ABSTRACT. Objective. To examine bone development in children and adolescents who have uncomplicated idiopathic epilepsy and had received monotherapy with carbamazepine or valproic acid for at least 1 year.Methods. Thirty-nine patients from 6 to 19 years of age (18 girls) were studied. Total bone mineral content (BMC) and trabecular volumetric bone mineral density were measured at the distal radius using peripheral quantitative computed tomography. Maximum isometric grip force was determined with a standard dynamometer. Alkaline phosphatase activity and deoxypyridinoline (a marker of bone resorption) were assessed in serum and urine, respectively.Results. Trabecular volumetric bone mineral density was significantly decreased in the entire group (z score mean ؎ standard deviation: ؊0.62 ؎ 1.04) and in the subgroup using valproic acid (؊0.75 ؎ 1.18). In the carbamazepine subgroup, there was a similar but nonsignificant trend (؊0.50 ؎ 0.90). Total BMC and isometric maximum grip force were normal in the entire study population (0.10 ؎ 1.22) and in the 2 subgroups. The relationship between BMC and grip force was similar between patients and healthy participants. Urinary levels of deoxypyridinoline were significantly elevated above normal in the whole study population (1.35 ؎ 2.00) and in both the valproic acid and the carbamazepine subgroups.Conclusion. Bone turnover can be increased, but bone mass is adequate in children and adolescents who have uncomplicated idiopathic epilepsy and who receive monotherapy with carbamazepine or valproic acid. Pediatrics 2001;108(6). URL: http://www.pediatrics.org/ cgi/content/full/108/6/e107; anticonvulsant, bone density, bone mass, bone metabolism, muscle.ABBREVIATIONS. CBZ, carbamazepine; VPA, valproic acid; BMD, bone mineral density; vBMD, volumetric bone mineral density; pQCT, peripheral quantitative computed tomography; BMC, bone mineral content; SD, standard deviation.

The diagnostic accuracy in pediatric neurology has been considerably improved by new methods such as magnetic resonance imaging and molecular genetic analysis. However, standard diagnostic techniques continue to play an important role. The authors analyzed the diagnostic value of electromyography (EMG) and nerve conduction studies (NCS) in a retrospective study of 498 pediatric patients. The overall consistency between EMG results and the final clinical diagnosis in all children examined was 98%. In myogenic diseases, the concordance between EMG and clinical findings was lower (80%), because some patients with congenital myopathies showed normal EMG findings in this group. Peripheral neurogenic diseases were in all but one of the cases diagnosed correctly (99.5%). No decrease in diagnostic reliability was found in the younger age group. EMG and NCS examinations have to be adapted to the needs of children by an experienced examiner, but continue to be valuable diagnostic methods in pediatric neurology.

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