Antiepileptics pharmacotherapy or antidiabetics may hold potential in ‎treatment of ‎‎epileptic ‎patients with diabetes mellitus: A narrative review

Several studies have reported the association of diabetes mellitus with epilepsy. With respect to ‎the management of diabetes–epilepsy patients, these studies pointed out the beneficial effects of ‎the ketogenic diet. Ketogenic diets may have antiepileptic properties as the utilization of ketone ‎bodies in the brain instead of glucose delays or inhibits the degradation of γ-aminobutyric acid ‎‎(GABA) transaminase, and thereby enhances the concentration of GABA. By restoring normal ‎intracerebral GABA levels and reducing the cerebral inflammation linked to epilepsy, metformin ‎is useful in preventing seizures. Sitagliptin is one of the dipeptidyl dipeptidase-4 inhibitors, ‎which have a positive impact on epilepsy in experimental animal models with pentylenetetrazole-‎induced seizures, by reducing reactive oxygen species, (antioxidant effect), normalization of ‎GABA level, suppression of neuroinflammation (autophagy) and reduced neuronal damage ‎‎(antiapoptotic effect). Weight gain is a well-known side effect of anti-seizure medications. ‎Sodium valproate can cause dyslipidemia and inhibit glucose transporter-1 in the brain, putting ‎patients with epilepsy and diabetes at risk of developing atherosclerosis. It's worth looking at ‎how ferroptosis and autophagy contribute to the etiology of diabetes and epilepsy, as well as ‎how antiepileptics and antidiabetics alter these pathological processes. Therefore, it was worth ‎performing a narrative-review on the effects of antiepileptics on diabetes, the effect of ‎antidiabetics on epilepsy, as well the net results of antiepileptic–antidiabetic interactions in those ‎patients.‎