IMMUNOLOGICAL EVALUATION OF CHILDREN TREATED WITH ANTIEPILEPTIC DRUGS

In order to evaluate cellular and humoral immunity in children who wer e 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 p atients were subdivided according to the type of drug received: in par ticular, 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 t he beginning of antiepileptic drug therapy and after 6, 12 and 18 mont hs of therapy. All plasma levels of AEDs were within the therapeutic r ange. All children of the three groups had a normal number of lymphocy tes per millimeter of blood; also the values of CD3, CD4, CD8, CD20 an d CD56 and the serum levels of complement (C3 and C4) mere similar to those of healthy controls. The natural killer cell activity of childre n receiving CBZ showed a significant reduction: this reduction was pre sent 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) an d 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 mon otherapy significant abnormalities of serum immunoglobulin concentrati ons, serum complement values and lymphocyte subsets are not present. C BZ is shown to have a reducing effect on the natural killer cell activ ity, but the real role of this abnormality in the immune system of the se patients needs more investigation.