Meta-analysis of the Relationship Between Plasma Homocysteine Levels and Carbamazepine Monotherapy in Epileptic Patients

OBJECTIVE To evaluate the relationship between carbamazepine(CBZ) monotherapy and plasma homocysteine(Hcy) levels in epileptic patients. METHODS Articles concerning the homocysteine levels in carbamazepine monotherapy patients with epilepsy and published from building a database to March 2016 through VIP, Wanfang, CNKI, Cochrance Library, PubMed, Web of Science, EMBASE by searching the key words of carbamazepine, homocysteine, epilepsy and epilep*. The quality of controlled clinical trials (CCT) found in the study was assessed by the Newcastle-Ottawa scale(NOS), the relevant data of included studies were performed through RevMan 5.2 software.RESULTS A total of 22 eligible studies were enrolled in this meta-analysis, including 9 Chinese literature and 13 English literature. The study included a total of 1 604 cases, including 575 cases of patient group and normal control group 1 029 cases. Results of meta-analysis showed that plasma homocysteine levels in CBZ treated patients with epilepsy were higher than healthy control group SMD=1.55, 95% CI: 1.09, 2.01, P<0.000 01, there was significant heterogeneity in the estimates according to I² test (P<0.000 01; I²=93%). Futher subgroup analysis showed that no significant difference was present when grouped by regional and age, but the risk of heterogeneity in West Asian group(I²=58%, P=0.07) was diminished when compared with overall groups (I²=93%, P<0.000 01). The result of sensitivity analysis by Stata 12.0 showed good stability. Using the funnel plot method, Begg method for meta-analysis to detect publication bias, the results showed substantially symmetrical funnel plot, Pr>|Z|=0.091>0.05 (no statistical significance), suggesting that the study there was no significant publication bias. Loss factor of safety (Nfs) 0.05 equaled 7 269.16 (P=0.05), required the addition of about 7 269 negative results of the study in order to overthrow the conclusions of this study. CONCLUSION Carbamazepine monotherapy presence on the metabolism of plasma homocysteine in patients with epilepsy, the seizures significantly rise plasma homocysteine levels, appropriate to add folic acid, vitamin B₁₂ and vitamin B₆ to reduce homocysteine may be beneficial for patients with epilepsy taking carbamazepine.