Erişkin epilepsi hastalarında insülin direnci ve obezitenin değerlendirilmesi

Year 2018, Volume: 15 Issue: 2, 55 - 58, 14.08.2018

Özlem Ethemoğlu

Abstract

Amaç: Epilepsi kronik bir hastalıktır. Epilepsi hastalarında inme, diabet,
kalp hastalığı, hipertansiyon, tiroid bozukluğu, migren, anksiyete ve depresyon
gibi komorbid durumların normal popülasyona göre daha sık karşılaşıldığı
bildirilmiştir. Bizim bu çalışmadaki amacımız epilepsi hastalarında insülin
direnci ve obezite varlığını araştırmaktır.

Materyal ve
Metod: Çalışmaya Harran Tıp
Fakültesi Nöroloji Poliliniğinden takipli 100 epilepsi hastası ve 45 sağlıklı
kontrol alındı. Hastaların yaşı, cinsiyeti, hastalığının süresi, nöbet tipi,
nöbet sıklığı, antiepileptik tedavisi incelendi.

Bulgular: Hastaların 51’si (%51) erkek, 49’u (%49) kadın idi. Hastaların yaş
ortalaması 27.12 ± 9.46, hastalık süresinin ortalaması 12 ± 9.52 idi. Epilepsi
hasta grubunda, sağlıklı kontrol grubuna göre insülin direnci ve ortalama vücut
kitle indeksi anlamlı olarak daha yüksek idi. Yine epilepsi hastalarında,
sağlıklı kontrollere göre obezite anlamlı olarak daha fazla idi. Kontrollü
epilepsi ile dirençli epilepsi grubu ve monoterapi ile politerapi alan gruplar
arasında vücut kitle indeksi, serum insülin seviyesi ve insülin direnci
açısından istatiksel olarak anlamlı bir ilişki saptanmadı.

Sonuç: Epilepsi
hastalarında normal popülasyona göre ortalama insülin direnci değerleri ve
obezite anlamlı olarak daha fazla idi. Epilepsi hastalarında, insülin direnci
ve kilo alımının yakın takibi ve erken dönemde önlem alınması, bu faktörlere
bağlı gelişebilecek metabolik sendrom, kognitif etkilenme, inme ve
kardiovasküler hastalıkların önlenmesi açısından önemlidir

Keywords

Epilepsi, Obezite, Vücut kitle indeksi

Evaluation of insulin resistance and obesity in adult epileptic patients

Abstract

Aim:
Epilepsy is a chronic disease. It has been reported that comorbid conditions
such as stroke, diabetes, heart disease, hypertension, thyroid disorder,
migraine, anxiety and depression are more common in epilepsy patients than in
the normal population. Our aim in this study is to investigate the presence of
insulin resistance and obesity in epileptic patients.

Material and Methods: The study included 100 epileptic patients who were admitted to Harran
Medical Faculty Neurology Policlinic and 45 healthy controls Age, gender,
duration of illness, seizure type, seizure frequency, antiepileptic treatment
were studied.

Results:
51 (51%) of the patients were male and 49 (49%) were female. The mean age of
the patients was 27.12 ± 9.46 and the mean duration of illness was 12 ± 9.52.
In the epilepsy group, mean insulin resistance and mean body mass index were
significantly higher than in the healthy control group. Also, in epileptic
patients, obesity was significantly higher than healthy controls. There was no
statistically significant relationship between controlled epilepsy and
resistant epilepsy group and between monotherapy and polytherapy groups in
terms of body mass index, serum insulin level and insulin resistance.

Conclusion: The mean insulin resistance values and obesity were significantly
higher in the epilepsy patients than in the normal population. In epileptic
patients, close follow-up of weight gain and insülin resistance and early
prevention are important in terms of prevention of metabolic syndrome,
cognitive impairment, stroke and cardiovascular diseases that may be caused by
these factors.

Keywords

Epilepsy, Obesity, Body mass index, Insulin resistance

References

• KAYNAKLAR1) Ruiz-Giménez J, Sánchez-Alvarez JC, Cañadillas-Hidalgo F, Serrano-Castro PJ; Andalusian Epilepsy Society. Antiepileptic treatment in patients with epilepsy and other comorbidities. Seizure. 2010 Sep;19(7):375-82.
• Tellez-Zenteno JF, Matijevic S, Wiebe S. Somatic comorbidity of epilepsy in the general population in Canada. Epilepsia 2005;46(12):1955–62.
• Tellez-Zenteno JF, Patten SB, Jette´ N, Williams J, Wiebe S. Psychiatric comorbidity in epilepsy: a population-based analysis. Epilepsia 2007;48(12 (December)): 2336–44.
• Ben-Menachem E. Weight issues for people with epilepsy-a review. Epilepsia 2007; 48: 42-5.
• Hinnell C, Williams J, Metcalfe A, et al. Health status and health-related behaviors in epilepsy compared to other chronic conditions-a national population-based study.Epilepsia 2010; 51: 853-61.
• El-Khatib F, Rauchenzauner M, Lechleitner M, Hoppichler F, Naser A, Waldmann M, et al. Valproate, weight gain and carbohydrate craving: a gender study. Seizure 2007;16(3):226–32.
• Sperling MR. Overview: Endocrine and reproductive dysfunction in epilepsy. Epilepsia 1991;32(Suppl 6):1.
• Dana-Haeri J, Trimble Mr, Oxley J. Prolactin and gonadotrophin changes following generalised and partial seizures. J Neurol Neurosurg Psychiatry 1983;46(4):331–5.
• Janousek J, Barber A, Goldman L, Klein P. Obesity in adults with epilepsy. Epilepsy Behav. 2013 Sep;28(3):391-4. doi: 10.1016/j.yebeh.2013.05.012.
• Silveira DC, Klein P, Ransil BJ, Liu Z, Hori A, Holmes GL, et al. Lateral asymmetry in activation of hypothalamic neurons with unilateral amygdaloid seizures. Epilepsia 2000;41:34–41.
• Williams KW, Elmquist JK. Lighting up the hypothalamus: coordinated control of feeding behavior. Nat Neurosci 2011;14:277–8.
• Hafizi N, Alipoor E, Hosseinzadeh-Attar MJ. Obesity and epilepsy: The first step of a long road. Epilepsy Behav. 2017 Feb; 67: 135-136. doi: 10.1016/j.yebeh.2016.12.004.
• Luef G, Abraham I, Hoppichler F, et al. Increase in postprandial serum insülin levels in epileptic patients with valproic acid therapy. Metabolism 2002;51:1274–8.
• Pack AM, Morrell MJ, Randall A, et al. Bone health in young women with epilepsy after one year of antiepileptic drug monotherapy. Neurology 2008;70:1586–93
• Ensrud KE, Walczak TS, Blackwell TL, et al., Osteoporotic Fractures in Men (MrOS) Study Research Group. Antiepileptic drug use and rates of hip bone loss in older men: a prospective study. Neurology 2008;71:723–30.
• Najafi MR, Bazooyar B, Zare M, Aghaghazvini MR, Ansari B, Rajaei A, Dashti M. The Investigation of Insulin Resistance in Two Groups of Epileptic Patients Treated with Sodium Valproate and Carbamazepine. Adv Biomed Res. 2017 Mar 7;6:25. doi: 10.4103/2277-9175.201689.
• McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993;270:2207 12
• Greenwood CE, Winocur G. High-fat diets, insulin resistance and declining cognitive function. Neurobiol Aging 2005;26:42–5.
• Young SE, Mainous III AG, Carnemolla M. Hyperinsulinemia and cognitive decline in a middle-aged cohort. Diabetes Care 2006;29:2688–93
• Martin R, Vogtle L, Gilliam F, Faught E.What are the concerns of older adults living with epilepsy? Epilepsy Behav 2005;7:297–300
• Hamed SA. Atherosclerosis in epilepsy: its causes and implications. Epilepsy Behav. 2014 Dec;41:290-6. doi: 10.1016/j.yebeh.2014.07.003.
• Marqués-Iturria I, Pueyo R, Garolera M, Segura B, Junqué C, García-García I, et al. Frontal cortical thinning and subcortical volume reductions in early adulthood obesity. Psychiatry Res 2013;214:109–15
• Kuusisto J, Koivisto K, Mykkänen L, Helkala EL, Vanhanen M, Hänninen T, et al. Association between features of the insulin resistance syndrome and Alzheimer's disease independently of apolipoprotein E4 phenotype. BMJ 1997;315:1045–9.
• Hermann B, Seidenberg M, Jones J. The neurobehavioural comorbidities of epilepsy: can a natural history be developed? Lancet Neurol 2008;7:151–60
• Chang CS, Liao CH, Lin CC, Lane HY, Sung FC, Kao CH. Patients with epilepsy are at an increased risk of subsequent stroke: a population-based cohort study. Seizure 2014. http://dx.doi.org/10.1016/j.seizure.2014.02.007
• Annegers JF, Hauser WA, Shirts SB. Heart disease mortality and morbidity in patients with epilepsy. Epilepsia 1984;25:699–704.
• Hamed SA, Hamed EA, Hamdy R, Nabeshima T. Vascular risk factors and oxidative stress as independent predictors of asymptomatic atherosclerosis in adult patients with epilepsy. Epilepsy Res 2007;74:183–92.
• Arida RM, Scorza FA, de Albuquerque M, Cysneiros RM, de Oliveira RJ, Cavalheiro EA. Evaluation of physical exercise habits in Brazilian patients with epilepsy. Epilepsy Behav 2003; 4: 507-10.
• Wong J, Wirrell E. Physical activity in children/teens with epilepsy compared with that in their siblings without epilepsy. Epilepsia 2006; 47: 631-9
• Silveira DC, Klein P, Ransil BJ, Liu Z, Hori A, Holmes GL, et al. Lateral asymmetry in activation of hypothalamic neurons with unilateral amygdaloid seizures. Epilepsia 2000;41:34–41.
• Williams KW, Elmquist JK. Lighting up the hypothalamus: coordinated control of feeding behavior. Nat Neurosci 2011;14:277–8.
• Elliott JO, Lu B, Shneker B, et al. Comorbidiy, health screening and quality of life among persons with a story of epilepsy. Epilepsy Behav 2009;(14):125–9.
• Hinnell C, Williams J, Metcalfe A, et al. Health status and health-related behaviors in epilepsy compared to other chronic conditions. A national population-based study. Epilepsia 2010 (Article online in advance of print. Published Online: January 7 2010).
• Ladino LD, Hernández-Ronquillo L, Téllez-Zenteno JF. Obesity and its association with generalised epilepsy, idiopathic syndrome, and family history of epilepsy. Epileptic Disord. 2014 Sep;16(3):343-53. doi: 10.1684/epd.2014.0677