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Chassoux F, Navarro V, Quirins M, Laurent A, Gavaret M, Cousyn L, Crépon B, Landré E, Marchi A, Soufflet C, Rusu-Devaux V, Mancusi RL, Piketty ML, Souberbielle JC. Vitamin D deficiency and effect of treatment on seizure frequency and quality of life parameters in patients with drug-resistant epilepsy: A randomized clinical trial. Epilepsia 2024. [PMID: 38980968 DOI: 10.1111/epi.18050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/13/2024] [Accepted: 06/13/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE This study was undertaken to assess the effect of treatment of vitamin D deficiency in drug-resistant epilepsy. METHODS We conducted a multicenter, double-blind, placebo-controlled, randomized clinical trial, including patients aged ≥15 years with drug-resistant focal or generalized epilepsy. Patients with 25-hydroxyvitamin D (25[OH]D) < 30 ng/mL were randomized to an experimental group (EG) receiving vitamin D3 (cholecalciferol, 100 000 IU, five doses in 3 months) or a control group (CG) receiving matched placebo. During the open-label study, EG patients received 100 000 IU/month for 6 months, whereas CG patients received five doses in 3 months then 1/month for 3 months. Monitoring included seizure frequency (SF), 25(OH)D, calcium, albumin, creatinine assays, and standardized scales for fatigue, anxiety-depression, and quality of life (Modified Fatigue Impact Scale [M-FIS], Hospital Anxiety and Depression Scale, Quality of Life in Epilepsy [QOLIE-31]) at 3, 6, and 12 months. The primary efficacy outcome was the percentage of SF reduction compared to the reference period and CG at 3 months. Secondary outcomes were SF and bilateral tonic-clonic seizure (BTCS) reduction, scale score changes, and correlations with 25(OH)D during the follow-up. RESULTS Eighty-eight patients were enrolled in the study (56 females, aged 17-74 years), with median baseline SF per 3 months = 16.5 and ≥2 antiseizure medications in 88.6%. In 75 patients (85%), 25(OH)D was <30 ng/mL; 40 of them were randomly assigned to EG and 34 to CG. After the 3-month blinded period, SF reduction did not significantly differ between groups. However, during the open-label period, SF significantly decreased (30% median SF reduction, 33% responder rate at 12 months). BTCSs were reduced by 52%. M-FIS and QOLIE-31 scores were significantly improved at the whole group level. SF reduction correlated with 25(OH)D > 30 ng/mL for >6 months. SIGNIFICANCE Despite no proven effect after the 3-month blinded period, the open-label study suggests that long-term vitamin D3 supplementation with optimal 25(OH)D may reduce SF and BTCSs, with a positive effect on fatigue and quality of life. These findings need to be confirmed by further long-term studies. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03475225 (03-22-2018).
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Affiliation(s)
- Francine Chassoux
- Department of Neurosurgery, Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences, Paris, France
| | - Vincent Navarro
- Epilepsy Unit, Pitié-Salpêtrière Hospital and Paris Brain Institute, Assistance Publique Hopitaux de Paris, Sorbonne University, Paris, France
| | - Marion Quirins
- Department of Neurology, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Agathe Laurent
- Department of Neurosurgery, Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences, Paris, France
| | - Martine Gavaret
- Department of Clinical Neurophysiology, Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences, Paris, France
- Institute of Psychiatry and Neuroscience of Paris, Université Paris Cité, INSERM UMR 1266, Paris, France
| | - Louis Cousyn
- Epilepsy Unit, Pitié-Salpêtrière Hospital and Paris Brain Institute, Assistance Publique Hopitaux de Paris, Sorbonne University, Paris, France
| | - Benoit Crépon
- Department of Clinical Neurophysiology, Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences, Paris, France
| | - Elisabeth Landré
- Department of Neurosurgery, Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences, Paris, France
| | - Angela Marchi
- Department of Clinical Neurophysiology, Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences, Paris, France
| | - Christine Soufflet
- Department of Clinical Neurophysiology, Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences, Paris, France
| | - Violeta Rusu-Devaux
- Department of Clinical Neurophysiology, Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences, Paris, France
| | - Rossella Letizia Mancusi
- Direction of Clinical Research and Innovation, Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences, Paris, France
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Pludowski P. Supplementing Vitamin D in Different Patient Groups to Reduce Deficiency. Nutrients 2023; 15:3725. [PMID: 37686757 PMCID: PMC10489803 DOI: 10.3390/nu15173725] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Studies indicate a high prevalence of vitamin D deficiency in both the general population and at-risk groups. Given the association between vitamin D deficiency and various diseases, addressing this concern becomes crucial, especially in situations where routine monitoring is challenging. MATERIALS AND METHODS A systematic literature review of the current knowledge on vitamin D dosing in diverse at-risk populations and the application of the findings to a broader clinical perspective. RESULTS The reviewed studies revealed a high prevalence of vitamin D deficiency among patients with musculoskeletal disorders, systemic connective tissue diseases, corticosteroid use, endocrine and metabolic conditions, malabsorption syndromes, obesity, chronic kidney disease, cancer, and central nervous system diseases. Vitamin D deficiency was often more severe compared to the general population. Higher dosages of vitamin D beyond the recommended levels for the general population were shown to be effective in improving vitamin D status in these at-risk individuals. Additionally, some studies suggested a potential link between intermittent vitamin D administration and improved adherence. CONCLUSION Simplified dosing could empower clinicians to address vitamin D deficiency, particularly in high-risk populations, even without routine monitoring. Further research is needed to establish the optimal dosing regimens for specific at-risk populations.
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Affiliation(s)
- Pawel Pludowski
- Department of Biochemistry, Radioimmunology and Experimental Medicine, The Children's Memorial Health Institute, 04-730 Warsaw, Poland
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Asadi-Pooya AA, Shahisavandi M, Sadeghian S, Nezafat A, Nabavizadeh SA, Barzegar Z. Is the risk of COVID-19 contraction increased in patients with epilepsy? Epilepsy Behav 2021; 115:107734. [PMID: 33450616 PMCID: PMC7831817 DOI: 10.1016/j.yebeh.2020.107734] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/20/2020] [Accepted: 12/20/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of the current study was to investigate the rates of contracting COVID-19 in various populations to provide evidence on the susceptibility of patients with epilepsy (PWE) to contracting symptomatic COVID-19. METHODS We surveyed a random sample of three groups of people: patients with epilepsy, people with psychiatric problems, and a group of the general population. The survey included four general questions (age, sex, education, and medical/psychiatric problem) and four COVID-19 specific questions (contracting COVID-19, relatives with COVID-19, wearing a face mask, and frequent hand washings). RESULTS Three hundred and fifty -eight people were surveyed (108 healthy individuals, 154 patients with epilepsy, and 96 patients with psychiatric problems). Thirty-eight (11%) people had a history of COVID-19 contraction. The only factor that had a significant association with COVID-19 contraction was a relative with COVID-19 (Odds Ratio: 5.82; 95% Confidence Interval: 2.85-11.86; p = 0.0001). Having epilepsy did not increase the risk of COVID-19 contraction. CONCLUSION Symptomatic COVID-19 does not seem to be more likely in PWE. The single most important factor associated with contracting COVID-19 is a close relative with this infection. Isolation of people with SARS-CoV-2 infection and observation of their close contacts may reduce the risk of secondary infections.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, United States.
| | - Mina Shahisavandi
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeid Sadeghian
- Department of Pediatric Neurology, Golestan Medical, Educational, and Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Abdullah Nezafat
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Zohreh Barzegar
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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