Some Epilepsy Drugs May Raise Parkinson Disease Risk

Some antiepileptic drugs (AEDs) are associated with an increased risk of developing Parkinson disease, according to findings from a nested case-control study published in JAMA Neurology.

“To the best of our knowledge, this is the first observational study to investigate a range of AEDs and their association with incident [Parkinson disease],” said Daniel Belete, MBChB, Preventive Neurology Unity, Queen Mary University of London, and co-authors. “As such, it sets the scene and highlights the need for further work to corroborate our findings in other large data sets because these findings could have important implications for clinical decision-making.”

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The study included 1422 individuals with a Hospital Episode Statistics (HES)-coded Parkinson disease diagnosis and 8598 matched controls. Both groups were sourced from the UK Biobank, and exposure to AEDs (carbamazepine, lamotrigine, levetiracetam, and sodium valproate) was determined using prescription data routinely collected during primary care. Odds ratios and 95% CIs were calculated using adjusted logistic regression models for individuals prescribed AEDs before the first date of HES-coded diagnosis of Parkinson disease.

Overall, the odds ratio (OR) for Parkinson disease diagnosis following prescription of any of the AEDs under study was 1.80 (95% CI, 1.35-2.40). Odds of Parkinson disease diagnosis were higher for those who were prescribed more than 1 AED and had higher numbers of AED issues.

Odds ratios varied for each AED under examination. The OR for Parkinson disease following carbamazepine treatment was 1.43 (95% CI, 0.97-2.11); following lamotrigine treatment was 2.83 (95% CI, 1.53-5.25); following levetiracetam treatment was 3.02 (95% CI, 1.51-6.05), and following sodium valproate treatment was 3.82 (2.41-6.05).

The authors noted that while it is possible that AEDs are actually associated with drug-induced parkinsonism that has been misdiagnosed as idiopathic Parkinson disease, they took measures to reduce the risk of misclassification, including using strict definitions of incident Parkinson disease. They also excluded AED prescriptions within 1, 2, and 5 years of Parkinson disease diagnosis rate.

Reference

Belete D, Jacobs BM, Simonet C, et al. Association between antiepileptic drugs and incident Parkinson disease in the UK Biobank. JAMA Neurol. Published online December 27, 2022. doi:10.1001/jamaneurol.2022.4699