Serum folate deficiency in children receiving anticonvulsant therapy.

The occurrence of megaloblastic anemia is not uncommon in adults receiving anticonvulsant therapy, but it rarely occurs in childhood. Macrocytosis and subnormal serum folate have been reported in many adults receiving anticonvulsant therapy. Hematologic studies including assays of serum folic acid were performed in 37 epileptic children receiving various anticonvulsant regimens and 20 healthy children. Values for hemoglobin, hematocrit, red cell count, red cell indices, and Arneth (polymorphonuclear lobe) counts were not significantly different in the two groups. Serum folate levels were significantly lower in the childiren receiving anticonvulsant drugs-mean 6.4 ± 4.8 mµg/ml compared to 12.7 ± 5.1 mµg/ml in the controls. Subnormal folate levels were found in 51% of epileptic children and slight macrocytosis was found in 19%, all of whom had subnormal folate levels. None were anemic. There was no correlation between the Serum folate level and either the age of the patient or the duration of anticonvulsant therapy. Although the exact etiology of subnormal folate levels is unknown, anticonvulsant drug-induced folate deficiency may be necessary for adequate seizure control.