Epilepsy and vascular risk: Evaluation of the influence of antiseizure medications on atherosclerotic disease

Objective Patients with epilepsy have increased vascular risk, and the use of antiseizure medications (ASM) seems to be a contributing factor. We aimed to analyze the differences in vascular risk profiles among epilepsy patients treated with ASM that exhibit varying interactions with the cytochrome P450 enzyme system, using surrogate sonographic markers of vascular risk. Methods Prospective longitudinal observational study including patients with epilepsy on ongoing, stable ASM for more than 1 year and a control group. Patients were subdivided into four groups according to ASM enzyme interactions (strong inducers–group 1; weak inducers–group 2; non‐inducers–group 3; and inhibitors–group 4). Clinical data, blood tests, and ultrasound studies assessing cerebral blood flow (CBF), carotid intima‐media complex thickness (CA‐IMT), pulsatility index (PI), and the presence of atherosclerotic carotid plaques were collected at baseline and after 1 year. Results A total of 159 participants were included, comprising 126 patients with epilepsy and 33 controls. The proportion of female participants was 56.0%, the median age was 46 years (IQR 38, 54), and 64.0% had vascular risk factors. CBF was higher in controls than in epilepsy patients at both baseline and 1‐year follow‐up (675 vs. 560 mL/100gr/min in group 1, p < 0.001). After 1 year, PI was higher in groups 1 and 2 than in controls (0.86 and 0.90 vs. 0.80, p = 0.037). At baseline, group 1 presented a higher number of carotid plaques compared to group 3 (13 vs. 2, p = 0.002). The progression of CBF, CA‐IMT and PI over a 1‐year period did not differ significantly between groups. Significance Patients with epilepsy showed an overall decrease in CBF, whereas the enzyme‐inducing group had a higher number of carotid plaques and higher PI, which may reflect an increased risk of macro and microvascular disease. These data emphasize the importance of comprehensive care addressing vascular risk factors in these patients.