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Rickets in children receiving anticonvulsant drugs. Biochemical and hormonal markers
Insights
Epileptic children on antiepileptic drugs showed mild vitamin D deficiency and altered mineral metabolism. Primidone-treated patients had the lowest levels, suggesting drug-specific effects on nutrient levels.
Area of Science:
- Pediatric Endocrinology
- Clinical Neurology
- Nutritional Biochemistry
Background:
- Epilepsy treatment often involves long-term antiepileptic drug (AED) use.
- Certain AEDs are associated with potential metabolic disturbances, including effects on bone and mineral metabolism.
- Previous studies have indicated a link between AEDs and altered vitamin D and calcium levels in children.
Purpose of the Study:
- To investigate the impact of common AEDs (phenobarbital, phenytoin, primidone) on serum calcium, phosphorus, alkaline phosphatase, 25-hydroxyvitamin D, and parathyroid hormone levels in epileptic children.
- To identify potential differences in these metabolic parameters based on specific AEDs used.
- To compare these levels with those in a control group of healthy children.
Main Methods:
- Cross-sectional study comparing 41 epileptic children (aged 2-16 years) on AEDs with 39 age-matched healthy controls.
- Serum levels of calcium, phosphorus, alkaline phosphatase, 25-hydroxyvitamin D, and immunoreactive parathyroid hormone were measured.
- Patients were stratified based on AEDs received, duration of treatment, and number of drugs used.
Main Results:
- Epileptic children exhibited significantly lower serum calcium, phosphorus, and 25-hydroxyvitamin D concentrations compared to controls.
- A significant increase in serum alkaline phosphatase was observed in the epileptic group.
- Patients receiving primidone, particularly in combination therapy and for longer durations, showed the lowest serum calcium and 25-hydroxyvitamin D levels, along with higher phenobarbital levels.
Conclusions:
- Long-term AED therapy in epileptic children is associated with mild vitamin D deficiency and alterations in mineral metabolism.
- Primidone appears to be associated with more pronounced effects on calcium and vitamin D levels.
- The observed minimal vitamin D deficiency contrasts with other studies, suggesting potential differences in patient populations or treatment protocols warranting further investigation.
Abstract:
Forty-one epileptic children, aged 2 to 16 years, receiving combinations of phenobarbital, phenytoin, and primidone, and 39 control children were studied. The epileptics demonstrated slight but significant reductions in serum calcium, phosphorus, and 25-hydroxyvitamin D concentrations, and a significant increase in serum alkaline phosphatase values. No significant difference in serum immunoreactive parathyroid hormone levels was noted. Further analysis of the data revealed that patients whose drug therapy included primidone had the lowest serum levels of calcium and 25-hydroxyvitamin D. They had also received the largest number of drugs for the longest duration, and had serum phenobarbital levels that were significantly higher than those of other patients. The minimal degree of vitamin D deficiency in our epileptic children contrasts with the results of other investigations and warrants emphasis. The reasons for this difference are not apparent.