two AEDs were also prescribed for mood stabilization.
“An unanswered question the paper acknowledges is what about people who get AEDs for reasons other than seizures? Are they also at increased risk for PD? I’m guessing,” said Gilbert.
She stressed that people who use AEDs for seizures “should not jump to the conclusion that they must stop these drugs lest they increase their risk of developing PD.” Seizures “can be dangerous,” she said. They can injure themselves during a seizure and can cause brain damage if the seizure cannot be stopped or if seizures occur in rapid succession. says.
For these reasons, “people who are prone to seizures should protect themselves with an AED,” says Gilbert, “and should always contact a neurologist with any questions.”
The Preventive Neurology Unit is funded by Barts Charity. This study used the Apocrita High Performance Cluster facility supported by the Queen Mary University London Research IT Service. Noyce has received grants from Barts Charity, Parkinson’s UK, Cure Parkinson’s, Michael J. Fox Foundation, Innovate UK, Solvemed, and Alchemab, and personal expenses from AstraZeneca, AbbVie, Zambon, BIAL, uMedeor, Alchemab, Britannia, and Charco Neurotech. received. submitted work. Disclosures of other authors are given in the original article. Gilbert has not reported any related financial relationships.
JAMA Neurology. Published online on December 27, 2022.
Batya Swift Yasgur MA, LSW is a freelance writer in counseling in Teaneck, NJ. She is a regular contributor to numerous medical publications, including Medscape and her WebMD, and is the author of consumer health books, Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom. I have. (Memoirs of two brave Afghan sisters who told her their story).
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