Association Between Antiepileptic Drugs and Incident Parkinson Disease in the UK Biobank

[Sydney75]

I am unable to post full text article, this is the summary with one comment regarding gabapentin. Interestingly my husband takes gabapentin for back/nerve pain. Prior to his diagnosis he was on a a dose about (600mg), taxes (900mg now) max for pain threshold is (2400-3600). Makes me wonder if we cut back will his PD symptoms improve. However, I would think as the science states patient has PD long before symptoms become evident.

-Syd

December 27, 2022

Association Between Antiepileptic Drugs and Incident Parkinson Disease in the UK Biobank

Daniel Belete, MBChB1; Benjamin M. Jacobs, MSc1,2; Cristina Simonet, MD1; et alJonathan P. Bestwick, MSc1; Sheena Waters, PhD1; Charles R. Marshall, PhD1,2; Ruth Dobson, PhD1,2; Alastair J. Noyce, PhD1,2

Author Affiliations

JAMA Neurol. Published online December 27, 2022. doi:10.1001/jamaneurol.2022.4699

Full

Text

Key Points

Question Are antiepileptic drugs (AEDs) associated with increased risk of developing Parkinson disease (PD)?

Findings In this case-control study of 1433 individuals with a Hospital Episode Statistics–coded diagnosis of PD and 8598 controls in the UK Biobank, prescription of an AED was associated with an increased risk of subsequent PD.

Meaning The findings of this study suggest an association between certain AEDs and PD; the relative contribution of epilepsy and AEDs should be further examined in light of these findings.

Abstract

Importance Recent studies have highlighted an association between epilepsy and Parkinson disease (PD). The role of antiepileptic drugs (AEDs) has not been explored.

Objective To investigate the association between AEDs and incident PD.

Design, Setting, and Participants This nested case-control study started collecting data from the UK Biobank (UKB) in 2006, and data were extracted on June 30, 2021. Individuals with linked primary care prescription data were included. Cases were defined as individuals with a Hospital Episode Statistics (HES)–coded diagnosis of PD. Controls were matched 6:1 for age, sex, race and ethnicity, and socioeconomic status. Prescription records were searched for AEDs prescribed prior to diagnosis of PD. The UKB is a longitudinal cohort study with more than 500 000 participants; 45% of individuals in the UKB have linked primary care prescription data. Participants living in the UK aged between 40 and 69 years were recruited to the UKB between 2006 and 2010. All participants with UKB-linked primary care prescription data (n = 222 106) were eligible for enrollment in the study. Individuals with only a self-reported PD diagnosis or missing data for the matching variables were excluded. In total, 1477 individuals were excluded; 49 were excluded due to having only self-reported PD, and 1428 were excluded due to missing data.

Exposures Exposure to AEDs (carbamazepine, lamotrigine, levetiracetam, and sodium valproate) was defined using routinely collected prescription data derived from primary care.

Main Outcomes and Measures Odd ratios and 95% CIs were calculated using adjusted logistic regression models for individuals prescribed AEDs before the first date of HES-coded diagnosis of PD.

Results In this case-control study, there were 1433 individuals with an HES-coded PD diagnosis (cases) and 8598 controls in the analysis. Of the 1433 individuals, 873 (60.9%) were male, 1397 (97.5%) had their race and ethnicity recorded as White, and their median age was 71 years (IQR, 65-75 years). An association was found between AED prescriptions and incident PD (odds ratio, 1.80; 95% CI, 1.35-2.40). There was a trend for a greater number of prescription issues and multiple AEDs being associated with a greater risk of PD.

Conclusions and Relevance This study, the first to systematically look at PD risk in individuals prescribed the most common AEDs, to our knowledge, found evidence of an association between AEDs and incident PD. With the recent literature demonstrating an association between epilepsy and PD, this study provides further insights.

Full Text

Comment

1 Comment for this article

December 28, 2022

Explore Risk For Parkinson Disease (PD) With Antiepileptic Drugs (AEDs) Use Among Non-Epilepsy Patients

Deepak Gupta, MD | Anesthesiology, Wayne State University/Detroit Medical Center

Belete et al. should be commended for their pioneering investigation. However, they may have missed out on an opportunity to expand their investigation into exploring risk for PD with AED use among non-epilepsy patients having chronic pain or bipolar disorder. Gabapentin and pregabalin, which Belete et al. did not include in their investigation, may be often used as analgesics chronically, while carbamazepine and sodium valproate, which Belete et al. included in their investigation, may be often used as mood stabilizers.

[park_bear]

Interesting, but do remember that association is not causation. They named many different drugs. It is possible that one or more is problematic, but it is also possible something about epilepsy is problematic for Parkinson's.

[Sydney75 in reply to park_bear]

Plus PD is happening in brain long before symptoms start. But it makes me wonder if it is important to be on less gabapentin for hwp pain.

[Veravrida]

Hi, I was on gabapentin and fycompa, both AED. I was diagnozed with PD 4 years ago and started with Sinemet 25/100, 300 mg a day and Xadago. Because I have neckpain and very stiff shoulders the neurologist suggested the AED, I should also help me with internal tremor he told me. I felt like a was his guiny pig. It did not help me so I cut down the gabapentin and the fycompa completely and it makes no difference whatsoever for me. My symptoms did not get worse. For the neck and backpain I have electric acupuncture now, this helps me a lot. And I feel that yoga and qigong are also helping. I met this vietnamese lady who is learning me a lot about the holistic way to get better, and bit by bit I do. I prefer taking as less meds as possible and finding the more natural way to deal with mister Parkinson. I hope this is of some use for you.

[Baca]

Hi Sydney, I have found Gabapentin to be a nightmare!

My first neurologist poured on gabapentin until I was taking 3000 mg a day. I hit another car backing out of the driveway. I attempted to go dove hunting with my children and grandkids.

I couldn’t even step over small terrain variations with out loosing my balance.

I fell down in my horse corral opening the gate luckily my horse halted instead of bolting out as usual.

I finally started taking control over my treatment but only after losing a few years of my life thinking doctors know what they are doing better than the patient.

I dropped the dosage step by step until I was only taking 600 mg in the evening to keep my neuropathy from preventing me to sleep.

My advice is to understand your medical issues and the options for treatment, all medications have side effects and interaction with foods and other medication.

Use your God given ability to understand what is good for you and fight to control your life anyway that gives you an edge over your affliction!

I have Parkinson’s Disease but it doesn’t have me. I try to over come all the symptoms individually by concentrating my effort. I do wood carving to engage my fine motor skills. I concentrate on keeping my letters the same size when I write. You can do marvelous things with your mind to stay in control of your life DO NOT GIVE UP!

[Sydney75]

Thank you! They seem to always want to increase gabapentin! Stopped at 900mg it gets a bit crazy when you take other meds. Our movement specialist is not a fan of gabapentin.