Background: The relationship between epilepsy, antiepileptic drugs (AEDs), and microvascular damage is complex and multifaceted. Long-term AED therapy, particularly with enzyme-inducing AEDs, has been implicated in the development of microangiopathy in patients with epilepsy. With this study, we aimed to evaluate the microvascular structure in epilepsy with nailfold videocapillaroscopy (NVC).

Objectives: While AEDs are essential for managing epilepsy, their long-term use can contribute to microvascular damage, highlighting the need for careful monitoring and potential therapeutic adjustments. In this context, our study utilized NVC to assess changes in capillary density and morphology among patients undergoing prolonged AED treatment, aiming to establish a clearer understanding of the potential microvascular implications associated with these medications.

Methods: In this cross-sectional observational study, demographic data, clinical findings, and laboratory characteristics of 36 patients with epilepsy were obtained. The patient group was divided into categories according to the treatments they received. Patients, and 38 healthy peers underwent NVC examination. Capillaroscopy assessments were performed according to the 2020 standardization recommendations by the EULAR SG MC/RD and the Scleroderma Clinical Trials Consortium Group on Capillaroscopy. Capillaroscopy patterns were classified as normal, nonspecific and scleroderma patern according to system provided by EULAR SG MC/RD. The parameters evaluated from images were as follows; capillary morphology, capillary width (apical loop) presence of abnormal capillaries, and capillaroscopic changes (capillary tortuousity, capillary cross, enlarged capillary, giant capillary, and microhemorrhages).

Results: Wider apical loops were detected in children with epilepsy (p=0.007) and the presence of dilated capillaries was more common in the patient group (p=0.02). The capillary density was statistically lower in patients’ group. Mean abnormal capillary (p=0.006) and mean microhemorrhage (p=0.001) values were higher in the epilepsy group. As a normal capillary variation, capillary tortuousity was more common in healthy children (p=0.005). There was a negative correlation between disease duration and mean capillary density; capillary density decreased with increasing disease duration, which may be a marker of microvascular damage (r=-0.343, p=0.04).

Conclusion: In addition to notable capillaroscopic changes, a reduced density was observed in individuals who had experienced epilepsy for an extended period, indicating that NVC serves as an easy and non-invasive method for evaluating early microvascular impairment in epilepsy patients undergoing AED treatment.

REFERENCES: [1] Nai-Ching, Chen., Chih-Hsin, Chen., Tsu-Kung, Lin., Shang-Der, Chen., Meng-Han, Tsai., Chiung-Chih, Chang., Wan-Chen, Tsai., Yao-Chung, Chuang. (2018). Risk of Microangiopathy in Patients with Epilepsy under Long-term Antiepileptic Drug Therapy. Frontiers in Neurology, 9:113-113. doi: 10.3389/FNEUR.2018.00113.

[2] M., Cutolo., Sabrina, Paolino., Vanessa, Smith., Vanessa, Smith. (2019). Nailfold capillaroscopy in rheumatology: ready for the daily use but with care in terminology. Clinical Rheumatology, 38(9):2293-2297. doi: 10.1007/S10067-019-04716-W.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.