Hypophosphatemia compared to classical biomarkers of tonic clonic seizures

Barbella, Giuseppina; Barras, Pierre; Rossetti, Andrea O.; Nový, Jan

doi:10.1016/j.eplepsyres.2020.106326

Cited by 9 publications

(3 citation statements)

References 18 publications

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“…Despite numerous hypotheses that have been proposed to explain the cause of bone diseases due to the use of anticonvulsant drugs, the precise mechanism is not known (17) , the current study shows the effects of long term anticonvulsant therapy with different mechanism of action "hepatic enzyme inducer like carbamazepine and inhibitor like Valproate" on bone metabolism and increase the risk of fractures. As there were no statistically significant changes in age, sex, bone biomarkers, and density before starting therapy between treated groups and the control, Apart from the statistically significant difference in the level of phosphorus between the controlled group and the other two groups of epileptic patients before receiving ASM, as this can be explained by several studies reported that phosphate is depleted in those who had a seizure, and some hypothesize that it is a nonspecific marker of seizures (21) . It is well known that low levels of phosphorus can also affect the energy demand needed by the brain, causing various neurological symptoms, such as numbness, weakness, seizures, and coma, in patients with low levels of phosphorus (1.0 mg/dL or less) (22) , and this was also supported by the study done by (Barras et al, 2019) (23) that found most of their convulsion patients had hypophosphatemia.…”

Section: Discussionmentioning

confidence: 85%

Evaluation of Osteoporosis Among Epileptic Patients on Monotherapy

Taha,

Hana Istifo

2024

IJPS

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Epilepsy is a common chronic neurological disorder that affects almost 50 million people worldwide. Most patients require long-term, and sometimes lifelong therapy with antiseizure medications (ASMs), our case control study evaluates the long-term effect of carbamazepine (CBZ) and valproate (VPA) on bone mineral density and bone health biochemical markers. 50 patients with newly diagnosed epilepsy who had no history of antiseizure medications (ASMs) intake prior were divided into 2 groups. In the first group, 25 patients started carbamazepine (CBZ) monotherapy, while the second group included 25 patients who started receiving valproate (VPA) monotherapy. Another 25 healthy individuals were considered as a control group. The primary outcome of our study is to evaluate the percentage of osteoporosis compared to the duration of ASM therapy measured by the T score at two different sites in the body at baseline, after 3 and 6 months of therapy, while measurements of bone biomarker variables are considered secondary outcomes. We found that CBZ and VPA significantly decreased the level of vitamin D3, Ca, P, the L3-L5, and right femoral neck T score with prolonged treatment duration, while the level of ALP increased with increasing duration of treatment in patients treated with CBZ but not in the VPA group. Furthermore, CBZ significantly decreased bone health biomarkers and T score before VPA and the control group, as well as there were no significant differences between the two sexes who received CBZ or VPA therapy on bone biomarkers. In conclusion, valproate will not affect bone biomarkers earlier, but with a longer duration of therapy, they may have the same effect as carbamazepine which requires the prescription of supportive vitamin D and Ca along with ASMs.

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Section: Discussionmentioning

confidence: 85%

Evaluation of Osteoporosis Among Epileptic Patients on Monotherapy

Taha,

Hana Istifo

2024

IJPS

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“…A hipofosfatémia teve uma sensibilidade superior aos níveis sérios elevados de CPK, enquanto os níveis de lactacto não permitiram distinguir CTC de outras causas de alteração do estado de consciência. 12 Ambos os estudos apontam para que a hipofosfatémia será um fenómeno transitório, sublinhando a importância do tempo da colheita de sangue na sua determinação.…”

Section: Discussionunclassified

Hypophosphatemia as Potential Biomarker of Tonic-Clonic Seizures in the Emergency Room

Oliveira,

Pimentel

2024

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Transient alteration of consciousness is common in the emergency department. Tonic-clonic seizures (TCS) are a frequent presumptive diagnosis, but there is no reliable postictal biological marker. We report the case of a 19-year-old man with two episodes of generalized TCS, four months apart. Both were associated with moderate-to-severe hypophosphatemia (0.9 mg/dL, reference range 3.0-4.5 mg/dL). The investigation of phospho-calcium metabolism was negative, and phosphorus levels normalized between the two episodes and after the second TCS. The diagnosis of epilepsy was made based on the occurrence of two unprovoked TCS 24 hours apart. The patient started antiseizure medication after the second TCS and has remained free of seizures (20 months of follow-up). Routine EEG with sleep showed slow temporal activity without epileptiform activity, and the brain magnetic resonance imaging was normal. Changes in serum phosphorus are not usually associated with acute symptomatic seizures. In this case, hypophosphatemia might have been a marker of TC.

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“…Phosphorus is an integral part of adenosine triphosphate (ATP), adenosine monophosphate (AMP), and phospholipid membranes in cell membranes and organelles, making it a crucial piece in the body’s metabolism and function [ 15 ]. Phosphorus has been reported to be found depleted in several studies relating to tonic-clonic seizures, and some hypothesize that it may be a nonspecific marker for seizures [ 16 ]. It has also been shown that low phosphorus levels can be detrimental to the energy demands required by the brain, leading to multiple neurological symptoms such as numbness, weakness, seizures, and coma in patients with exceptionally low phosphorus levels, i.e., 1.0 mg/dL or less [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Seizures, Vitamin D Deficiency, and Severe Hypophosphatemia: The Unique Presentation of a SARS-CoV-2 Case

Yeh

Bell

Anderson

et al. 2023

Cureus

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a virus that belongs to the species severe acute respiratory syndrome-related coronavirus (SARSr-CoV), which is related to the SARS-CoV-1 virus that caused the 2002-2004 SARS outbreak. SARS-CoV-2 causes coronavirus disease 2019 (COVID-19). It has been associated with electrolyte abnormalities. In this report, we discuss the case of a SARS-CoV-2-infected person presenting with recurrent seizure episodes resulting from hypophosphatemia. A 52-year-old male patient with questionable prior seizure history presented to the emergency department (ED) twice within eight days with recurring seizure episodes. While the physical examination at the first presentation was significant for a head laceration with post-ictal confusion, that at the second presentation was only significant for post-ictal confusion. Laboratory examination at the first visit revealed SARS-CoV-2 positivity, hypokalemia, hypophosphatemia, and low vitamin D levels. On the second visit, the patient was again found to have hypophosphatemia. CT of the head and the cervical spine, as well as radiographs of the chest done on the first visit, were all normal. On his first visit, the patient’s electrolyte abnormalities were corrected, and he was discharged with antiepileptic medications after 24 hours of observation and consultation with neurology. However, his vitamin D levels, the results of which came back only after his first discharge, were corrected only during his second visit. This time, he was discharged from the ED and had an effective resolution of symptoms. SARS-CoV-2 infections can result in vitamin D deficiency and hypophosphatemia, resulting in seizures, and hence should be treated with both replacement therapies and antiepileptic medications. This case also highlights the importance of obtaining phosphorus and vitamin D levels in SARS-CoV-2-infected patients with seizures.

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Hypophosphatemia compared to classical biomarkers of tonic clonic seizures

Cited by 9 publications

References 18 publications

Evaluation of Osteoporosis Among Epileptic Patients on Monotherapy

Evaluation of Osteoporosis Among Epileptic Patients on Monotherapy

Hypophosphatemia as Potential Biomarker of Tonic-Clonic Seizures in the Emergency Room

Seizures, Vitamin D Deficiency, and Severe Hypophosphatemia: The Unique Presentation of a SARS-CoV-2 Case

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