How does untreated epilepsy affect alkaline phosphatase levels and what is the primary approach to managing epilepsy?

From the Guidelines

Untreated epilepsy does not have a direct connection to elevated alkaline phosphatase levels, but rather certain antiepileptic drugs used to treat epilepsy can cause this elevation. The primary approach to managing epilepsy is pharmacotherapy with antiepileptic drugs (AEDs) tailored to the specific seizure type, as epilepsy affects over 70 million people worldwide and has a profound negative impact on quality of life, general health, employment status, and income 1. Some key points to consider in epilepsy management include:

• The frontline therapy for epilepsy is anti-epileptic drugs (AEDs), although a large subset of patients fails to manage their seizures with pharmacologic solutions alone 1.
• Seizures are completely eliminated in 47% of patients with the first attempted AED and in an additional 14% of patients after the second or third AED 1.
• Certain AEDs, particularly enzyme-inducing drugs, can increase ALP levels by inducing liver enzymes, but this elevation is usually not clinically significant and should be monitored during routine blood work.
• Newer AEDs like levetiracetam, lamotrigine, and lacosamide have less impact on liver enzymes and may be preferred for patients with pre-existing liver conditions.
• Regular monitoring of ALP and other liver function tests is recommended for patients on long-term AED therapy, especially during the first few months of treatment.
• The goal of epilepsy management is to achieve seizure freedom with minimal side effects, which often requires individualized treatment approaches and sometimes combination therapy. Epilepsy has a threefold increase in risk of death and is associated with a significant burden on quality of life, making effective management crucial 1.

From the Research

Connection between Untreated Epilepsy and Elevated Fosfatase Alkhaline

• There is no direct evidence in the provided studies that links untreated epilepsy to elevated fosfatase alkhaline (alkaline phosphatase) levels 2, 3, 4, 5, 6.
• However, study 4 compared the effects of second-generation antiepileptic drugs (AEDs) to first-generation AEDs on bone metabolism in patients with epilepsy, and found that levetiracetam had less adverse effects on blood bone metabolism markers compared to first-generation AEDs.

Effect of Untreated Epilepsy on Alkaline Phosphatase Levels

• The studies provided do not directly address the effect of untreated epilepsy on alkaline phosphatase levels 2, 3, 4, 5, 6.
• Study 4 found that levetiracetam had a significant effect on serum alkaline phosphatase (ALP) levels compared to first-generation AEDs, with a standardized mean difference (SMD) of -1.17 (95% CI -2.08 to -0.25) 4.

Primary Approach to Managing Epilepsy

• The primary approach to managing epilepsy is through the use of antiepileptic drugs (AEDs) 2, 3, 5, 6.
• Studies 2 and 3 compared the efficacy of different AEDs, including carbamazepine, lamotrigine, and levetiracetam, and found that they have different effects on seizure control and tolerability.
• Study 5 found that lamotrigine and carbamazepine have different effects on treatment failure and seizure control, and that the choice between these drugs should be made with careful consideration.
• Study 6 provides a general overview of the diagnosis and treatment of epilepsy, and emphasizes the importance of accurate diagnosis and effective treatment to achieve complete seizure control.