Role of different anti-seizure medications on carotid intima–media thickness: A systematic review and meta-analysis

BACKGROUND: Various types of anti-seizure medication (ASMs) may have an impact on the cardiac health of patients who have epilepsy. One of the most important noninvasive predictive factors related to cardiovascular disease is carotid intima-media thickness (CIMT). The objective of this systematic review and meta-analysis is to determine the effect of both mono- and poly-therapy with ASMs on CIMT. METHODS: Four databases (PubMed, Scopus, Web of Science, and Embase) were searched for records. Studies that measured the effect of ASMs on CIMT were eligible to be included. The case and control data of studies were extracted. Also, the quality assessment of each included study was assessed by the risk of bias in non-randomized studies of interventions (ROBINS-I) checklist. Additionally, the random-effect model analysis was performed by the Comprehensive Meta-Analysis Software (CMA) version 3.0. RESULTS: Twenty-nine studies were included in the systematic review, and 15 studies were eligible to perform meta-analysis. Among both poly-therapy, and monotherapy with valproate sodium, carbamazepine, levetiracetam, and phenytoin, CIMT had significantly higher thickness compared to the control group (SMD: 1.82, 1.18, 1.33, 1.83, and 1.15 with 95%CI: [0.34, 3.3], [0.67, 1.7], [0.38, 2.27], [0.1, 3.56], and [-0.49, 2.8], respectively) (P-value: .001, .001, .001, .001, and .007, respectively). CONCLUSION: The potential risk of cardiovascular diseases related to CIMT may be elevated by using both mono- and polytherapy with valproate sodium, carbamazepine, levetiracetam, and phenytoin.