Antiepileptic Drugs and Bone Metabolism in Children

Abstract

There are conflicting results concerning bone metabolism in children receiving antiepileptic medication, with data concentrating on neurologically impaired patients. We performed a multicenter cross-sectional study in otherwise healthy children who received monotherapy with valproic acid, oxcarbazepine, lamotrigine, sulthiame, levetiracetam, or topiramate for at least 6 months. Data on calcium, phosphorus, alkaline phosphatase, 25-OH vitamin D, and parathormone were collected. Among 128 patients, 24.4% had hypocalcemia, 25.4% hypophosphatemia, and 13.3% (n = 17) 25-OH vitamin D levels <10 ng/mL. All patients were clinically asymptomatic. Mean calcium concentrations were found to be significantly lower among the study population (2.41 mmol/L) compared with healthy controls (2.53 mmol/L). Lowest mean concentration was observed in patients treated with sulthiame followed by oxcarbazepine and valproic acid. No influence of calcium intake or therapy on bone metabolism was noted. Effects on bone metabolism of anticonvulsive monotherapy are not restricted to neurologically impaired children but also affect otherwise healthy children.

Vitamin D levels in epileptic children on long-term anticonvulsant therapy

“…17,34,36,38,39 These latter studies found this to be the case for non-enzyme-inducing anticonvulsants (valproic acid) use 36,38 or new anticonvulsants (lamotrigine, topiramate, oxcarbazepine, sulthiamine). 17,39 In this study, none of the subjects had vitamin D deficiency, but we found higher prevalence of vitamin D insufficiency in epileptic children (39%) compared to control subjects (13%).…”

“…25,29,31,41 Third, most of our subjects consumed valproic acid which has less impact on reducing vitamin D levels than enzymeinducing anticonvulsants. 25,32,38 Several studies have shown that valproic acid was not associated with vitamin D deficiency. 36,38 Mean daily intake of vitamin D in our study was lower than that recommended by the Institute of Medicine (IOM).…”

“…25,32,38 Several studies have shown that valproic acid was not associated with vitamin D deficiency. 36,38 Mean daily intake of vitamin D in our study was lower than that recommended by the Institute of Medicine (IOM). This might be due to subjects consuming only small amounts of milk and fish (sources of vitamin D), or sub-optimal vitamin D supplementation.…”

Metabolic bone disorders in children with epilepsy

“…Similarly, in a recent study, BMD in pediatric epileptic patients has been found to be decreased by 9%. In particular, 5 patients, all boys, showed levels, although the patients under lamotrigine treatment had normal levels of calcium [20]. Additionally, a study by Lee et al found that lamotrigine treatment didn't affect BMD, vitamin D or calcium levels [5].…”

“…Topiramate, a newer antiepileptic drug, has been associated with decreased levels of BMD [3,13], osteoporosis, hypocalcemia and increased bone turnover [5]. Finally, treatment with sulthiame, a carbonic anhydrase inhibitor, is associated with reduced calcium levels [20].…”