Effects of three-months folate supplementation on early vascular abnormalities in hyperhomocysteinemic patients with epilepsy

•Patients on long term anti-seizure medication (ASM) develop higher homocysteinemia levels and marked alterations of vascular properties.•Folic acid supplementation reduced carotid Intima-Media-Thickness and improved Flow Mediated Dilation, distensibility coefficient, and Beta stiffness.•MMP-9 and TIMP-1 were significantly higher in hyperhomocysteinemic people with epilepsy in respect to controls, and their values significantly reduced after folic acid supplementation.•Patients treated with a single enzyme-inducing ASM showed worse vascular parameters in respect to those treated with not enzyme-inducing ASM.•An adequate correction of homocysteinemia levels through folate supplementation should be considered to improve the cardiovascular burden, preferring not enzyme-inducing ASM in high-risk patients.