Study On The Peripheral Vestibular Function Of Epilepsy Patients And Influence Of AEDs

Background: Epilepsy is a common chronic brain disease,most patients need to take at least one Antiepileptic Drugs(AEDs)for a long time,which can lead to vestibular dysfunction,and the main symptoms include dizziness/vertigo,ataxia,imbalance,nystagmus,etc.Vestibular toxicity symptoms have been confirmed to be more common in patients with drug intoxication or drug polytherapy.The common ones are Carbamazepine(CBZ),Valproate(VPA),Oxcarbazepine(OXC),Lamotrigine(LTG),Levetiracetam(LEV)etc.The Velocity Step Test(VST),as a methodology for assessing peripheral vestibular function by measuring the slow-phase velocity(SPV)and Canal Paralysis(CP)values of nystagmus,either CP or SPV abnormal indicates a VST abnormal.At present,there is no report on peripheral vestibular function in epilepsy patients by this method.Objective: To evaluate peripheral vestibular function and the effect of antiepileptic drugs in epilepsy patients with VST.Methods: Epilepsy patients who met the criteria for inclusion and exclusion were compared with healthy subjects for DHI score and VST examination,and the statistical comparison analysis between groups was carried out according to the following solutions: 1)According to the medication plan,the epilepsy patients were divided into no medication group,monotherapy group and multiple groups.The differences in DHI scores,VST abnormal rate,CP value,and SPV abnormal rate were compared between each group and the control group.2)The monotherapy group was further divided into VPA,OXC,LEV,LTG,and CBZ subgroups,and the differences in VST measurement values among different single drugs were compared;3)According to the mechanism of drug action,it could be divided into membrane stabilizer group,SV2 A conjugate group,multiple mechanisms group,compare the difference of VST measurement value;Results:1.DHI: The total score,physical,emotional and functional scores of drug monotherapy and polytherapy group were higher than those of healthy control group.There was no significant difference between the control group and the untreated group.2.VST results:(1)There was significant difference in the abnormal rate of VST results between the monotherapy drug group,polytherapy group,non-drug group and the control group(P=0.021),and the monotherapy drug group was the highest(more than 45%).(2)There was no statistical difference in the abnormal rate of VST among the five drug subgroups.(3)Comparison of different drug mechanisms: The abnormal rates of VST results in both the multiple mechanisms group and the membrane stabilizer group were more than 50%,which was significantly higher than that in the SV2 A group(P=0.039).3.CP value result:(1)There was statistical difference in the asymmetry rate among the four groups(P=0.023),and the CP value in the monotherapy drug group was significantly higher than that in the control group(P=0.011)and the non-drug group(P=0.007).The single drug group had the highest incidence of asymmetry,more than 40%;(2)There were differences in abnormal rates of CP values greater than 20% in the five drug subgroups,and 18.7% in the LEV group was significantly lower than that in the other drug subgroups(P=0.044).(3)Comparison of different drug mechanisms: CP values of multiple mechanism group,SV2 A group and membrane stabilizer group showed no significant difference4.SPV results:(1)There was no statistical difference in the abnormal rate of SPV among the four groups.(2)There were significant differences in low SPV rates among the five monotherapy subgroups(P=0.004): nearly half of the VPA group had abnormal SPV,which was significantly higher than the other groups(P=0.001).(3)Comparison of different mechanisms of action:there were significant differences in the low rate of SPV among the three groups,and the SV2 A group was significantly lower than the membrane stabilizer group and the multiple mechanisms group(P=0.001).Conclusions: This study indicates that antiepileptic drugs could cause different degrees of peripheral vestibular dysfunction,and there are certain differences in the effects of different drug regimen on peripheral vestibular function.VST can be used as an early detection method for subclinical vestibular dysfunction in patients with epilepsy.