Immunological Evaluation of Children Treated with Antiepileptic Drugs

In order to evaluate cellular and humoral immunity in children who were given carbamazepine (CBZ), sodium valproate (VPA) or phenobarbital (PHB) as monotherapy, we studied 137 children and adolescents suffering from various types of epilepsy and 50 healthy control children. The patients were subdivided according to the type of drug received: in particular, Group 1: 50 (26 female, 24 male) children received only CBZ; their age ranged from 2.3 years to 16.0 years (mean ± SD, 8.1 ± 7.9 years); Group 2: 50 (26 female, 24 male) children received only VPA with age from 2.8 to 15.1 (8.9 ± 7.1) years; Group 3: 37 (20 female, 17 male) children who were given only PHB with age from 2.0 to 13.9 (8.4 ± 7.8) years. 50 sex and age- matched healthy children served as controls. All the patients of groups 1, 2 and 3 were studied before the beginning of antiepileptic drug therapy and after 6, 12 and 18 months of therapy. All plasma levels of AEDs were within the therapeutic range. All children of the three groups had a normal number of lymphocytes per millimeter of blood; also the values of CD3, CD4, CD8, CD20 and CD56 and the serum levels of complement (C3 and C4) were similar to those of healthy controls. The natural killer cell activity of children receiving CBZ showed a significant reduction: this reduction was present after 6 months of therapy (baseline: 45.2%; after 6 months: 32.6%; after 12 months 31.3 %; (all determinations vs baseline:p<0.01) and continued to be present until the end of the study (36.9%; p<0.05). Our data suggest that, in children receiving CBZ, VPA and PHB on monotherapy significant abnormalities of serum immunoglobulin concentrations, serum complement values and lymphocyte subsets are not present. CBZ is shown to have a reducing effect on the natural killer cell activity, but the real role of this abnormality in the immune system of these patients needs more investigation.