Antiepileptic drugs, hyperhomocysteinemia and B-vitamins supplementation in patients with epilepsy.

Homocysteine (Hcy) is a sulfur-containing, nonprotein amino acid reversibly formed and secreted during metabolism of methionine. Elevated total Hcy levels (hyper-tHcy) have been associated with cardiovascular disease in multiple large-scale epidemiologic studies and, in particular, patients with epilepsy exhibit elevated plasma tHcy levels more frequently than the general population caused by polymorphisms in the MTHFR gene and chronic treatment with older antiepileptic drugs. Folic acid alone or folic acid combined with other B-vitamins have all been shown to reduce tHcy concentration in patients on chronic treatment with antiepileptic drugs, however, which is the most appropriate supplementation scheme of folic acid and/or B-vitamins in patients with epilepsy still remains matter of debate. We review the latest findings on the role of supra-physiological tHcy concentrations as vascular risk factor in patients with epilepsy and discuss the possible role played by folate and other B-vitamins supplementation in epileptic patient with hyper-tHcy.