Abstract: Introduction: Long-term antiepileptic drug (AED) therapy is essential in managing chronic epilepsy, but it carries the risk of hepatotoxicity—often presenting as asymptomatic transaminitis. This case report highlights a patient with significant liver enzyme elevation without clinical signs of liver dysfunction.
Case Illustration: Female 19-year-old with a history of epilepsy since the age of 4 years presented to the emergency department with a seizure episode. She had been on long-term polytherapy with levetiracetam (2×500 mg), divalproex sodium (3×500 mg), carbamazepine (3×500 mg), and phenytoin (3×100 mg). Laboratory tests showed elevated SGOT/SGPT levels (413/260 U/L) without any clinical manifestations of liver dysfunction. Viral hepatitis screening was negative, and the elevation was suspected to be related to cumulative hepatotoxic effects of her AED regimen. She was advised to undergo routine liver function monitoring and consider adjusting to less hepatotoxic agents.
Discussion: Asymptomatic transaminitis is a recognized but often under-monitored complication of long-term AED use, particularly in combination therapy. Treatment with lipophilic antiepileptic drugs such as valproic acid, phenytoin, and carbamazepine have high hepatotoxic potential, while newer agents like levetiracetam are more suitable for patients with liver disease. The absence of hepatoviral infection markers in this case supports the suspicion of drug-induced liver injury.
Conclusion: Asymptomatic transaminitis may occur as complication of long-term AED use, particularly in combination regimens. Routine monitoring of liver function is essential in epilepsy patients undergoing chronic therapy to facilitate early detection of hepatotoxicity and prevent serious complications.
Keywords: Antiepileptic drugs, Epilepsy, Hepatotoxicity, Long-term use, Transaminitis.
Title: ASYMPTOMATIC TRANSAMINITIS IN EPILEPSY PATIENT: A HIDDEN RISK OF LONG-TERM ANTIEPILEPTIC DRUG USE
Author: Pertiwi I Gusti Agung Ayu Ary Indah, Astri Asvinia Made, Sumada I Ketut, Yuliani Desie, Jayanthi Ni Made Kurnia Dwi
International Journal of Healthcare Sciences
ISSN 2348-5728 (Online)
Vol. 13, Issue 1, April 2025 - September 2025
Page No: 278-282
Research Publish Journals
Website: www.researchpublish.com
Published Date: 19-June-2025
