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[Phosphorus-calcium metabolism in children under prolonged treatment with anticonvulsants. (II)]
M J Peña Griñán1, M D Lluch Fernández, M J Montoya García
1Departamento de Pediatría, Hospital Universitario Virgen Macarena, Sevilla.
Insights
Anticonvulsant drugs like phenobarbital and polytherapy significantly reduce 25-Hydroxycholecalciferol levels in children. Alkaline phosphatase increased with phenobarbital, carbamazepine, and polytherapy, impacting phosphocalcium metabolism.
Area of Science:
- Pediatric Endocrinology
- Clinical Biochemistry
- Pharmacology
Background:
- Anticonvulsant drugs are widely used in children for epilepsy management.
- Prolonged use of certain anticonvulsants may affect bone metabolism.
- Phosphocalcium metabolism is crucial for skeletal health in growing children.
Purpose of the Study:
- To compare the effects of different anticonvulsant drugs on phosphocalcium metabolism in children.
- To assess biochemical parameters including 25-Hydroxycholecalciferol, alkaline phosphatase, calcium, parathyroid hormone, and osteocalcin.
- To investigate the influence of treatment duration on these metabolic parameters.
Main Methods:
- Comparative biochemical analysis in 98 children aged 1-14 years.
- Assessment of 25-Hydroxycholecalciferol, alkaline phosphatase, calcium, parathyroid hormone, and osteocalcin levels.
- Group comparisons included phenobarbital, carbamazepine, valproate, polytherapy, and a control group.
Main Results:
- Phenobarbital and polytherapy significantly decreased 25-Hydroxycholecalciferol levels (p=0.0001).
- Alkaline phosphatase was significantly higher in children on phenobarbital, carbamazepine, and polytherapy (p<0.05).
- No significant differences were observed for calcium, parathyroid hormone, or osteocalcin levels across groups or with duration.
Conclusions:
- Phenobarbital and polytherapy demonstrate the most significant impact on 25-Hydroxycholecalciferol levels in pediatric patients.
- Elevated alkaline phosphatase suggests potential bone turnover alterations with certain anticonvulsants.
- Long-term anticonvulsant therapy requires monitoring of vitamin D status and bone metabolism markers.
Abstract:
Comparative assessments were made regarding the effects of prolonged administration of anticonvulsant drugs (phenobarbital, carbamazepine, valproate and polytherapy) on the different biochemical parameters related to phosphocalcium metabolism, in 98 children between 1 and 14 years. The most patent effect was on the levels of 25-Hydroxycholecalciferol which went down significantly (p = 0.0001) in children treated with phenobarbital (34.5 +/- 17 ng/ml) or polytherapy (28.4 +/- 18 ng/ml) in relation to those treated with carbamazepine (49.2 +/- 15 ng/ml) or valproate (43.1 +/- 15 ng/ml) and to control group (45.9 +/- 13 ng/ml). The alkaline phosphatase has been found significantly higher among those treated with phenobarbital, carbamazepine and polytherapy, evidencing significant differences in relation to those treated with valproate and to control group (p less than 0.05). For calcium, parathyroid hormone and osteocalcine levels no differences were found in the different drugs, nor with control group. Depending on the duration of treatment there was a significant reduction (p = 0.02) in the levels of 25-Hydroxycholecalciferol in children treated over 3 years, but no difference for calcium, phosphorous, alkaline phosphatase and PTH under this parameter.