Elevated serum alkaline phosphatase in epilepsy: Effect of age and treatment.

Purpose: The major goal of epilepsy management using antiepileptic drug therapy is to attain seizure freedom without any adverse effects. However, the reported adverse effects of antiepileptic drugs on the hematological and biochemical profiles are subject of considerable debate in clinical practice. The objective of the present study was to investigate the effect of antiepileptic drug therapy on the hematobiochemical parameters in patients with epilepsy and to investigate the association of altered parameters with different demographic and clinical variables. Methods: A cross-sectional study involving 567 patients with epilepsy (drug-naive, N=223; phenytoin, N=85; carbamazepine, N=114; valproate, N=100; and multitherapy, N=45) and 37 healthy controls, aged 5-60 years, from North India was conducted. Hematological and biochemical profiling of all the subjects was performed at a single center. Results: Of all the parameters evaluated, only alkaline phosphatase (ALP) levels were found to be elevated in drug-free as well as patients on antiepileptic drug therapy. Early age and higher pretreatment seizure frequency were significantly associated with higher ALP levels (p<0.0001) while prolonged treatment duration and higher doses of antiepileptic drugs were inversely related to them (p<0.01). Though preliminary analysis demonstrated the involvement of epilepsy type, multivariate logistic regression eliminated the possibility. Conclusions: Our findings, for the first time, suggested that elevated ALP levels in patients with epilepsy are attributed to the disease, epilepsy itself and not antiepileptic drug therapy.