Introduction: Few studies have evaluated the effects of antiepileptic drug (AED) therapy on trace element status in children and their results have been conflicting.The newer AEDs are considered to have a more acceptable safety profile, but this confidence is somewhat guarded in the absence of long-term data. This cross-sectionalstudy was conducted to analyze serum trace elements levels in epileptic children treated with conventional and newerAEDs and compare them with healthy controls.

Methods: The study included 92 epileptic children and 28 healthy controls. The participant distribution was as follows,Group I: Phenytoin(PHT) (n=35), Group II: Valproate(VPA) (n=30), Group III: Valproate plus Levetiracetam(VPA+LEV)(n=27), Group IV: Healthy controls(n=28). Serum levels of seven trace elements i.e. zinc, copper, magnesium, manganese, iron, selenium and strontium were determined using inductively coupled plasma-atomic emission spectrometry(ICP-AES).

Results: Phenytoin monotherapy was associated with increased copper(1568.8µg/L vs. 1053.6 µg/L,p=0.009) and strontium(37.0µg/L vs. 30.7µg/L,p<0.001) concentrations & decreased manganese levels(1.5µg/L vs. 1.9µg/L,p=0.04). Valproate monotherapy treated children had decreased serum zinc(1010.5µg/L vs. 1242.9µg/L,p=0.01) and selenium levels(67.0µg/L vs. 84.7µg/L,p=0.02) as compared to healthy controls. However, in VPA+LEV group no significant differences were observed in trace-element profile as compared to healthy children.

Conclusions: A significant difference in trace element levels in VPA and PHT treated children suggests a possible association between AED therapy and trace element alterations. However, levetiracetam in combination with valproate was not associated with these alterations. These findings further support its favorable adverse effect profile as compared to conventional AEDs.