Summary
No significant difference was found in a comparison between the values of unreduced serum folic acid of 48 epileptics treated with hydantoin and 38 controls as measured by a competitive protein-binding assay. The average folic acid value was 7.73 nmol/l in the epileptics, a little higher than the 7.18 nmol/l found in the controls. This result supports the hypothesis that the folate deficiency in epileptics is caused by blocking the conversion of folic acid to 5-methyltetrahydrofolic acid by phenytoin.
Zusammenfassung
Bei einem Vergleich der mit Hilfe der kompetitiven Protein-Bindungs-Analyse gemessenen Werte der unreduzierten Folsäure im Serum zwischen 48 mit Hydantoin behandelten Epileptikern und 38 Normalpersonen ergab sich kein signifikanter Unterschied der Mittelwerte. Durchschnittlich lag der Folsäurespiegel bei den Epileptikern mit 7,73 nmol/l gegenüber 7,18 nmol/l bei den Kontrollpersonen etwas höher. Dieser Befund stützt die Hypothese, daß der Folatmangel bei Epileptikern auf einer Blockierung der Umwandlung von Folsäure in 5-Methyltetrahydrofolsäure durch Diphenylhydantoin beruht.
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Literatur
Child, J. A., Khattak, B. Z., Knowles, J. P.: Macrocytosis in patients on anticonvulsant drugs. Br. J. Haematol. 16, 451–455 (1969)
Davis, R. E., Reed, P. A., Smith, B. K.: Serum pyridoxal, folate, and vitamin B 12 levels in institutionalized epileptics. Epilepsia 16, 463–468 (1975)
Dunn, R. T., Foster, L. B.: Radioassay of serum folate. Clin. Chem. 19, 1101–1105 (1973)
Fehling, C., Jagerstad, M., Lindstrand, K., Westesson, A. K.: The effect of anticonvulsant therapy upon the absorption of folates. Clin. Sci. 44, 595–600 (1973)
Herbert, V., Zalusky, R.: Selective concentration of folic acid acitivity in cerebrospinal fluid. Fed. Proc. 20, 453 (1961)
Hoffbrand, A. V., Necheles, T. F.: Mechanism of folate deficiency in patients receiving phenytoin. Lancet 2, 528–530 (1968)
Horwitz, S. J., Klipstein, F. A., Lovelace, R. E.: Relation of abnormal folate metabolism to neuropathy developing during anticonvulsant drug therapy. Lancet 1, 563–565 (1968)
Ibbotson, R. N., Dilena, B. A., Horwood, J. M.: Studies on deficiency and absorption of folates in patients on anticonvulsant drugs. Australas. Ann. Med. 16, 144–150 (1967)
Jensen, O. N., Olesen, O. V.: Folic acid and anticonvulsive drugs. Arch. Neurol. 21, 208–214 (1969)
Klipstein, F. A.: Subnormal serum folate and macrocytosis associated with anticonvulsant drug therapy. Blood 23, 68–86 (1964)
Levitt, M., Nixon, P. F., Pincus, J., Bertino, J. R.: Transport characteristics of folates in cerebrospinal fluid: A study using doubly labeled 5-methyltetrahydrofolate and 5-formyltetrahydrofolate. J. Clin. Invest. 50, 1301–1308 (1971)
Malpas, J. S., Spray, G. H., Witts, L. J.: Serum folic acid and vitamin B12 levels in anticonvulsant therapy. Br. Med. J. 1, 955–957 (1966)
Mannheimer, E., Pakesch, F., Reimer, E. E., Vetter, H.: Die hämatologischen Komplikationen der Epilepsiebehandlung mit Hydantoinkörpern. Med. Klin. 47, 1397–1401 (1952)
Mattson, R. H., Gallagher, B. B., Reynolds, E. H., Glass, D.: Folate therapy in epilepsy. Arch. Neurol. 29, 78–81 (1973)
Nelson, E. W., Gerda, J. J., Wilder, B. J., Streiff, R. R.: Effect of diphenylhydantoin on the bioavailability of citrus folate. Am. J. Clin. Nutr. 31, 82–87 (1978)
Preece, J., Reynolds, E. H., Johnson, A. L.: Relationship of serum to red cell folate concentrations in drug treated epileptic patients. Epilepsia 2, 335–340 (1971)
Reynolds, E. H., Milner, G., Matthews, D. M., Chanarin, L.: Anticonvulsant therapy, megaloblastic haemopoiesis and folic acid metabolism. Quart. J. Med. 35, 521–537 (1966)
Rothenberg, S. P., Dacosta, M., Rosenberg, Z.: A radioassay for serum folate: Use of a twophase sequential incubation, ligand-binding system. New Engl. J. Med. 286, 1335–1339 (1972)
Snaith, R. P., Mehta, S., Raby, A. H.: Serum folate and vitamin B12 in epileptics with and without mental illness. Br. J. Psychiatr. 116, 179–183 (1970)
Taguchi, C.: Clinical and experimental studies on folic acid deficiency due to anticonvulsants. II. Investigations on patients receiving anticonvulsants and experimental study on the effect of diphenylhydantoin on the absorption of folic acid in rats. Acta Med. Okayama 25, 551–566 (1971)
Woodbury, D. M., Kemp, J. W.: Pharmacology and mechanisms of action of diphenylhydantoin. Psychiatr. Neurol. Neurochir. 74, 91–115 (1971)
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Krause, K.H., Schmidt-Gayk, H., Gutscher, D. et al. Serumfolsäurespiegel unter antiepileptischer Langzeittherapie. Arch. Psychiatr. Nervenkr. 228, 91–94 (1980). https://doi.org/10.1007/BF00365747
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DOI: https://doi.org/10.1007/BF00365747