Summary:Purpose: To study the markers of bone turnover in epilepsy patients in the different stages of the pubertal growth before and after the beginning of carbamazepine (CBZ) monotherapy.Methods: We have investigated bone turnover in 60 epilepsy patients treated with CBZ. They were stratified according to pubertal stage and compared with a control group of 60 sexand age-matched healthy children.Results: After 2 years of therapy, we found higher values of the serum markers of bone formation [bone alkaline phosphatase (bone ALP), osteocalcin (OC), carboxy-terminal propeptide of type I procollagen (PICP), amino-terminal propeptide of type III procollagen (PIIINP)], and of bone resorption [carboxy-terminal telopeptide of type I collagen (ICTP) and the urinary cross-linked N-telopeptides of type I collagen (NTX)] in patients than in control subjects, in presence of a normal vitamin D metabolism.Conclusions: CBZ induces an increase of bone formation and of bone resorption that seems to be independent of the pubertal stage. Key Words: Bone metabolism-CarbamazepineEpilepsy patients-Vitamin D-Pubertal stage.In recent years, many reports of altered calcium, vitamin D, and bone metabolism associated with anticonvulsant therapy have been published (1-5), but the results of these studies are conflicting. Recently some biochemical markers have been proposed to provide information about the dynamics of bone turnover. In particular, the markers of bone formation are osteocalcin (OC) or bone ␥-carboxyglutamic acid protein, noncollagenous protein of the bone matrix secreted by osteoblasts; circulating peptides of type I collagen, like the carboxy-terminal propeptide of type I procollagen (PICP) (6); and aminoterminal propeptide of type III procollagen (PIIINP), which reflects the rate of collagen type III synthesis (7). Among the markers of bone resorption, there are the serum cross-linked carboxy-terminal telopeptide of type I collagen (ICTP) and the urinary cross-linked N-telopeptides of type I collagen (NTX), which are the degraded products from osteoclastic activity (8). The aims of the study were to evaluate, prospectively, whether and to what extent differences exist in bone metabolism in prepubertal, pubertal, and postpubertal patients receiving CBZ in comparison to healthy controls and to determine the possible relations between these parameters and CBZ dosage and its serum concentration. MATERIALS AND METHODSWe studied 60 children with new onset of idiopathic partial seizures; their age ranged from 6.5 to 19.0 years. These patients were subdivided in three groups according to their pubertal stage: 20 (10 boys and 10 girls) prepubertal children (Ph1G1 and Ph1B1, respectively), 20 (10 boys and 10 girls) pubertal children (Ph2G2-Ph4G4 and Ph2B2-Ph4B4, respectively), and 20 (10 boys and 10 girls) postpubertal children (Ph4G4-Ph5G5 and Ph4B4-Ph5B5, respectively).The stage of sexual development was evaluated according to Tanner classification (9).Patients were recruited from the

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VEGF serum concentrations are increased in prepubertal and pubertal children with diabetes. Glycaemic control influences VEGF serum levels. Severity of microvascular complications is associated with marked increase of VEGF concentrations in the serum of these patients.

Weight gain has been recognized as an adverse effect of valproic acid therapy, but there are are no data about serum leptin levels in patients receiving this drug. To evaluate if valproic acid treatment in epileptic patients in whom obesity develops modifies serum levels of insulin and leptin, 40 female patients with epilepsy were evaluated before therapy and after 1 year of therapy. At the end of follow-up, 15 patients were obese and showed higher serum leptin and insulin levels than patients who did not gain weight. As in other types of obesity, elevation of serum leptin concentrations is related to the increase in body mass index.

The aim of this multicentric, prospective and uncontrolled study was to evaluate the efficacy and safety of levetiracetam in 110 children with refractory epilepsy, of whom 21 were less than 4 years old. After a median follow-up period of 7 months, levetiracetam administration was effective (responders with >50% decrease in seizure frequency) in 39% of children, of whom 10 (9%) became seizure-free. The efficacy was higher in patients with localization-related epilepsy (58% of responders) than in those with generalized epilepsy (37% of responders). Levetiracetam was well tolerated. The main side effects of somnolence and irritability occurred in 14% of patients. In one patient acute choreoathetosis occurred after few doses of levetiracetam. Overall, the adverse effects were not severe. Children younger than 4 years were particularly tolerant. In conclusion, the present study confirms that levetiracetam is effective and well tolerated as an add-on treatment in children with refractory epilepsy. Our preliminary data also indicate that levetiracetam may be a valid therapeutic option for epilepsy in infants and young children.