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Vitamin D Status in Children on Anticonvulsant Therapy

Madhava Vijayakumar1, Ajitha Bk2, Biju George3

  • 1Department of Pediatrics, Government Medical College, Manjeri, Kerala, India.

Indian Journal of Pediatrics
|July 28, 2021
PubMed

Insights

Children on long-term anticonvulsants frequently experience vitamin D deficiency, particularly those with cerebral palsy. The hot, dry season in Kerala offers some protection against this deficiency.

Area of Science:

  • Pediatric Endocrinology
  • Neurology
  • Nutritional Science

Background:

  • Anticonvulsant therapies are widely used in children for epilepsy management.
  • Long-term use of certain anticonvulsants is associated with altered vitamin D metabolism.
  • Limited data exists on vitamin D status in children using newer anticonvulsants like levetiracetam.

Purpose of the Study:

  • To evaluate vitamin D status in children receiving long-term anticonvulsant treatment.
  • To identify risk factors associated with vitamin D deficiency in this pediatric population.
  • To specifically assess children on levetiracetam, a commonly used anticonvulsant.

Main Methods:

  • A comparative study design involving children on antiepileptic drugs (n=269) and healthy controls (n=295).
  • Assessment of serum biochemistry, 25-hydroxyvitamin D (25OHD), parathormone (PTH), calcium, and phosphorous levels.
  • Evaluation of dietary intake, sun exposure, and season of sampling.

Main Results:

  • Children on anticonvulsants exhibited significantly lower serum 25OHD levels and higher prevalence of vitamin D deficiency and insufficiency compared to controls.
  • Cases showed lower serum calcium and phosphorous, and elevated PTH and alkaline phosphatase.
  • Vitamin D deficiency was notably higher in children with cerebral palsy (CP).
  • No significant difference in 25OHD levels was observed based on anticonvulsant type (cytochrome P450 inducers/non-inducers, carbamazepine, valproate, levetiracetam).
  • Independent risk factors for vitamin D deficiency included anticonvulsant use, presence of CP, and season.

Conclusions:

  • Vitamin D deficiency is a common complication of long-term anticonvulsant therapy in children.
  • Children with cerebral palsy are at a particularly high risk for vitamin D deficiency.
  • The hot, dry season in Kerala (March-May) appears to be protective against vitamin D deficiency.
Abstract

Keywords:
25 hydroxyvitamin DAntiepileptic drugCerebral palsyEpilepsyLevetiracetamSodium valproate

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