Sunday, 22 April 2012

Epilepsy and Dupuytren's - A real link?

Ever since I first found out about Ledderhose I have heard about the link between it and epilepsy or at least Ledderhose and epilepsy medication and that is exactly what I am going to cover today. 


So where to start, well as always there is information out there on the link between Dupuytren's and the above things but nothing at all to discuss Ledderhose and epilepsy unless it covers both which is where I'll start. 


(1) Coral et al, 1999, Dupuytren's and Ledderhose's diseases associated with chronic use of anticonvulsants. Case report


Ok so it is where I would start if I could access this article and if it was not in a foreign language. Still I can use this paper to set the scene as from the abstract I can tell that it is about an individual that was taking medication for epilepsy which had not been diagnosed and then developed Dupuytren's and Ledderhose. Sure this case by itself is not a concrete case as it is one person and you can't do stats on n=1. 


(2) Arafa et al, 1992, Dupuytren's and epilepsy revisited. 


So in this paper they are looking in epilepsy centres to see if there is an increased level of Dupuytren's cases, again I would say that their evidence doesn't fully support the case. They are looking at 2 different centre, in one they seen a normal level of Dupuytren's at around 15% (normal compared to control group) and in the other they actually see a huge increase to close to 40% incidence of Dupuytren's. Although I say they cannot say for sure that there is an increase they do say that the levels of contracture and the progress of the disease is noticeably quicker which suggests that the there is something to this link. Whether it is that the drugs cause an increase in the factors that cause disease progression or what is unclear but is there this link is the main question. 


(3) Critchley et al, 1976, Dupuytren's disease in epilepsy: result of prolonged administration of anticonvulsants. (Free access) 


In this study they are again looking in epilepsy centres and this time see an incidence of 56%. They also say that these nodules were bilateral and often associated with knuckle pads and Ledderhose. They actually go so far as to try and explain it and say that there is an increased level with length of time on medication (I am assuming above the increased link with increased age) and that they think that the medication alters the level of growth hormones in peripheral tissue this is linked to Dupuytren's. 


I actually can't find much more information that what I have discussed above, certainly all three studies suggest that there is something to this link and I see why specialists add this to the list of checks they make when coming across Dupuytren's and Ledderhose patients. It would be nice if a new and fresh study could be done to prove this link and who knows maybe there is one out there that I have missed or there is one being done. Be sure to let me know if you know of anything.