J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 10, Number 2, February 2018, pages 137-145

Impact of Oxidative Stress and Newer Antiepileptic Drugs on the Albumin and Cortisol Value in Severe Motor and Intellectual Disabilities With Epilepsy

Figure 1. Relations of albumin level and the cortisol level. There was no significant correlation between albumin value and cortisol value in old AED group (r = -0.195, P = 0.39) (a). For the newer AED group, a significant correlation was found between the albumin value and the cortisol value (r = -0.641, P < 0.01) (b).

**Table 1.** Measurement Evaluation Standard Value of d-ROMs Test
Evaluation	Standard value	Unit
*1 U.CARR = 0.08 mg/100 mL H₂O₂.
d-ROMs test		*U.CARR
Normal range	250 - 300
Border range	301 - 320
Low-level oxidative stress	321 - 340
Intermediate level oxidative stress	341 - 400
High-level oxidative stress	401 - 500
Very high-level oxidative stress	> 500
BAP test		µmol/L
Normal range	< 2,200
Border range	2,000 - 2,200
Slight lack state	1,800 - 1,999
Lack state	1,600 - 1,799
Severe lack state	1,400 - 1,599
Very severe lack state	< 1,400

Table 1. Measurement Evaluation Standard Value of d-ROMs Test

Evaluation

Standard value

Unit

*1 U.CARR = 0.08 mg/100 mL H₂O₂.

d-ROMs test

*U.CARR

Normal range

250 - 300

Border range

301 - 320

Low-level oxidative stress

321 - 340

Intermediate level oxidative stress

341 - 400

High-level oxidative stress

401 - 500

Very high-level oxidative stress

> 500

BAP test

µmol/L

Normal range

< 2,200

Border range

2,000 - 2,200

Slight lack state

1,800 - 1,999

Lack state

1,600 - 1,799

Severe lack state

1,400 - 1,599

Very severe lack state

< 1,400

**Table 2.** Background of the Patients
	Newer AED addition group (n = 23)	Old AED alone group (n = 21)
*Hypertension, diabetes, hyperlipidemia, kidney disease, infectious disease. ^†There is overlap in a value.
Sex
Male	16 (69.6%)	14 (66.7%)
Female	7 (30.4%)	7 (33.3%)
Age (years)
Average ± standard deviation	26.5 ± 7.3	29.8 ± 8.3
Maximum	39	45
Minimum	10	12
Median	27.0	30.0
Main disease
Cerebral palsy	9 (39.1%)	14 (66.7%)
Hypoxia encephalopathic aftereffects	3 (13.0%)	2 (9.5%)
Epileptic encephalopathy aftereffects	3 (13.0%)	0
Cerebral hemorrhage aftereffects	2 (8.7%)	0
Lissencephaly	2 (8.7%)	0
CFC syndrome	0	2 (9.5%)
Meningitis aftereffects	1 (4.3%)	0
Dentatorubral-pallidoluysian atrophy (DRPLA)	1 (4.3%)	0
Acute encephalopathic aftereffects	1 (4.3%)	0
Theophylline encephalopathic aftereffects	1 (4.3%)	0
Arthrogryposis	0	1 (4.8%)
Schizencephaly	0	1 (4.8%)
Psychomotor retardation	0	1 (4.8%)
Renal damage
Available	0	0
None	23	21
Liver damage
Available	0	0
None	23	21
Comorbidities*
Available	0	0
None	23	21
Use of AED^†
Valproate sodium (VPA)	19 (24.1%)	15 (40.5%)
Phenytoin (PHT)	6 (7.6%)	6 (16.2%)
Phenobarbital (PB)	6 (7.6%)	5 (13.5%)
Clonazepam (CZP)	6 (7.6%)	0
Carbamazepine (CBZ)	4 (7.7%)	6 (16.2%)
Zonisamide (ZNS)	4 (5.1%)	1 (2.7%)
Clobazam (CLB)	3 (3.8%)	2 (5.4%)
Ethosuximide (ESM)	2 (2.5%)	1 (2.7%)
Others	3 (3.8%)	1 (2.7%)
Lamotrigine (LTG)	11 (13.9%)	0
Levetiracetam (LEV)	15 (19.0%)	0

Table 2. Background of the Patients

Newer AED addition group (n = 23)

Old AED alone group (n = 21)

*Hypertension, diabetes, hyperlipidemia, kidney disease, infectious disease. ^†There is overlap in a value.

Sex

Male

16 (69.6%)

14 (66.7%)

Female

7 (30.4%)

7 (33.3%)

Age (years)

Average ± standard deviation

26.5 ± 7.3

29.8 ± 8.3

Maximum

Minimum

Median

27.0

30.0

Main disease

Cerebral palsy

9 (39.1%)

14 (66.7%)

Hypoxia encephalopathic aftereffects

3 (13.0%)

2 (9.5%)

Epileptic encephalopathy aftereffects

3 (13.0%)

Cerebral hemorrhage aftereffects

2 (8.7%)

Lissencephaly

2 (8.7%)

CFC syndrome

2 (9.5%)

Meningitis aftereffects

1 (4.3%)

Dentatorubral-pallidoluysian atrophy (DRPLA)

1 (4.3%)

Acute encephalopathic aftereffects

1 (4.3%)

Theophylline encephalopathic aftereffects

1 (4.3%)

Arthrogryposis

1 (4.8%)

Schizencephaly

1 (4.8%)

Psychomotor retardation

1 (4.8%)

Renal damage

Available

None

Liver damage

Available

None

Comorbidities*

Available

None

Use of AED^†

Valproate sodium (VPA)

19 (24.1%)

15 (40.5%)

Phenytoin (PHT)

6 (7.6%)

6 (16.2%)

Phenobarbital (PB)

6 (7.6%)

5 (13.5%)

Clonazepam (CZP)

6 (7.6%)

Carbamazepine (CBZ)

4 (7.7%)

6 (16.2%)

Zonisamide (ZNS)

4 (5.1%)

1 (2.7%)

Clobazam (CLB)

3 (3.8%)

2 (5.4%)

Ethosuximide (ESM)

2 (2.5%)

1 (2.7%)

Others

3 (3.8%)

1 (2.7%)

Lamotrigine (LTG)

11 (13.9%)

Levetiracetam (LEV)

15 (19.0%)

**Table 3.** Blood Test Results (Newer AED Addition Group) (n = 23)
	Unit	Measurement point 1	Measurement point 2	P value
Measurement point 1: approximately 1 week ago when newer AED was added. Measurement point 2: it is approximately 1 year later from point 1. Wilcoxon signed-rank test was used for statistical analysis.
d-ROMs value	U.CARR	415.7 ± 75.1	376.1 ± 92.5	< 0.05
BAP value	µmol/L	2,282.1 ± 210.4	2,378.7 ± 221.	< 0.05
Albumin (Alb)	g/dL	3.79 ± 0.38	4.05 ± 0.37	< 0.05
Aspartate aminotransferase (AST)	U/L	19.3 ± 6.3	19.5 ± 6.7	0.97
Alanine aminotransferase (ALT)	U/L	17.3 ± 7.2	19.3 ± 14.2	0.69
Blood urea nitrogen (BUN)	mg/dL	9.3 ± 3.9	9.9 ± 3.5	0.58
Serum creatinine (Scr)	mg/dL	0.36 ± 0.09	0.36 ± 0.10	0.49
Sodium ion (Na)	mEq/L	138.7 ± 4.0	138.4 ± 3.0	0.49
Chloride ion (Cl)	mEq/L	99.4 ± 5.2	98.6 ± 5.0	0.14
Red blood cell (RBC)	10⁴/µL	440.9 ± 48.9	443.2 ± 39.2	0.08
Hemoglobin (Hb)	g/dL	12.9 ± 1.8	13.5 ± 1.1	0.06
Hematocrit (Hct)	%	40.1 ± 4.5	40.6 ± 4.6	0.21
White blood cell (WBC)	10²/µL	73.0 ± 18.1	75.3 ± 18.0	0.49
Platelet (PLT)	10⁴/µL	25.7 ± 8.2	23.5 ±7.5	0.33

Table 3. Blood Test Results (Newer AED Addition Group) (n = 23)

Unit

Measurement point 1

Measurement point 2

P value

Measurement point 1: approximately 1 week ago when newer AED was added. Measurement point 2: it is approximately 1 year later from point 1. Wilcoxon signed-rank test was used for statistical analysis.

d-ROMs value

U.CARR

415.7 ± 75.1

376.1 ± 92.5

< 0.05

BAP value

µmol/L

2,282.1 ± 210.4

2,378.7 ± 221.

< 0.05

Albumin (Alb)

g/dL

3.79 ± 0.38

4.05 ± 0.37

< 0.05

Aspartate aminotransferase (AST)

U/L

19.3 ± 6.3

19.5 ± 6.7

0.97

Alanine aminotransferase (ALT)

U/L

17.3 ± 7.2

19.3 ± 14.2

0.69

Blood urea nitrogen (BUN)

mg/dL

9.3 ± 3.9

9.9 ± 3.5

0.58

Serum creatinine (Scr)

mg/dL

0.36 ± 0.09

0.36 ± 0.10

0.49

Sodium ion (Na)

mEq/L

138.7 ± 4.0

138.4 ± 3.0

0.49

Chloride ion (Cl)

mEq/L

99.4 ± 5.2

98.6 ± 5.0

0.14

Red blood cell (RBC)

10⁴/µL

440.9 ± 48.9

443.2 ± 39.2

0.08

Hemoglobin (Hb)

g/dL

12.9 ± 1.8

13.5 ± 1.1

0.06

Hematocrit (Hct)

40.1 ± 4.5

40.6 ± 4.6

0.21

White blood cell (WBC)

10²/µL

73.0 ± 18.1

75.3 ± 18.0

0.49

Platelet (PLT)

10⁴/µL

25.7 ± 8.2

23.5 ±7.5

0.33

**Table 4.** Blood Test Results (Old AED Addition Group) (n = 21)
	Unit	Measurement point 1	Measurement point 2	P value
Measurement point 1: point of periodical drawing blood from April 2015 to September. Measurement point 2: it is approximately 1 year later from point 1. Wilcoxon signed-rank test was used for statistical analysis.
d-ROMs value	U.CARR	366.2 ± 86.7	385.0 ± 92.5	< 0.05
BAP value	µmol/L	2,336.6 ± 221.0	2,276.3 ± 165.4	0.14
Albumin (Alb)	g/dL	3.91 ± 0.45	3.89 ± 0.44	0.52
Aspartate aminotransferase (AST)	U/L	17.7 ± 8.1	20.2 ± 7.8	0.06
Alanine aminotransferase (ALT)	U/L	16.6 ± 11.2	16.0 ± 8.2	0.54
Blood urea nitrogen (BUN)	mg/dL	10.5 ± 3.8	10.5 ± 3.9	0.49
Serum creatinine (Scr)	mg/dL	0.39 ± 0.15	0.39 ± 0.14	0.83
Sodium ion (Na)	mEq/L	137.9 ± 4.2	138.2 ± 3.8	0.32
Chloride ion (Cl)	mEq/L	100.1 ± 4.0	100.2 ± 4.2	0.71
Red blood cell (RBC)	10⁴/µL	423.1 ± 44.6	423.9 ± 42.6	0.60
Hemoglobin (Hb)	g/dL	12.9 ± 1.4	12.1 ± 2.5	0.30
Hematocrit (Hct)	%	39.2 ± 3.7	38.7 ± 4.2	0.97
White blood cell (WBC)	10²/µL	67.0 ± 23.8	64.6 ±17.5	0.62
Platelet (PLT)	10⁴/µL	22.9 ± 9.9	22.7 ± 7.6	0.98

Table 4. Blood Test Results (Old AED Addition Group) (n = 21)

Unit

Measurement point 1

Measurement point 2

P value

Measurement point 1: point of periodical drawing blood from April 2015 to September. Measurement point 2: it is approximately 1 year later from point 1. Wilcoxon signed-rank test was used for statistical analysis.

d-ROMs value

U.CARR

366.2 ± 86.7

385.0 ± 92.5

< 0.05

BAP value

µmol/L

2,336.6 ± 221.0

2,276.3 ± 165.4

0.14

Albumin (Alb)

g/dL

3.91 ± 0.45

3.89 ± 0.44

0.52

Aspartate aminotransferase (AST)

U/L

17.7 ± 8.1

20.2 ± 7.8

0.06

Alanine aminotransferase (ALT)

U/L

16.6 ± 11.2

16.0 ± 8.2

0.54

Blood urea nitrogen (BUN)

mg/dL

10.5 ± 3.8

10.5 ± 3.9

0.49

Serum creatinine (Scr)

mg/dL

0.39 ± 0.15

0.39 ± 0.14

0.83

Sodium ion (Na)

mEq/L

137.9 ± 4.2

138.2 ± 3.8

0.32

Chloride ion (Cl)

mEq/L

100.1 ± 4.0

100.2 ± 4.2

0.71

Red blood cell (RBC)

10⁴/µL

423.1 ± 44.6

423.9 ± 42.6

0.60

Hemoglobin (Hb)

g/dL

12.9 ± 1.4

12.1 ± 2.5

0.30

Hematocrit (Hct)

39.2 ± 3.7

38.7 ± 4.2

0.97

White blood cell (WBC)

10²/µL

67.0 ± 23.8

64.6 ±17.5

0.62

Platelet (PLT)

10⁴/µL

22.9 ± 9.9

22.7 ± 7.6

0.98