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World J Virol. Nov 25, 2022; 11(6): 467-476
Published online Nov 25, 2022. doi: 10.5501/wjv.v11.i6.467
Potential risk of liver injury in epileptic patients during COVID-19 pandemic
Nasim Tabrizi, Athena Sharifi-Razavi
Nasim Tabrizi, Athena Sharifi-Razavi, Department of Neurology, Mazandaran University of Medical Sciences, Sari 4815838477, Iran
Author contributions: Sharifi-Razavi A designed the outline, coordinated the writing of the paper and wrote first draft of manuscript; Tabrizi N searched the literature, revised first draft and wrote final manuscript.
Conflict-of-interest statement: Nasim Tabrizi and Athena Sharifi-Razavi are faculty member of Mazandaran University of Medical Sciences.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Athena Sharifi-Razavi, MD, Assistant Professor, Department of Neurology, Mazandaran University of Medical Sciences, Bou Ali Sina Hospital, Pasdaran Boulevard, Sari 4815838477, Iran. athena.sharifi@yahoo.com
Received: September 13, 2022
Peer-review started: September 13, 2022
First decision: September 29, 2022
Revised: October 8, 2022
Accepted: October 27, 2022
Article in press: October 27, 2022
Published online: November 25, 2022
Processing time: 70 Days and 18.6 Hours
Abstract

Most of the antiseizure medications (ASMs) are metabolized in liver and many of them particularly first-generation ASMs have the potential to increase liver enzymes or induce liver injury. Hence, treatment of new onset seizures or epilepsy by ASMs during the course of coronavirus disease 2019 (COVID-19), which could potentially be complicated by hepatic dysfunction, is a challenging clinical issue. Intravenous form of levetiracetam which has no significant hepatic metabolism or drug-drug interaction is often a favorable option to control seizures in acute phase of COVID-19. Administration of enzyme inducer ASMs and valproate with the well-known hepatotoxicity and common drug interactions is not generally recommended. In patients with epilepsy who are under control with potentially hepatotoxic ASMs, close observation and cautious dose reduction or drug switch should be considered if any evidence of hepatic impairment exists. However, risks of possible breakthrough seizures should be weighed against benefits of lowering the hazard of liver injury. In patients with epilepsy who receive polytherapy with ASMs, transient dose modification with the tendency to increase the dose of ASMs with more favorable safety profile and less drug interaction and decrease the dose of drugs with main hepatic metabolism, high protein binding, potential to cause liver injury and known drug-drug reaction should be considered. Finally, decision making should be individualized based on patients’ conditions and course of illness.

Keywords: COVID-19; Epilepsy; Seizure; Drug induced liver injury; Corona virus; Hepatic failure

Core Tip: Most of antiseizure medications (ASMs) are metabolized in liver and many of them particularly first-generation ASMs have the potential to increase liver enzymes or induce liver injury. Hence, treatment of new onset seizures or epilepsy by ASMs during the course of coronavirus disease 2019 (COVID-19), which could potentially be complicated by hepatic dysfunction, is a challenging clinical issue. In this review, we aimed to discuss the potential risks of liver injury in patients with COVID-19 who are under treatment for epilepsy or need to receive ASMs to subside acute symptomatic seizures.