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Al Khalifah R, Hamad MH, Hudairi A, Al-Sulimani LK, Al Homyani D, Al Saqabi D, Bashiri FA. Prevalence and Related Risk Factors of Vitamin D Deficiency in Saudi Children with Epilepsy. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1696. [PMID: 36360424 PMCID: PMC9688346 DOI: 10.3390/children9111696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 09/09/2023]
Abstract
BACKGROUND Vitamin D has a role in the pathogenesis of many medical disorders, especially those of the central nervous system. It is essential in maintaining the bone health of children. However, patients with epilepsy are at high risk of developing vitamin D deficiency due to antiseizure medications (ASMs). Therefore, we aimed to assess the prevalence of vitamin D deficiency and related risk factors in children with epilepsy. METHODS This is the baseline report of a pragmatic, randomized, controlled, open-label trial that assessed the impact of vitamin D supplementation in preventing vitamin D deficiency (NCT03536845). We included children with epilepsy aged 2-16 years who were treated with ASMs from December 2017 to March 2021. Children with preexisting vitamin D metabolism problems, vitamin-D-dependent rickets, malabsorption syndromes, renal disease, and hepatic disease were excluded. The baseline demographic data, anthropometric measurements, seizure types, epilepsy syndromes, ASMs, and seizure control measures were recorded. Blood tests for vitamin D (25-hydroxyvitamin D [25(OH)D), serum calcium, serum phosphorus, and parathyroid hormone levels were performed. Based on vitamin D concentration, patients were categorized as deficient (<50 nmol/L), insufficient (74.9-50 nmol/L), or normal (>75 nmol/L). RESULTS Of 159 recruited children, 108 (67.92%) had generalized seizures, 44 (27.67%) had focal seizures, and 7 (4.4%) had unknown onset seizures. The number of children receiving monotherapy was 128 (79.0%) and 31 (19.1%) children were receiving polytherapy. The mean vitamin D concentration was 60.24 ± 32.36 nmol/L; 72 patients (45.28%) had vitamin D deficiency and 45 (28.3%) had vitamin D insufficiency. No significant difference in vitamin D concentration was observed between children receiving monotherapy and those receiving polytherapy. The main risk factors of vitamin D deficiency were obesity and receiving enzyme-inducer ASMs. CONCLUSIONS The prevalence of vitamin D deficiency was high among children with epilepsy. Obese children with epilepsy and those on enzyme-inducer ASMs were at increased risk for vitamin D deficiency. Further studies are needed to establish strategies to prevent vitamin D deficiency.
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Affiliation(s)
- Reem Al Khalifah
- Division of Pediatric Endocrinology, Department of Pediatrics, College of Medicine, King Saud University Medical City, King Saud University, Riyadh 11461, Saudi Arabia
| | - Muddathir H. Hamad
- Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, King Saud University Medical City, King Saud University, Riyadh 11461, Saudi Arabia
| | - Abrar Hudairi
- Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, King Saud University Medical City, King Saud University, Riyadh 11461, Saudi Arabia
| | - Lujain K. Al-Sulimani
- Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, King Saud University Medical City, King Saud University, Riyadh 11461, Saudi Arabia
| | - Doua Al Homyani
- Division of Pediatric Endocrinology, Department of Pediatrics, College of Medicine, King Saud University Medical City, King Saud University, Riyadh 11461, Saudi Arabia
| | - Dimah Al Saqabi
- College of Medicine Research Center, King Saud University, Riyadh 11461, Saudi Arabia
| | - Fahad A. Bashiri
- Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, King Saud University Medical City, King Saud University, Riyadh 11461, Saudi Arabia
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Dong N, Guo HL, Hu YH, Yang J, Xu M, Ding L, Qiu JC, Jiang ZZ, Chen F, Lu XP, Li XN. Association between serum vitamin D status and the anti-seizure treatment in Chinese children with epilepsy. Front Nutr 2022; 9:968868. [PMID: 36105574 PMCID: PMC9464910 DOI: 10.3389/fnut.2022.968868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/10/2022] [Indexed: 01/10/2023] Open
Abstract
ObjectiveTo compare the serum 25-OH-VitD levels, the major marker of vitamin D (VitD) status, between healthy children and children with epilepsy before initiation of and during anti-seizure medications (ASMs) treatment and to evaluate the potential influence factors on 25-OH-VitD levels. Another major aim was to assess the potential role of VitD supplementation.MethodsFor comparison, we finally enrolled and collected data from 6,338 healthy children presenting to Health Care Department and 648 children visiting primary care pediatricians with symptoms of epilepsy in Children’s Hospital of Nanjing Medical University from January 2019 to June 2021. The demographic and biochemical characteristics of each child were extracted from the hospital information system.ResultsSerum 25-OH-VitD levels in 648 children with epilepsy were significantly lower than those of 6,338 healthy children (P < 0.0001), and the percentage of VitD insufficiency and deficiency status in pediatric patients was 49.19%. Of note, the serum 25-OH-VitD levels in children with newly diagnosed epilepsy before receiving any ASMs treatment were also significantly lower than those in healthy controls. Interestingly, ASMs therapy, alone or in combination, did not consistently reduce baseline serum VitD levels in children with epilepsy. The lower serum VitD levels in pediatric patients than those in healthy children might be related to the disease itself, rather than the ASMs treatment. As expected, VitD supplementation substantially increased the serum 25-OH-VitD levels (P < 0.0001). More critically, children with epilepsy receiving VitD supplementation achieved good seizure control in our study.SignificanceIn this retrospective study, the childhood epilepsy before initiation of and during ASMs treatment decreased the serum 25-OH-VitD concentrations, suggesting a clear association between epileptic disease and the risk of VitD deficiency. ASMs coadministration and long-term valproic acid treatment did not worse VitD-deficiency status, but in the small group receiving VitD supplementation, there was a significant improvement in reduction of seizure frequency. Therefore, pediatric clinicians are urged to raise public awareness of epilepsy-associated VitD deficiency.
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Affiliation(s)
- Na Dong
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
- Institute of Pharmaceutical Science, China Pharmaceutical University, Nanjing, China
| | - Hong-Li Guo
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Ya-Hui Hu
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jiao Yang
- Department of Information Science, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Min Xu
- Department of Neurology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Le Ding
- Department of Neurology, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Jin-Chun Qiu
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Zhen-Zhou Jiang
- Institute of Pharmaceutical Science, China Pharmaceutical University, Nanjing, China
| | - Feng Chen
- Pharmaceutical Sciences Research Center, Department of Pharmacy, Children’s Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Feng Chen,
| | - Xiao-Peng Lu
- Department of Neurology, Children’s Hospital of Nanjing Medical University, Nanjing, China
- Xiao-Peng Lu,
| | - Xiao-Nan Li
- Department of Children Health Care, Children’s Hospital of Nanjing Medical University, Nanjing, China
- Xiao-Nan Li,
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Altowigri A, Mirghani HO. Blount Disease, Vitamin D deficiency, and Associated Comorbidities: A review and Meta-analysis. WORLD JOURNAL OF ENVIRONMENTAL BIOSCIENCES 2021; 10:5-8. [DOI: 10.51847/j96vx6dhpc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
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Scott M, Corrigan N, Bourke T, Thompson A, Mallett P. Should vitamin D supplementation routinely be prescribed to children receiving antiepileptic medication? Arch Dis Child 2021; 106:90-92. [PMID: 33032993 DOI: 10.1136/archdischild-2020-320168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Maura Scott
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Neil Corrigan
- Department of Paediatrics, Altnagelvin Area Hospital, Derry, Northern Ireland, UK
| | - Thomas Bourke
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK.,Centre for Medical Education, Queens University Belfast, Belfast, UK
| | - Andrew Thompson
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Peter Mallett
- Paediatric SimEd Team, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK
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Morris-Paxton AA, Truter I. Prescribing patterns of vitamin D and analogues in a private healthcare patient population in South Africa. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2020. [DOI: 10.1080/16070658.2020.1757878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Angela Ann Morris-Paxton
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Nelson Mandela University, Port Elizabeth, South Africa
| | - Ilse Truter
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Nelson Mandela University, Port Elizabeth, South Africa
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Menninga N, Koukounas Y, Margolis A, Breslow R, Gidal B. Effects of enzyme-inducing antiseizure medication on vitamin D dosing in adult veterans with epilepsy. Epilepsy Res 2020; 161:106287. [PMID: 32088519 DOI: 10.1016/j.eplepsyres.2020.106287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/28/2020] [Accepted: 02/04/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The association of antiseizure medication (ASM) and bone density abnormalities has long been recognized; however, there remains a lack of consensus on efficacy and optimal vitamin D dosing in patients receiving enzyme inducing and non-inducing ASMs. The objective was to explore the relationship between ASMs and vitamin D supplementation requirements in a population of adult patients with epilepsy. METHODS Patients with a diagnosis of epilepsy receiving supplemental vitamin D were included in this retrospective chart review. All instances of 25-hydroxyvitamin D3 (25-OHD) measured among those patients were compared between patients taking an enzyme inducing antiseizure medication (EIASM) to patients receiving ASM regimens only containing non-enzyme inducing antiseizure medications (NIASM). ASM use, prescription and over the counter (OTC) vitamin D use, 25-OHD plasma concentration, presence of chronic kidney disease (CKD), age, gender, and ethnicity were collected. Multiple linear regression was used to adjust for potentially confounding variables; the model included a cluster by participant term to account for repeated patients in the dataset. RESULTS There were 542 vitamin D levels evaluated from 172 unique patients. There was an 11.5 % higher absolute percent increase in patients who achieved a 25-OHD level over 30 ng/mL in the NIASM (p = 0.012). Patients on EIASMs were supplemented with an additional 508 units of vitamin D daily (95 %CI 136-878, p = 0.007). When adjusted for CKD, OTC vitamin D use, OTC multivitamin use, age, gender, and ethnicity, patients on EIASMs were supplemented with an additional 445 units of vitamin D (95 %CI -69 to 960, p = 0.089) compared to NIASM use. CONCLUSIONS Patients taking EIASMs had an increase in vitamin D deficiency and vitamin D supplementation suggesting that EIASMs impact vitamin D metabolism. Closer monitoring of vitamin D status in patients with epilepsy, especially those on EIASMs, is warranted. This evaluation suggests that for patients taking ASM, use of a lower dose OTC requires closer monitoring of vitamin D status in patients with epilepsy, especially those on EIASMs, is warranted. vitamin D agent may not be adequate.
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Affiliation(s)
- Nathan Menninga
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States
| | - Yannis Koukounas
- University of Wisconsin-Madison School of Pharmacy, Madison, WI, United States; Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Amanda Margolis
- University of Wisconsin-Madison School of Pharmacy, Madison, WI, United States.
| | - Robert Breslow
- University of Wisconsin-Madison School of Pharmacy, Madison, WI, United States
| | - Barry Gidal
- University of Wisconsin-Madison School of Pharmacy, Madison, WI, United States
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Aygun H, Ayyildiz M, Agar E. Effects of vitamin D and paricalcitol on epileptogenesis and behavioral properties of WAG/Rij rats with absence epilepsy. Epilepsy Res 2019; 157:106208. [PMID: 31581040 DOI: 10.1016/j.eplepsyres.2019.106208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/10/2019] [Accepted: 09/14/2019] [Indexed: 10/26/2022]
Abstract
AIM Vitamin D (Vit D) has been considered as a neurosteroid and has a pivotal role in neuroprotection including epilepsy. Vit D regulator acts via a Vit D receptor (VDR). WAG/Rij rats have a genetically epileptic model of absence epilepsy with comorbidity of depression. The aim of the present study was to investigate the effect of Vit D and paricalcitol (PRC) on WAG/Rij rats. MATERIAL AND METHODS Sixty-three male WAG/Rij rats and seven male Wistar rats were used. The effects of acute and chronic treatment with Vit D (5.000 and 60.000 IU/kg, i.p) and PRC (0.5, 5 and 10 μg/kg, i.p) on absence seizures, and related psychiatric comorbidity were investigated in WAG/Rij rats. Depression-like behavior was assayed by using the forced swimming test (FST) and; anxiety-like behavior by using the open field test (OFT). RESULTS Acute Vit D treatments (5.000 and 60.000 IU/kg) similarly reduced the number and duration of spike-wave discharges (SWDs) and showed anxiolytic-antidepressive effect whereas there were no significant changes in other measured parameters between the daily and the bolus dose of Vit D. Acute administration of PRC (0.5, 5 and 10 μg/kg) showed anti-convulsive and anxiolytic-antidepressive effect. The dose (0.5 μg/kg) of PRC was the most effective dose. Chronic treatment was more effective than acute therapy in all parameters. CONCLUSION The results of the present study demonstrate that Vit D and PRC have antiepileptic and anxiolytic-antidepressive effects on the absence epilepsy in WAG/Rij rats.
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Affiliation(s)
- Hatice Aygun
- Department of Physiology, Faculty of Medicine, University of Tokat Gaziosmanpasa, Tokat, Turkey.
| | - Mustafa Ayyildiz
- Department of Physiology, Faculty of Medicine, University of Ondokuz Mayis, Samsun, Turkey
| | - Erdal Agar
- Department of Physiology, Faculty of Medicine, University of Ondokuz Mayis, Samsun, Turkey
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Kija E, Gidal BE, Shapson-Coe A, Cader S, van der Watt G, Delport S, Wilmshurst JM. Vitamin D abnormalities and bone turn over analysis in children with Epilepsy in the Western Cape of South Africa. Seizure 2019; 73:84. [PMID: 31420230 DOI: 10.1016/j.seizure.2019.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Edward Kija
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa; Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Barry E Gidal
- University of Wisconsin School of Pharmacy, Madison, WI, USA
| | | | - Shihaam Cader
- Department of Dietetics, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - George van der Watt
- Department of Chemical Pathology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Steve Delport
- Department of Endocrinology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Jo M Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Neuroscience Institute, University of Cape Town, South Africa.
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Sharawat IK, Dawman L. Bone turnover analysis and vitamin D status in children with epilepsy. Seizure 2019; 73:83. [PMID: 31420231 DOI: 10.1016/j.seizure.2019.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/10/2019] [Accepted: 07/13/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Indar Kumar Sharawat
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Satellite Center, Una, Himachal Pradesh, India
| | - Lesa Dawman
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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