Zur H�ufigkeit der Osteopathia antiepileptica beim Erwachsenen in Abh�ngigkeit von Behandlungsdauer und Medikamentendosis

Abstract

Of 837 epileptics over 16 years of age treated with mono- or combined hydantoin therapy 20.3% showed radiographic signs of anticonvulsant osteomalacia. With the exception of the patients with severe disturbances of the skeletal system no positive correlation was found with duration of therapy. The percentage of moderate bone changes was the highest in the patients treated for 1 to 2 years; the percentage of severe bone changes in the group treated over 10 years. The rate of osteomalacia correlated with the total dose of hydantoin, phenobarbital, or primidone; the correlation with the dose per year was even more evident. The risk of osteomalacia rose distinctly with doses over 3000 equivalent units/year. The patients with combined hydantoin-barbiturate treatment showed a higher risk than those treated with phenytoin alone. The rate of osteomalacia was the highest in the patients aged under 20 years and over 50 years. Males showed a relatively higher rate of osteomalacia than females, they were treated however with a higher dose per year. The chemical parameters blood alkaline phosphatase and 25-hydroxycholecalciferol corresponded to the radiographic signs, whereas calcium and anorganic phosphate showed no correlation. Early routine radiologic and chemical control especially of the epileptic patients with high risk of osteomalacia should be routinely performed in future.

Long-term anticonvulsant therapy leads to low bone mineral density — evidence for direct drug effects of phenytoin and carbamazepine on human osteoblast-like cells

“…This is the first study to demonstrate a correlation between duration of therapy with anticonvulsant drugs and BMD using the more precise dual-energy X-ray absorptiometry. Recent studies have used radi ology techniques or single photon absorptiometry at radial sites to assess a relation between duration of antiepileptic therapy and changes in bone structure or BMD (Mehregan et al, 1979;Wolschendorf et al, 1983;Moller et al, 1982). In our study, BMD de creased with the duration of therapy in the lumbar spine as well as in the femoral neck region in both sexes.…”

Dental Root Abnormalities and Gingival Overgrowth in Epileptic Patients Receiving Anticonvulsant Therapy

“…The population studied comprised 46 institutionalized mentally retarded patients with epilepsy; 26 males aged 13 to 40 years (mean 23.5 years) and 20 females aged 14 to 33 years (mean 24.3 years) receiving anticonvulsant therapy (DPH + PB). A control group consisted of 45 nonepileptic mentally retarded patients in the same institution who were not receiving anticonvulsants: 31 males aged 12 to 33 years (mean 21.1 years) and 14 females aged 19…”

9 Nebenwirkungen der Antiepileptika

“…Die Ergebnisse der Knochendichtemessungen bei den Patienten der Heidelberger Antiepileptika-Studie mit unterschiedlicher Behandlungsdauer ohne Nachweis von Unterschieden zwischen den einzelnen Gruppen bestätigen zwar die früher aufgrund radiologischer Befunde aufgestellte Hypothese [182], wonach es bereits in den ersten beiden Jahren der Antiepileptikatherapie zu Veränderungen am Knochen kommt, zeigen aber keine besondere Gefährdung der über 10 Jahre Behandelten, wie es -in allerdings diskreter Ausprägung -bei Zugrundelegung radiologischer Kriterien gesehen worden war [148]. Hiermit stimmt überein, daß in der Heidelberger Antiepileptika-Studie ja auch keine Korrelation zwischen Knochendichte und Therapiedauer gefunden wurde [142] [142].…”