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Fan HC, Chiang KL, Chang KH, Chen CM, Tsai JD. Epilepsy and Attention Deficit Hyperactivity Disorder: Connection, Chance, and Challenges. Int J Mol Sci 2023; 24:ijms24065270. [PMID: 36982345 PMCID: PMC10049646 DOI: 10.3390/ijms24065270] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/20/2023] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
Comorbidities are common in children with epilepsy, with nearly half of the patients having at least one comorbidity. Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder characterized by hyperactivity and inattentiveness level disproportional to the child’s developmental stage. The burden of ADHD in children with epilepsy is high and can adversely affect the patients’ clinical outcomes, psychosocial aspects, and quality of life. Several hypotheses were proposed to explain the high burden of ADHD in childhood epilepsy; the well-established bidirectional connection and shared genetic/non-genetic factors between epilepsy and comorbid ADHD largely rule out the possibility of a chance in this association. Stimulants are effective in children with comorbid ADHD, and the current body of evidence supports their safety within the approved dose. Nonetheless, safety data should be further studied in randomized, double-blinded, placebo-controlled trials. Comorbid ADHD is still under-recognized in clinical practice. Early identification and management of comorbid ADHD are crucial to optimize the prognosis and reduce the risk of adverse long-term neurodevelopmental outcomes. The identification of the shared genetic background of epilepsy and ADHD can open the gate for tailoring treatment options for these patients through precision medicine.
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Affiliation(s)
- Hueng-Chuen Fan
- Department of Pediatrics, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
- Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
| | - Kuo-Liang Chiang
- Department of Pediatric Neurology, Kuang-Tien General Hospital, Taichung 433, Taiwan
- Department of Nutrition, Hungkuang University, Taichung 433, Taiwan
| | - Kuang-Hsi Chang
- Department of Medical Research, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan
| | - Chuan-Mu Chen
- Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
- The iEGG and Animal Biotechnology Center, and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Correspondence: (C.-M.C.); (J.-D.T.); Tel.: +886-4-22840319-701 (C.-M.C.); +886-4-24730022-21731 (J.-D.T.)
| | - Jeng-Dau Tsai
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: (C.-M.C.); (J.-D.T.); Tel.: +886-4-22840319-701 (C.-M.C.); +886-4-24730022-21731 (J.-D.T.)
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Clements ME, Holtslander L, Johnson JR, Johnson RW. Select HDAC Inhibitors Enhance Osteolysis and Bone Metastasis Outgrowth but Can Be Mitigated With Bisphosphonate Therapy. JBMR Plus 2023; 7:e10694. [PMID: 36936362 PMCID: PMC10020917 DOI: 10.1002/jbm4.10694] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022] Open
Abstract
Breast cancer has a high predilection for spreading to bone with approximately 70% of patients who succumb to disease harboring bone disseminated tumor cells. Despite this high prevalence, treatments for bone metastatic breast cancer predominantly manage morbidities, including pain and hypercalcemia, rather than reducing bone metastasis incidence or growth. Histone deacetylase inhibitors (HDACi), including panobinostat, entinostat, and valproic acid, typically slow primary tumor progression and are currently in clinical trials for the treatment of many cancers, including primary and metastatic breast cancer, but their effects on bone metastatic disease have not been examined in preclinical models. We report that treatment with the HDACi panobinostat, but not entinostat or valproic acid, significantly reduced trabecular bone volume in tumor-naïve mice, consistent with previous reports of HDACi-induced bone loss. Surprisingly, treatment with entinostat or panobinostat, but not valproic acid, increased tumor burden and incidence in an experimental model of breast cancer bone metastasis. In vitro, multiple HDACi stimulated expression of pro-osteolytic genes in breast tumor cells, suggesting this may be a mechanism by which HDACi fuel tumor growth. In support of this, combination therapy of panobinostat or entinostat with the antiresorptive bisphosphonate zoledronic acid prevented bone metastatic progression; however, the addition of zoledronic acid to panobinostat therapy failed to fully correct panobinostat-induced bone loss. Together these data demonstrate that select HDACi fuel bone metastatic growth and provide potential mechanistic and therapeutic avenues to offset these effects. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Miranda E Clements
- Program in Cancer BiologyVanderbilt UniversityNashvilleTNUSA
- Vanderbilt Center for Bone Biology, Department of Medicine, Division of Clinical PharmacologyVanderbilt University Medical CenterNashvilleTNUSA
| | - Lauren Holtslander
- Vanderbilt Center for Bone Biology, Department of Medicine, Division of Clinical PharmacologyVanderbilt University Medical CenterNashvilleTNUSA
- Department of Medicine, Division of Clinical PharmacologyVanderbilt University Medical CenterNashvilleTNUSA
| | - Joshua R Johnson
- Vanderbilt Center for Bone Biology, Department of Medicine, Division of Clinical PharmacologyVanderbilt University Medical CenterNashvilleTNUSA
- Department of Medicine, Division of Clinical PharmacologyVanderbilt University Medical CenterNashvilleTNUSA
| | - Rachelle W Johnson
- Program in Cancer BiologyVanderbilt UniversityNashvilleTNUSA
- Vanderbilt Center for Bone Biology, Department of Medicine, Division of Clinical PharmacologyVanderbilt University Medical CenterNashvilleTNUSA
- Department of Medicine, Division of Clinical PharmacologyVanderbilt University Medical CenterNashvilleTNUSA
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Reduced Volumetric Bone Mineral Density of the Spine in Adolescent Rett Girls with Scoliosis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121902. [PMID: 36553345 PMCID: PMC9777162 DOI: 10.3390/children9121902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/07/2022]
Abstract
In advanced Rett syndrome (RTT), limited or complete loss of ambulation, nutritional problems and scoliosis are unfavorable factors for bone mineral density (BMD). Still, there are few data available in this research area. Spinal quantitative computed tomography (QCT) allows an exact measurement of the volumetric BMD (vBMD) in this patient group. Two examiners measured vBMD of thoracic and lumbar vertebrae on asynchronous calibrated CTs that were acquired prior to surgical scoliosis correction (n = 21, age 13.6 ± 2.5 years). The values were compared to age- and sex-matched healthy controls to additionally derive Z-scores (n = 22, age 13.8 ± 2.0 years). The results showed the most significant reduction of vBMD values in non-ambulatory RTT patients, with p < 0.001 and average BMD-Z-score −1.5 ± 0.2. In the subgroup comparison, non-ambulatory patients with valproate treatment had significant lower values (p < 0.001) than ambulatory patients without valproate therapy, with an average BMD-Z-score of −2.3 ± 0.2. Comparison of the Z-scores to critical BMD thresholds of 120 and 80 mg/cm3 showed normal Z-scores in case of the ambulatory RTT subgroup, as opposed to BMD-Z-scores of the non-ambulatory RTT subgroups, which were partially below osteopenia-equivalent values. Furthermore, valproate treatment seems to have a direct effect on vBMD in RTT patients and when combined with loss of ambulation, BMD-Z-scores are reduced to osteoporosis-equivalent levels or even further.
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Mhaimeed N, Mhaimeed N, Shad MU. Pharmacokinetic mechanisms underlying clinical cases of valproic acid autoinduction: A review. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Li Y, Zhang R, Ren M, Liu H, Yang M. Experimental study on the effects of simvastatin in reversing the femoral metaphyseal defects induced by sodium valproate in normal and ovariectomized rats. Heliyon 2022; 8:e10480. [PMID: 36105473 PMCID: PMC9465351 DOI: 10.1016/j.heliyon.2022.e10480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/29/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Long-term treatment with antiepileptic drugs may cause secondary osteoporosis. The present study investigated the influence of simvastatin (SIM) in reversing the effects of valproate on bone defect healing in normal and ovariectomized (OVX) rats. Methods Bone defects in femora were established in seven experimental groups of rats: control (vehicle), sodium valproate (SVP; 300 mg/kg/d), SVP plus SIM (25 mg/kg/d), sham control (sham), OVX, OVX SVP and OVX SVP plus SIM. All rats were euthanized at 8 weeks after bone defect creation. Results Micro-CT, biomechanical and histological evaluations demonstrated lower bone strength and delayed bone healing in the SVP therapy group compared with the SVP plus SIM therapy group. Biochemical and immunohistochemical results showed that osteocalcin (OCN), collagen I (Col I) and procollagen type I N-terminal propeptide (P1NP) levels decreased, tartrate-resistant acid phosphatase type 5 precursor (TRACP-5b) expression increased, and Dickkopf-1 (DKK-1) and receptor activator of nuclear factor-κ B ligand (RANKL) expression were upregulated in the SVP therapy rats compared with the SVP plus SIM therapy group. Bone loss was exacerbated by OVX, but the effect of SIM in ameliorating bone loss was also more marked in the OVX rats. Conclusions This study indicated lower bone strength and delayed healing of bone defects in rats given SVP therapy, especially the OVX SVP treatment group. In contrast, treatment with SIM was effective in enhancing bone strength and promoting bone defect repair and showed significant influence on promoting osteogenesis and inhibiting osteoclastogenesis.
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Schafmeyer L, Al-Monajjed M, Linden T, Wunram HL, Semler O, Schoenau E, Duran I. Diagnostic Evaluation of the Functional Muscle-Bone Unit in Children With Cerebral Palsy With and Without Low Trauma Fractures. J Clin Densitom 2022; 25:334-342. [PMID: 35168895 DOI: 10.1016/j.jocd.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/20/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022]
Abstract
Children and adolescents with cerebral palsy (CP) are at increased risk of low trauma fractures (LTF) due to low bone mineral content (BMC). The risk of LTFs might be overestimated by only age - and sex adjusted Z-scores for BMC because Z-score based DXA techniques do not take into account other relevant parameters like height, muscle and fat mass. This study aimed to present an update of the functional muscle-bone unit-algorithm (uFMBU-A) to evaluate bone health in children with CP in order to predict the risk of LTF taking into account the parameters sex, age, height, muscle and fat mass. We performed a monocentric retrospective analysis of 177 DXA-scans of children and adolescents with CP aged 8-19. Six of these 177 patients had sustained at least 1 LTF. Age-, sex- and size adjusted Z-scores of total body less head (TBLH)-BMC, lean body mass and fat mass were calculated. The uFMBU-A was applied to the study group and results were compared with established Z-score based DXA-measurements and algorithm based diagnostic techniques concerning the prediction of LTF risk. The uFMBU-A had the greatest diagnostic odds ratio (13.3 [95% CI 2.41; 72.9]) of the evaluated predictors with a sensitivity of 50.0% (95% CI 11.8; 88.2), specifity of 93% (95% CI 88.1; 96.3). The uFMBU-A was the most accurate method of the evaluated parameters to predict LTF in children with CP and is recommended when evaluating bone health.
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Affiliation(s)
- Leonie Schafmeyer
- Center of Prevention and Rehabilitation, UniReha, Cologne, Germany, University of Cologne, Medical Faculty and University Hospital Cologne, Germany; Department of Neuropediatrics, University Children's Hospital, Klinikum Oldenburg, Oldenburg, Germany.
| | - Mike Al-Monajjed
- Center of Prevention and Rehabilitation, UniReha, Cologne, Germany, University of Cologne, Medical Faculty and University Hospital Cologne, Germany
| | - Tobias Linden
- Department of Neuropediatrics, University Children's Hospital, Klinikum Oldenburg, Oldenburg, Germany
| | - Heidrun Lioba Wunram
- Department of Psychiatry, Psychosomatics and Psychotherapy for Children and Adolescents, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Oliver Semler
- Center of Prevention and Rehabilitation, UniReha, Cologne, Germany, University of Cologne, Medical Faculty and University Hospital Cologne, Germany; Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Eckhard Schoenau
- Center of Prevention and Rehabilitation, UniReha, Cologne, Germany, University of Cologne, Medical Faculty and University Hospital Cologne, Germany; Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Ibrahim Duran
- Center of Prevention and Rehabilitation, UniReha, Cologne, Germany, University of Cologne, Medical Faculty and University Hospital Cologne, Germany
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A. NF, Kumar R, V. DK, Chaudhary DG. A Comparative Study of Serum 25-Hydroxy Vitamin D Levels in Children with Seizures Receiving Monotherapy and Polytherapy. JOURNAL OF CHILD SCIENCE 2021. [DOI: 10.1055/s-0041-1740467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractThe association between serum 25-hydroxy vitamin D (25(OH)D) antiepileptic drugs (AEDs) and bone health in individuals with epilepsy has been recognized for more than 30 years. Several studies indicate an increased risk for bone loss in patients on antiepileptic medication as well as low levels of serum 25(OH)D. Patients on polytherapy AED are at a higher risk of adverse drug effects compared with those on monotherapy. The present study assessed serum 25(OH)D levels in children receiving AED and compares those children receiving monotherapy versus polytherapy. This is a prospective cross-sectional study conducted in a tertiary care hospital setting on children with seizures receiving AEDs for period of more than 6 months. Participants were enrolled in three groups: 25 children on monotherapy, 25 children on polytherapy, and 25 healthy controls. Serum 25(OH)D level was performed for all children and analyzed. Serum 25(OH)D levels were normal in 52%, insufficient levels in 43.3%, and deficient in 6.7% of children. Vitamin D level was insufficient in 40% of children receiving monotherapy and 52% receiving polytherapy AED. Vitamin D deficiency was present in 4% in monotherapy group and 16% in polytherapy group which was statistically significant (p-value 0.047). Vitamin D deficiency was higher in children receiving AED compared with normal controls. Vitamin D deficiency and insufficiency were higher in children on polytherapy. Our study emphasized the importance of monitoring vitamin D levels in children receiving AED to detect abnormalities in vitamin D levels.
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Affiliation(s)
- Nazeem Fathima A.
- Saveetha Medical College and Hospital, Thandalam, Kancheepuram, Tamil Nadu, India
| | - Radha Kumar
- Department of Pediatrics, Saveetha Medical College and Hospital, Thandalam, Kancheepuram, Tamil Nadu, India
| | - Dev Kumar V.
- Department of Pediatrics, Saveetha Medical College and Hospital, Thandalam, Kancheepuram, Tamil Nadu, India
| | - Devanand Gulab Chaudhary
- Department of Pediatrics, Saveetha Medical College and Hospital, Thandalam, Kancheepuram, Tamil Nadu, India
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Anwar MJ, Alenezi SK, Mahmood D, Azam F, Alharbi KS. An insight into the implications of estrogen deficiency and transforming growth factor β in antiepileptic drugs-induced bone loss. Eur J Pharmacol 2021; 907:174313. [PMID: 34245750 DOI: 10.1016/j.ejphar.2021.174313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/23/2021] [Accepted: 07/05/2021] [Indexed: 11/28/2022]
Abstract
There have been a number of reports that chronic antiepileptic drug (AEDs) therapy is associated with abnormal bone and calcium metabolism, osteoporosis/osteomalacia, and increased risk of fractures. Bony adverse effects of long term antiepileptic drug therapy have been reported for more than four decades but the exact molecular mechanism is still lacking. Several mechanisms have been proposed regarding AEDs induced bone loss; Hypovitaminosis D, hyperparathyroidism, estrogen deficiency, calcitonin deficiency. Transforming growth factor-β (TGF- β) is abundant in bone matrix and has been shown to regulate the activity of osteoblasts and osteoclasts in vitro. All isoforms of TGF- β are expressed in bone and intricately play role in bone homeostasis by modulating estrogen level. Ovariectomised animal have shown down regulation of TGF- β in bone that could also be a probable target of AEDs therapy associated bone loss. One of the widely accepted hypotheses regarding the conventional drugs induced bone loss is hypovitaminosis D which is by virtue of their microsomal enzyme inducing effect. However, despite of the lack of enzyme inducing effect of certain newer antiepileptic drugs, reduced bone mineral density with these drugs have also been reported. Thus an understanding of bone biology, pathophysiology of AEDs induced bone loss at molecular level can aid in the better management of bone loss in patients on chronic AEDs therapy. This review focuses mainly on certain new molecular targets of AEDs induced bone loss.
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Affiliation(s)
- Md Jamir Anwar
- Department of Pharmacology & Toxicology, Unaizah College of Pharmacy, Qassim University, Al-Qassim, Saudi Arabia.
| | - Sattam K Alenezi
- Department of Pharmacology & Toxicology, Unaizah College of Pharmacy, Qassim University, Al-Qassim, Saudi Arabia
| | - Danish Mahmood
- Department of Pharmacology & Toxicology, Unaizah College of Pharmacy, Qassim University, Al-Qassim, Saudi Arabia
| | - Faizul Azam
- Department of Pharmaceutical Chemistry & Pharmacognosy, Unaizah College of Pharmacy, Qassim University, Al-Qassim, Saudi Arabia
| | - Khalid Saad Alharbi
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakakah, Saudi Arabia
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Whitney DG, Kalia V, Rajapakse CS, Fedak Romanowski EM, Caird MS, Hurvitz EA, Jepsen KJ. The effect of age when initiating anti-seizure medication therapy on fragility fracture risk for children with epilepsy. Bone 2021; 149:115996. [PMID: 33962082 DOI: 10.1016/j.bone.2021.115996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anti-seizure medication (ASM) is necessary to manage epilepsy and often prescribed to children and adolescents, but can lead to iatrogenic effects, including bone fragility by altering bone metabolism. Disrupting bone metabolism during crucial developmental stages could have a lasting adverse effect on bone health. Therefore, the objective of this propensity score-matched, observational cohort study was to determine if age when initiating ASM therapy across developmental stages (from pre- to post-puberty) for individuals with epilepsy was associated with an increased risk of fragility fracture. METHODS Data from 01/01/2011 to 12/31/2018 were extracted from Optum Clinformatics® Data Mart. Children aged 4-21 years at baseline with at least 5 years of continuous health plan enrollment were included to allow for a 1-year baseline and 4-years of follow-up. The primary group of interest included new ASM users (i.e., treatment naïve) with epilepsy. The comparison group, no ASM users without epilepsy, was matched 1:14 to new ASM users with epilepsy for demographics and baseline fracture. To provide a proxy for developmental stages, age was categorized as 4-6 (pre-puberty), 7-10 (early puberty), 11-13 (mid-puberty), 14-17 (late puberty), and 18-21 (post-puberty). Crude incidence rate (IR; per 1000 person years) and IR ratio (IRR and 95% confidence intervals [CI]) were estimated for non-trauma fracture (NTFx) for up to 4-years of follow-up. RESULTS Prior to stratifying by age group, the crude NTFx IR (95% CI) of 20.6 (16.5-24.8) for new ASM users with epilepsy (n = 1205) was 34% higher (IRR = 1.34; 95% CI = 1.09-1.66) than the crude NTFx IR (95% CI) of 15.4 (14.4-16.3) for no ASM users without epilepsy. The groups exhibited a different pattern of NTFx incidence with age, with new ASM users showing a more dramatic increase and peaking at 11-13 years, then decreasing with the older age groups. The crude IR and IRR were elevated for new ASM users with epilepsy compared to no ASM users without epilepsy for each age group (10% to 55% higher), but was only statistically significant for 11-13 years (IRR = 1.55; 95% CI = 1.02-2.36). CONCLUSIONS Children with epilepsy initiating ASM therapy may be vulnerable to fragility fracture, especially when initiating ASM around the time of puberty. Clinicians should be aware of this age-related association and consider age-appropriate adjunct bone fragility therapies.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Vivek Kalia
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Chamith S Rajapakse
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA; Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Erin M Fedak Romanowski
- Department of Pediatrics, Division of Pediatric Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Michelle S Caird
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Karl J Jepsen
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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Whitney DG, Caird MS, Hurvitz EA, Rajapakse CS, Fedak Romanowski EM. Effect of levetiracetam and oxcarbazepine on 4-year fragility fracture risk among prepubertal and pubertal children with epilepsy. Epilepsia 2021; 62:2180-2189. [PMID: 34250606 DOI: 10.1111/epi.16998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether two commonly prescribed antiseizure medications (ASMs), levetiracetam (LEV) and oxcarbazepine (OXC), were associated with an increased risk of fragility fracture in children with epilepsy when initiating therapy during a crucial period of bone development, namely, pre- and midpuberty. METHODS Claims data from January 1, 2009 to December 31, 2018 were extracted from the Optum Clinformatics Data Mart. Children aged 4-13 years at baseline with at least 5 years of continuous health plan enrollment were included to allow for a 1-year baseline (e.g., pre-ASM exposure) and 4 years of follow-up. Children with epilepsy who were ASM naïve were grouped based on whether ASM treatment initiation included LEV or OXC. The comparison group included children without epilepsy and without ASM exposure. Crude incidence rate (IR; n per 1000 person-years) and IR ratio (IRR; with 95% confidence interval [CI]) were estimated for nontrauma fracture (NTFx), a claims-based proxy for fragility fracture, for up to 4 years of follow-up. Cox proportional hazards regression estimated the hazard ratio (HR; with 95% CI) after adjusting for demographic variables, motor impairment, and baseline fracture. RESULTS The crude IR (95% CI) of NTFx was 21.5 (21.2-21.8) for non-ASM-users without epilepsy (n = 271 346), 19.8 (12.3-27.2) for LEV (n = 358), and 34.4 (21.1-47.7) for OXC (n = 203). Compared to non-ASM-users, the crude IRR of NTFx was similar for LEV (IRR = .92, 95% CI = .63-1.34) and elevated for OXC (IRR = 1.60, 95% CI = 1.09-2.35); the crude IRR of NTFx was elevated for OXC compared to LEV (IRR = 1.74, 95% CI = 1.02-2.99). The findings were consistent after adjusting for covariates, except when comparing OXC to LEV (HR = 1.71, 95% CI = .99-2.93), which was marginally statistically insignificant (p = .053). SIGNIFICANCE Initiating OXC, but not LEV, therapy among 4-13-year-olds with epilepsy is associated with an elevated risk of fragility fracture. Studies are needed to determine whether these children could benefit from adjunct bone fragility therapies.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Michelle S Caird
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Chamith S Rajapakse
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Erin M Fedak Romanowski
- Department of Pediatrics, Division of Pediatric Neurology, University of Michigan, Ann Arbor, MI, USA
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Papassava M, Siomou E, Nakou I, Cholevas V, Challa A, Tzoufi M. Effects of long-term antiepileptic polytherapy on bone biochemical markers in ambulatory children and adolescents and possible benefits of vitamin D supplementation: a prospective interventional study. Epilepsy Behav 2021; 115:107708. [PMID: 33472116 DOI: 10.1016/j.yebeh.2020.107708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/13/2020] [Accepted: 12/13/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Our aim was to investigate any adverse effects of long-term polytherapy (VPA and add-on-therapy) on bone biochemical markers in ambulatory children and adolescents with epilepsy and the possible benefits of vitamin D supplementation on the same markers. METHODS In this prospective interventional study, the levels of 25(OH)D and the bone turnover markers of CrossLaps (CTX), total alkaline phosphatase (tALP), osteoprotegerin (OPG), and the receptor activator for nuclear factor kB (RANK) ligand (sRANKL) were determined in forty-two ambulatory children with epilepsy on polytherapy (valproic acid + one or more other from levetiracetam, topiramate, lamotrigine, or rufinamide). The same markers were assessed after a year's supplementation of vitamin D (400 IU/d) and were compared with those of clinically healthy controls. The respective mean (±SD) ages were 11.9 ± 4.6 and 11.4 ± 4.4 yrs. RESULTS The basal mean 25(OH)D levels in the patients did not differ from controls (23.9 ± 11.5 vs 27.4 ± 13.3 ng/ml), but increased significantly after the vitamin D intake (31.1 ± 13.3 ng/ml, p < 0.01). In parallel, basal serum CTX levels were found to be significantly lower in the patients than controls (0.89 ± 0.63 vs 1.22 ± 0.58 ng/ml, p < 0.02), but not tALP. Osteoprotegerin was higher in the patients (5.7 ± 7.7 pmol/L vs 2.6 ± 1.0 pmol/L, p < 0.03), while sRANKL did not differ. After vitamin D, the CTX levels increased to comparable levels in controls (0.99 ± 0.57 ng/ml), and those of OPG decreased to levels that did not differ from controls (4.9 ± 5.1 pmol/L). The ratio of OPG/sRANKL was higher in patients than controls before treatment (0.030 ± 0.045 vs 0.009 ± 0.005, p < 0.03), but decreased (0.026 ± 0.038) to comparable values in controls later. CONCLUSIONS These findings imply a lower bone turnover in the young patients on long-term polytherapy (VPA and add-on-therapy), but after one year's vitamin D intake, bone biochemical markers improved.
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Affiliation(s)
| | - Ekaterini Siomou
- Division of Pediatric Nephrology, Department of Pediatrics, University Hospital of Ioannina, Ioannina 451 10, Greece
| | - Iliada Nakou
- Division of Pediatric Neurology, University Hospital of Ioannina, Ioannina 451 10, Greece
| | - Vasileios Cholevas
- Pediatric Research Laboratory, University of Ioannina, Ioannina 451 10, Greece
| | - Anna Challa
- Pediatric Research Laboratory, University of Ioannina, Ioannina 451 10, Greece
| | - Meropi Tzoufi
- Division of Pediatric Nephrology, Department of Pediatrics, University Hospital of Ioannina, Ioannina 451 10, Greece
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12
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Fan HC, Wang SY, Peng YJ, Lee HS. Valproic Acid Impacts the Growth of Growth Plate Chondrocytes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3675. [PMID: 32456093 PMCID: PMC7277424 DOI: 10.3390/ijerph17103675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/13/2020] [Accepted: 05/21/2020] [Indexed: 12/24/2022]
Abstract
A range of bone abnormalities including short stature have been reported to be associated with the use of antiepileptic drugs (AEDs) in children. Exactly how AEDs impact skeletal growth, however, is not clear. In the present study, rat growth plate chondrocytes were cultured to study the effects of AEDs, including valproic acid (VPA), oxcarbazepine (OXA), levetiracetam (LEV), lamotrigine (LTG), and topiramate (TPM) on the skeletal growth. VPA markedly reduced the number of chondrocytes by apoptosiswhile other AEDs had no effect. The apoptosis associated noncleaved and cleaved caspase 3, and caspases were increased by exposure to VPA, which up-regulated cyclooxygenase 2 (COX-2) mRNA and protein levels likely through histone acetylation. The COX-2 inhibitor NS-398 attenuated the effects of VPA up-regulating COX-2 expression and decreased VPA-induced caspase 3 expression. The use of VPA in children should be closely monitored or replaced, where appropriate, by AEDs which do not apparently affect the growth plate chondrocytes.
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Affiliation(s)
- Hueng-Chuen Fan
- Department of Pediatrics, Tungs’ Taichung Metroharbor Hospital, Taichung 435, Taiwan;
- Department of Medical Research, Tungs’ Taichung Metroharbor Hospital, Taichung 435, Taiwan
- Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 35053, Taiwan
- Department of Life Sciences, National Chung Hsing University, Taichung 402, Taiwan
| | - Shih-Yu Wang
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (S.-Y.W.); (Y.-J.P.)
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
| | - Yi-Jen Peng
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (S.-Y.W.); (Y.-J.P.)
| | - Herng-Sheng Lee
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (S.-Y.W.); (Y.-J.P.)
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
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13
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Siniscalchi A, Murphy S, Cione E, Piro L, Sarro GD, Gallelli L. Antiepileptic Drugs and Bone Health: Current Concepts. PSYCHOPHARMACOLOGY BULLETIN 2020; 50:36-44. [PMID: 32508365 PMCID: PMC7255839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Chronic use of antiepileptic drugs (AEDs) can induce the development of adverse effects on bone metabolism. In epileptic patients treated with AED, the monitoring of biochemical markers of bone turnover, such as the measurement of serum 25 (OH) vitamin D, bone mineral density, before the beginning of the treatment and during the follow-up is not routinely required. In the future, monitoring of biochemical markers in epileptic patients treated with AED may help us for adequate prevention therapy.
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Affiliation(s)
- Antonio Siniscalchi
- Siniscalchi, Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy. Murphy, General Medicine, Stroke Unit, Mater Misericordiae University Hospital, Dublin, Ireland. Cione, Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, Rende (CS), Italy. Piro, Orthopedic Unit, Corigliano-Rossano Hospital, ASP Cosenza, Italy. De Sarro and Gallelli, Chair of Pharmacology, Department of Health Science, School of Medicine, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Sean Murphy
- Siniscalchi, Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy. Murphy, General Medicine, Stroke Unit, Mater Misericordiae University Hospital, Dublin, Ireland. Cione, Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, Rende (CS), Italy. Piro, Orthopedic Unit, Corigliano-Rossano Hospital, ASP Cosenza, Italy. De Sarro and Gallelli, Chair of Pharmacology, Department of Health Science, School of Medicine, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Erika Cione
- Siniscalchi, Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy. Murphy, General Medicine, Stroke Unit, Mater Misericordiae University Hospital, Dublin, Ireland. Cione, Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, Rende (CS), Italy. Piro, Orthopedic Unit, Corigliano-Rossano Hospital, ASP Cosenza, Italy. De Sarro and Gallelli, Chair of Pharmacology, Department of Health Science, School of Medicine, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Leonardo Piro
- Siniscalchi, Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy. Murphy, General Medicine, Stroke Unit, Mater Misericordiae University Hospital, Dublin, Ireland. Cione, Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, Rende (CS), Italy. Piro, Orthopedic Unit, Corigliano-Rossano Hospital, ASP Cosenza, Italy. De Sarro and Gallelli, Chair of Pharmacology, Department of Health Science, School of Medicine, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Giovambattista De Sarro
- Siniscalchi, Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy. Murphy, General Medicine, Stroke Unit, Mater Misericordiae University Hospital, Dublin, Ireland. Cione, Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, Rende (CS), Italy. Piro, Orthopedic Unit, Corigliano-Rossano Hospital, ASP Cosenza, Italy. De Sarro and Gallelli, Chair of Pharmacology, Department of Health Science, School of Medicine, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro, Italy
| | - Luca Gallelli
- Siniscalchi, Department of Neurology and Stroke Unit, Annunziata Hospital of Cosenza, Cosenza, Italy. Murphy, General Medicine, Stroke Unit, Mater Misericordiae University Hospital, Dublin, Ireland. Cione, Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, Rende (CS), Italy. Piro, Orthopedic Unit, Corigliano-Rossano Hospital, ASP Cosenza, Italy. De Sarro and Gallelli, Chair of Pharmacology, Department of Health Science, School of Medicine, University of Catanzaro, Clinical Pharmacology Unit, Mater Domini University Hospital, Catanzaro, Italy
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14
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Johnson EC, Helen Cross J, Reilly C. Physical activity in people with epilepsy: A systematic review. Epilepsia 2020; 61:1062-1081. [DOI: 10.1111/epi.16517] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Emma C. Johnson
- Research Department Young Epilepsy Surrey UK
- Great Ormond Street Hospital for Children National Health Service Trust London UK
| | - J. Helen Cross
- Research Department Young Epilepsy Surrey UK
- Great Ormond Street Hospital for Children National Health Service Trust London UK
- University College London Great Ormond Street Institute of Child Health London UK
| | - Colin Reilly
- Research Department Young Epilepsy Surrey UK
- University College London Great Ormond Street Institute of Child Health London UK
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15
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Sakai T, Honzawa S, Kaga M, Iwasaki Y, Masuyama T. Osteoporosis pathology in people with severe motor and intellectual disability. Brain Dev 2020; 42:256-263. [PMID: 31982226 DOI: 10.1016/j.braindev.2019.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/18/2019] [Accepted: 12/24/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES We assessed the severity and pathology of osteoporosis in children and adults with severe motor and intellectual disabilities (SMID) by evaluating bone enzymes, by which we aimed to determine adequate treatment approaches for preventing fractures. METHODS Ninety patients (44 men, 46 women; mean age, 34.5 years) underwent bone quality assessment. Quantitative ultrasonography (QUS) was used to measure the T-score and Z-score of the calcaneus, and blood tests were used to measure bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase 5b levels as bone formation and resorption markers, as well as calcium, phosphorous, and parathyroid hormone levels as routine examination. RESULTS Bone formation and resorption marker levels were within normal ranges in adults, although they were high during the growth period in children and adolescents and in elderly women. Patients receiving tube feeding showed a significantly lower Z-score than those without tube feeding. Tube feeding was a significant factor for the Z-score, whereas age, vitamin supplements, and anti-epileptic drugs were not. CONCLUSIONS The severity of osteoporosis in SMID started during the growth period and seems to be caused by a lack of an effective increase in bone mineral density. Any treatment should be started during the growth period. More study about tube feeding is needed.
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Affiliation(s)
- Tomoko Sakai
- Department of Rehabilitation Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Shiho Honzawa
- Department of Pediatrics, Tokyo Metropolitan Tobu Medical Center for Persons with Developmental/Multiple Disabilities, Tokyo, Japan
| | - Makiko Kaga
- Department of Pediatrics, Tokyo Metropolitan Tobu Medical Center for Persons with Developmental/Multiple Disabilities, Tokyo, Japan
| | - Yuji Iwasaki
- Department of Pediatrics, Tokyo Metropolitan Tobu Medical Center for Persons with Developmental/Multiple Disabilities, Tokyo, Japan
| | - Tatsuo Masuyama
- Department of Pediatrics, Tokyo Metropolitan Tobu Medical Center for Persons with Developmental/Multiple Disabilities, Tokyo, Japan
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16
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Ko A, Kong J, Samadov F, Mukhamedov A, Kim YM, Lee YJ, Nam SO. Bone health in pediatric patients with neurological disorders. Ann Pediatr Endocrinol Metab 2020; 25:15-23. [PMID: 32252212 PMCID: PMC7136510 DOI: 10.6065/apem.2020.25.1.15] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/02/2020] [Accepted: 03/10/2020] [Indexed: 12/17/2022] Open
Abstract
Patients with neurological disorders are at high risk of developing osteoporosis, as they possess multiple risk factors leading to low bone mineral density. Such factors include inactivity, decreased exposure to sunlight, poor nutrition, and the use of medication or treatment that can cause lower bone mineral density such as antiepileptic drugs, ketogenic diet, and glucocorticoids. In this article, mechanisms involved in altered bone health in children with neurological disorders and management for patients with epilepsy, cerebral palsy, and Duchenne muscular dystrophy regarding bone health are reviewed.
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Affiliation(s)
- Ara Ko
- Division of Pediatric Neurology, Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Juhyun Kong
- Division of Pediatric Neurology, Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Furkat Samadov
- Division of Pediatric Neurology, Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Neuroscience Center, National Children's Medical Center, Tashkent, Uzbekistan
| | - Akmal Mukhamedov
- Division of Pediatric Neurology, Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Neuroscience Center, National Children's Medical Center, Tashkent, Uzbekistan
| | - Young Mi Kim
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Yun-Jin Lee
- Division of Pediatric Neurology, Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Ook Nam
- Division of Pediatric Neurology, Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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17
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Emmett MJ, Lazar MA. Integrative regulation of physiology by histone deacetylase 3. Nat Rev Mol Cell Biol 2019; 20:102-115. [PMID: 30390028 DOI: 10.1038/s41580-018-0076-0] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Cell-type-specific gene expression is physiologically modulated by the binding of transcription factors to genomic enhancer sequences, to which chromatin modifiers such as histone deacetylases (HDACs) are recruited. Drugs that inhibit HDACs are in clinical use but lack specificity. HDAC3 is a stoichiometric component of nuclear receptor co-repressor complexes whose enzymatic activity depends on this interaction. HDAC3 is required for many aspects of mammalian development and physiology, for example, for controlling metabolism and circadian rhythms. In this Review, we discuss the mechanisms by which HDAC3 regulates cell type-specific enhancers, the structure of HDAC3 and its function as part of nuclear receptor co-repressors, its enzymatic activity and its post-translational modifications. We then discuss the plethora of tissue-specific physiological functions of HDAC3.
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Affiliation(s)
- Matthew J Emmett
- Institute for Diabetes, Obesity, and Metabolism, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Mitchell A Lazar
- Institute for Diabetes, Obesity, and Metabolism, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. .,Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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18
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Zhao J, Sang Y, Zhang Y, Zhang D, Chen J, Liu X. Efficacy of levetiracetam combined with sodium valproate on pediatric epilepsy and its effect on serum miR-106b in children. Exp Ther Med 2019; 18:4436-4442. [PMID: 31777547 PMCID: PMC6862620 DOI: 10.3892/etm.2019.8098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 08/21/2019] [Indexed: 12/28/2022] Open
Abstract
Efficacy of levetiracetam (LEV) combined with sodium valproate (SV) on pediatric epilepsy and its effect on serum miR-106b in children were investigated. One hundred and twenty children with epilepsy in Xuzhou Children's Hospital from July 2015 to July 2017 were enrolled, and divided into control group (n=60) and observation group (n=60) according to random sampling. Additionally, 100 children undergoing normal physical examination were collected as normal group. Patients in the control group were treated with SV, and patients in the observation group were treated with SV and LEV. RT-qPCR was used for detecting the relative expression of serum miR-106b in children. The clinical efficacy was evaluated. After treatment, the relative expression of serum miR-106b in the control group was significantly higher than that in the observation group (P<0.05). The difference in the control group was smaller than that in the observation group (P<0.05). According to the ROC curve analysis, when the cut-off value was 1.442, the sensitivity, specificity and area under curve (AUC) of miR-106b in the diagnosis of pediatric epilepsy were 94.00, 64.17 and 0.833 respectively. The clinical efficacy in the observation group was significantly better than that in the control group (P<0.05). Spearman's test showed that the expression of miR-106b gradually decreased with the continuous improvement of the clinical efficacy (P<0.05). The AUC of miR-106b was 0.833, 95% CI: 0.779 to 0.887, the cut-off was 1.442. LEV combined with SV is effective in the treatment of children with epilepsy, and does not increase the clinical ADR. The expression of serum miR-106b in children can be used as a clinical prognostic indicator and a potential diagnostic indicator.
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Affiliation(s)
- Jiaqiang Zhao
- Department of Neurology, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Yan Sang
- Department of Neurology, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Yuan Zhang
- Department of Neurology, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Dongli Zhang
- Department of Neurology, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Jiao Chen
- Department of Neurology, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Xiaoming Liu
- Department of Neurology, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
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19
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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; 69:186-192. [DOI: 10.1016/j.seizure.2019.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 04/25/2019] [Accepted: 04/28/2019] [Indexed: 01/24/2023] Open
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20
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Valproate decreases vitamin D levels in pediatric patients with epilepsy. Seizure 2019; 71:60-65. [PMID: 31207394 DOI: 10.1016/j.seizure.2019.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To compare Vitamin D (Vit D) levels in children with epilepsy on valproate monotherapy with healthy controls. METHODS A meta-analysis performed on articles identified from PubMed and Web of Science online databases evaluated using National Institute of Health National Heart, Lung, and Blood Institute Study Quality Assessment Tools. Subgroup analyses and publication bias assessments were also performed. RESULTS Eleven publications were eligible based on inclusion/exclusion criteria for the meta-analysis. Results noted a decrease in the mean Vit D level in children with epilepsy on valproate monotherapy compared with healthy children with a Standard Mean Difference = -0.313 [-0.457, -0.169]. Cumulative meta-analysis showed progressive negative effect of valproate therapy on Vit D levels across time. Other antiepileptic medications caused a similar effect on Vit D status. There was no evidence of publication bias in the analyses. Type of study design and country of origin introduced heterogeneities into the meta-analyses. CONCLUSION This meta-analysis provides evidence that long-term therapy with valproate causes a decrease in Vit D levels in children. Therefore, in children with a seizure disorder on long-term valproate therapy, 25-OH-Vit D levels should be monitored and appropriate supplementation implemented if levels are deficient.
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21
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Inaloo S, Paktinat M, Saki F, Katibeh P, Nemati H, Dabbaghmanesh MH, Omrani GHR. Bone mineral density loss in ambulatory children with epilepsy in spite of using supplemental vitamin D in Southern Iran: a case-control study. J Bone Miner Metab 2019; 37:537-544. [PMID: 30191457 DOI: 10.1007/s00774-018-0951-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/18/2018] [Indexed: 01/10/2023]
Abstract
Epilepsy might have adverse effect on bone density due to underlying disease, drugs, vitamin D deficiency, immobilization and malnutrition. We investigated the bone mineral density in ambulatory vitamin-D supplemented children with epilepsy. This case-control study was conducted on 90 epileptic children aged 11.4 ± 3.3 years, and age and gender matched controls in pediatric neurology clinics of Shiraz, in Southern Iran, 2016. Anthropometric measurements, puberty, sun exposure, physical activity and biochemical variables were assessed. Bone mineral density was evaluated by dual-energy X-ray absorptiometry method. Data were analyzed by SPSS.v21. Prevalence of low bone mass in femur was more in patients (27%) than the controls (9%) (P value = 0.002). Age, weight Z score and height Z score were the most significant associated factors on lumbar BMD, BMAD, and femur BMD. Seizure duration and how it responded to anticonvulsants were the most associated factors with both lumbar and femur bone density. Sodium valproate and carbomazepin usage had negative association with lumbar Z score (beta = - 0.216, P = 0.017 and beta = - 0.336, P = 0.027, respectively). We hypothesized that epilepsy per se could affect bone density by an unknown pathophysiology, which was independent from vitamin D deficiency, effects of anticonvulsant and physical activity.
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Affiliation(s)
- Soroor Inaloo
- Neonatology Research Center, Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Paktinat
- Neonatology Research Center, Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Forough Saki
- Shiraz Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Pegah Katibeh
- Neonatology Research Center, Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Nemati
- Neonatology Research Center, Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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22
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Rocha S, Ferraz R, Prudêncio C, Fernandes MH, Costa-Rodrigues J. Differential effects of antiepileptic drugs on human bone cells. J Cell Physiol 2019; 234:19691-19701. [PMID: 30941778 DOI: 10.1002/jcp.28569] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 01/10/2023]
Abstract
Antiepileptic drugs (AED) have been associated to in vivo deleterious consequences in bone tissue. The present work aimed to characterize the cellular and molecular effects of five different AED on human osteoclastogenesis and osteblastogenesis. It was observed that the different drugs had the ability to differentially modulate both processes, in a way dependent on the identity and dose of the AED. Shortly, valproic acid stimulated either osteoclastogenesis and osteoblastogenesis, whereas carbamazepine, gabapentin, and lamotrigine revealed an opposite behavior; topiramate elicited a decrease of osteoclast development and an increase in osteoblast differentiation. This is the first report describing the direct effects of different AED on human primary bone cells, which is a very important issue, because these drugs are usually consumed in long-term therapeutics, with acknowledged in vivo effects in bone tissue.
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Affiliation(s)
- Sara Rocha
- Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, U. Porto, Portugal.,Ciências Químicas e das Biomoléculas (CQB) e Centro de Investigação em Saúde e Ambiente (CISA), Escola Superior de Saúde do Instituto Politécnico do Porto, Portugal
| | - Ricardo Ferraz
- Ciências Químicas e das Biomoléculas (CQB) e Centro de Investigação em Saúde e Ambiente (CISA), Escola Superior de Saúde do Instituto Politécnico do Porto, Portugal.,REQUIMTE/LAQV, U. Porto, Portugal
| | - Cristina Prudêncio
- Ciências Químicas e das Biomoléculas (CQB) e Centro de Investigação em Saúde e Ambiente (CISA), Escola Superior de Saúde do Instituto Politécnico do Porto, Portugal.,i3S, Instituto de Inovação e Investigação em Saúde, Universidade do Porto, Portugal
| | - Maria Helena Fernandes
- Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, U. Porto, Portugal.,REQUIMTE/LAQV, U. Porto, Portugal
| | - João Costa-Rodrigues
- Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, U. Porto, Portugal.,ESS - Escola Superior de Saúde, P. Porto, Portugal.,Instituto Politécnico de Viana do Castelo, Escola Superior de Saúde, Portugal.,i3S, Instituto de Inovação e Investigação em Saúde, Universidade do Porto, Portugal
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23
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Yamada-Takeda M, Patel A, Fenton G. Energy Drink-Induced Breakthrough Seizure in a Patient on Valproic Acid-Considering Herbal Safety in Epilepsy. J Pharm Pract 2019; 32:485-487. [PMID: 30669934 DOI: 10.1177/0897190018825029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mikiko Yamada-Takeda
- Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Avni Patel
- University of New Mexico College of Pharmacy, Albuquerque, NM, USA
| | - Glen Fenton
- Department of Neurology, St. Louis University School of Medicine, St. Louis, MO, USA
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24
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El-Haggar SM, Mostafa TM, Allah HMS, Akef GH. Levetiracetam and lamotrigine effects as mono- and polytherapy on bone mineral density in epileptic patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:452-458. [PMID: 30066796 DOI: 10.1590/0004-282x20180068] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/19/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the effect of lamotrigine (LTG) and levetiracetam (LEV) as mono- and polytherapy on biochemical markers of bone turnover and bone mineral density in Egyptian adult patients with epilepsy. METHODS Forty-eight patients were divided into four groups: two received monotherapy of either LTG or LEV, and the other two groups received polytherapy comprising (valproate [VPA] + LTG or VPA + LEV). Thirty matched healthy participants were included in the study. Participants completed a nutritional and physical activity questionnaire. Biochemical markers of bone and mineral metabolism and bone mineral density of the lumbar spine were measured at baseline and at six months. RESULTS In the LEV monotherapy group, the bone formation markers showed a significant decrease in serum alkaline phosphatase and serum osteocalcin levels while the bone resorption marker showed a significant increase in urinary deoxypyridinoline levels. After six months of treatment, bone mineral density showed a significant decrease in all treated groups, while among monotherapy groups, this significant decrease was more prevalent in the LEV monotherapy group compared with the LTG monotherapy group. Furthermore, there was significant negative correlation between urinary deoxypyridinoline levels and bone mineral density in the LEV monotherapy group. CONCLUSION Using new generation antiepileptics, LEV monotherapies and polytherapy showed harmful effects on bone but LTG did not.
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Khalifah RA, Hudairi A, Homyani DA, Hamad MH, Bashiri FA. Vitamin D supplementation to prevent vitamin D deficiency for children with epilepsy: Randomized pragmatic trial protocol. Medicine (Baltimore) 2018; 97:e12734. [PMID: 30290685 PMCID: PMC6200520 DOI: 10.1097/md.0000000000012734] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Vitamin D deficiency is highly prevalent among children with epilepsy. Lack of high-quality evidence led to variability among scientific societies recommendations. Therefore, we aim to determine the efficacy of different common doses used in the pediatric practice to maintain optimal 25-hydroxy vitamin D (25 [OH] vitamin D) level in children with epilepsy and normal baseline 25 (OH) vitamin D level over 6 months of supplementation. METHODS This is a protocol for phase IV pragmatic randomized superiority controlled open-label trial at King Saud University Medical City in Riyadh. Children with epilepsy and receiving chronic antiepliptic medication and normal baseline 25 (OH) vitamin D level will be randomly assigned to receive Cholecalciferol 400 IU/day versus 1000 IU/day for 6 months. Our primary outcome is the proportion of children with vitamin D insufficiency (25 (OH) vitamin D level < 75nmol/L) at 6 months. Secondary outcomes include seizure treatment failure, seizure frequency, parathyroid hormone (PTH) levels, bone mineral density, and safety. DISCUSSION Our trial is set out to evaluate the efficacy of common different vitamin D maintenance doses on 25 (OH) vitamin D level, seizure control, and bone health for children with epilepsy. The results of our study will possibly help in shaping current vitamin D guidelines for vitamin D supplementation in children with epilepsy and provide a link between 25 (OH) vitamin D level and seizure control.
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Affiliation(s)
- Reem Al Khalifah
- College of Medicine, King Saud University
- Division of Pediatric Endocrinology
| | - Abrar Hudairi
- Division of Pediatric Neurology, Department of Pediatrics, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | - Muddathir H. Hamad
- Division of Pediatric Neurology, Department of Pediatrics, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Fahad A. Bashiri
- College of Medicine, King Saud University
- Division of Pediatric Neurology, Department of Pediatrics, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
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Abstract
PURPOSE OF REVIEW Psychotropics are prescribed to youth at rapidly growing rates and may negatively impact bone health. Little awareness exists of this association among prescribing providers. Childhood and adolescence are critical times for bone development. Understanding these effects and their management is important to informed psychotropic use. RECENT FINDINGS Through a variety of mechanisms, antidepressants, benzodiazepines, mood stabilizers, neuroleptics, and stimulants may all negatively impact pediatric bone health. This confers added risk of osteoporosis in a population already at high risk for suboptimal bone health. Awareness of psychotropic-mediated effects on pediatric bone development is clinically relevant to the use and monitoring of these agents. Clinicians can manage these effects through informed consent, vitamin D supplementation, lifestyle modifications, and reducing polypharmacy. For mood stabilizers, vitamin D level monitoring and secondary prevention is indicated. Future longitudinal studies and development of monitoring guidelines regarding psychotropic impact on bone health are necessary.
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Affiliation(s)
- Jessie N Rice
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, SPC 5766, Ann Arbor, MI, 48109-2700, USA.
| | - Carrie B Gillett
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, SPC 5766, Ann Arbor, MI, 48109-2700, USA
| | - Nasuh M Malas
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, SPC 5766, Ann Arbor, MI, 48109-2700, USA.,Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA
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McNamara NA, Romanowski EMF, Olson DP, Shellhaas RA. Bone Health and Endocrine Comorbidities in Pediatric Epilepsy. Semin Pediatr Neurol 2017; 24:301-309. [PMID: 29249510 DOI: 10.1016/j.spen.2017.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Antiseizure medications and dietary therapies have associated effects on the endocrine system. We provided an overview of the relationship between epilepsy treatment and bone health in children with epilepsy. Additionally, we discussed the effects of epilepsy treatment on other endocrine systems including thyroid function, growth, reproduction, and weight. The effect of epilepsy on bone health is multifactorial; there are direct and indirect effects of medication and dietary treatments as well as a decrease in physical activity, decreased sunlight exposure, decreased vitamin D levels, and additional comorbidities. Some medications have a greater effect on vitamin D and bone health than others, however all antiseizure medical treatments are associated with lower vitamin D levels in pediatric patients. We have provided practical suggestions for vitamin D surveillance in children with epilepsy as well as replacement strategies. Children with epilepsy have an increased likelihood of additional endocrine disorders including subclinical hypothyroidism, decreased growth, weight abnormalities, reproductive and sexual dysfunction. To a great extent, this is medication specific. Though more studies are needed to elucidate optimal treatment and monitoring of bone health and other endocrinopathies in children with epilepsy, it is critical that caregivers pay close attention to these issues to provide optimal comprehensive care to their patients.
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Affiliation(s)
- Nancy A McNamara
- Divisions of Pediatric Neurology, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
| | | | - David P Olson
- Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Renee A Shellhaas
- Divisions of Pediatric Neurology, Department of Pediatrics, University of Michigan, Ann Arbor, MI
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Simm PJ, Seah S, Gorelik A, Gilbert L, Nuguid J, Werther GA, Mackay MT, Freeman JL, Petty SJ, Wark JD. Impaired bone and muscle development in young people treated with antiepileptic drugs. Epilepsia 2017; 58:1931-1938. [DOI: 10.1111/epi.13893] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Peter J. Simm
- Department of Endocrinology and Diabetes; Royal Children's Hospital; Melbourne Victoria Australia
- Murdoch Childrens Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - Sebastian Seah
- Department of Medicine; Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Alex Gorelik
- Department of Medicine; Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
- Melbourne EpiCentre; Royal Melbourne Hospital; Parkville Victoria Australia
| | - Lauren Gilbert
- Department of Medicine; Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Jenning Nuguid
- Department of Medicine; Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
| | - George A. Werther
- Department of Endocrinology and Diabetes; Royal Children's Hospital; Melbourne Victoria Australia
- Murdoch Childrens Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - Mark T. Mackay
- Murdoch Childrens Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
- Department of Neurology; Royal Children's Hospital; Melbourne Victoria Australia
| | - Jeremy L. Freeman
- Murdoch Childrens Research Institute; Melbourne Victoria Australia
- Department of Neurology; Royal Children's Hospital; Melbourne Victoria Australia
| | - Sandra J. Petty
- Department of Medicine; Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
- Melbourne Brain Centre at Royal Melbourne Hospital; Melbourne Victoria Australia
- Academic Centre; Ormond College; Parkville Victoria Australia
| | - John D. Wark
- Department of Medicine; Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
- Bone & Mineral Medicine; Royal Melbourne Hospital; Melbourne Victoria Australia
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Pitetzis DA, Spilioti MG, Yovos JG, Yavropoulou MP. The effect of VPA on bone: From clinical studies to cell cultures—The molecular mechanisms revisited. Seizure 2017; 48:36-43. [DOI: 10.1016/j.seizure.2017.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/19/2017] [Accepted: 03/21/2017] [Indexed: 01/10/2023] Open
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Hasaneen B, Elsayed RM, Salem N, Elsharkawy A, Tharwat N, Fathy K, El-Hawary A, Aboelenin HM. Bone Mineral Status in Children with Epilepsy: Biochemical and Radiologic Markers. J Pediatr Neurosci 2017; 12:138-143. [PMID: 28904570 PMCID: PMC5588637 DOI: 10.4103/jpn.jpn_161_16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective: The aim of this study is to assess bone mineral status in children with epilepsy, on different antiepileptic drugs (AEDs) regimen, using dual-energy X-ray absorptiometry (DXA) and routine biochemical bone markers. Patients and Methods: This is observational prospective controlled cohort study, conducted at Mansoura University Children Hospital, from January 2014 to June 2015. In this study, we had 152 participants with ages 3–13 years, 70 children diagnosed with epilepsy and 82 were controls. Children classified into two groups according to the duration of treatment, Group 1 children maintained on AEDs for 6–24 months, Group 2 children ≥24 months. Bone mineral density (BMD) measured by DXA and biochemical markers includes serum calcium, phosphorus, alkaline phosphatase (ALP), and parathyroid hormone (PTH). Results: In this study, we found that the serum level of calcium and phosphate were significantly low (P > 0.05) in total cases versus control. We found that the serum level of and ALP and PTH were significantly high (P > 0.05) in total cases versus control. Regarding the DXA markers, there was a significant decrease of BMD and Z-score for the total body and lumbar area in the total cases versus control (P > 0.05). Conclusion: The present study showed that all AEDs (new and old) affect bone mineral status in children receiving therapy for more than 6 months, altering both biochemical markers (serum calcium, phosphorus, ALP, and PTH) and radiologic markers (BMD assessed using DXA). Children on AEDs for a longer duration (≥2 years) showed more severe side effects on BMD. Children receiving multiple AEDs are more prone to altered bone mineral status, especially with long duration of therapy. The study also highlights the role of DXA as a safe noninvasive method to assess BMD in children on long-term AEDs.
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Affiliation(s)
- Bothina Hasaneen
- Department of Pediatric, Pediatric Neurology Unit, Mansoura University, Mansoura, Egypt
| | - Riad Moustafa Elsayed
- Department of Pediatric, Pediatric Neurology Unit, Mansoura University, Mansoura, Egypt
| | - Nanees Salem
- Department of Pediatric, Pediatric Endocrinology Unit, Mansoura University, Mansoura, Egypt
| | - Ashraf Elsharkawy
- Department of Pediatric, Pediatric Endocrinology Unit, Mansoura University, Mansoura, Egypt
| | - Noha Tharwat
- Department of Pediatric, Pediatric Neurology Unit, Mansoura University, Mansoura, Egypt
| | - Khaled Fathy
- Department of Pediatric, Pediatric Neurology Unit, Mansoura University, Mansoura, Egypt
| | - Amany El-Hawary
- Department of Pediatric, Pediatric Endocrinology Unit, Mansoura University, Mansoura, Egypt
| | - Hadil M Aboelenin
- Department of Pediatric, Pediatric Endocrinology Unit, Mansoura University, Mansoura, Egypt
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Carpio LR, Bradley EW, Westendorf JJ. Histone deacetylase 3 suppresses Erk phosphorylation and matrix metalloproteinase (Mmp)-13 activity in chondrocytes. Connect Tissue Res 2017; 58:27-36. [PMID: 27662443 PMCID: PMC5609188 DOI: 10.1080/03008207.2016.1236088] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Histone deacetylase (Hdac3) inhibitors are emerging therapies for many diseases including cancers and neurological disorders; however, these drugs are teratogens to the developing skeleton. Hdac3 is essential for proper endochondral ossification as its deletion in chondrocytes increases cytokine signaling and the expression of matrix remodeling enzymes. Here we explored the mechanism by which Hdac3 controls matrix metalloproteinase (Mmp)-13 expression in chondrocytes. In Hdac3-depleted chondrocytes, extracellular signal-regulated kinase (Erk)1/2 as well as its downstream substrate, Runx2, were hyperphosphorylated as a result of decreased expression and activity of the Erk1/2 specific phosphatase, Dusp6. Erk1/2 kinase inhibitors and Dusp6 adenoviruses reduced Mmp13 expression and partially rescued matrix production in Hdac3-deficient chondrocytes. Postnatal chondrocyte-specific deletion of Hdac3 with an inducible Col2a1-Cre caused premature production of pErk1/2 and Mmp13 in the growth plate. Thus, Hdac3 controls the temporal and spatial expression of tissue-remodeling genes in chondrocytes to ensure proper endochondral ossification during development.
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Affiliation(s)
- Lomeli R. Carpio
- Mayo Graduate School, Rochester, MN, USA
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | | | - Jennifer J. Westendorf
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Simko J, Karesova I, Kremlacek J, Fekete S, Zimcikova E, Malakova J, Zivna H, Valis M, Palicka V. The effect of lamotrigine and phenytoin on bone turnover and bone strength: A prospective study in Wistar rats. Epilepsy Res 2016; 128:113-118. [DOI: 10.1016/j.eplepsyres.2016.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/22/2016] [Accepted: 10/22/2016] [Indexed: 11/08/2022]
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Carpio LR, Bradley EW, McGee-Lawrence ME, Weivoda MM, Poston DD, Dudakovic A, Xu M, Tchkonia T, Kirkland JL, van Wijnen AJ, Oursler MJ, Westendorf JJ. Histone deacetylase 3 supports endochondral bone formation by controlling cytokine signaling and matrix remodeling. Sci Signal 2016; 9:ra79. [PMID: 27507649 PMCID: PMC5409103 DOI: 10.1126/scisignal.aaf3273] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Histone deacetylase (HDAC) inhibitors are efficacious epigenetic-based therapies for some cancers and neurological disorders; however, each of these drugs inhibits multiple HDACs and has detrimental effects on the skeleton. To better understand how HDAC inhibitors affect endochondral bone formation, we conditionally deleted one of their targets, Hdac3, pre- and postnatally in type II collagen α1 (Col2α1)-expressing chondrocytes. Embryonic deletion was lethal, but postnatal deletion of Hdac3 delayed secondary ossification center formation, altered maturation of growth plate chondrocytes, and increased osteoclast activity in the primary spongiosa. HDAC3-deficient chondrocytes exhibited increased expression of cytokine and matrix-degrading genes (Il-6, Mmp3, Mmp13, and Saa3) and a reduced abundance of genes related to extracellular matrix production, bone development, and ossification (Acan, Col2a1, Ihh, and Col10a1). Histone acetylation increased at and near genes that had increased expression. The acetylation and activation of nuclear factor κB (NF-κB) were also increased in HDAC3-deficient chondrocytes. Increased cytokine signaling promoted autocrine activation of Janus kinase (JAK)-signal transducer and activator of transcription (STAT) and NF-κB pathways to suppress chondrocyte maturation, as well as paracrine activation of osteoclasts and bone resorption. Blockade of interleukin-6 (IL-6)-JAK-STAT signaling, NF-κB signaling, and bromodomain extraterminal proteins, which recognize acetylated lysines and promote transcriptional elongation, significantly reduced Il-6 and Mmp13 expression in HDAC3-deficient chondrocytes and secondary activation in osteoclasts. The JAK inhibitor ruxolitinib also reduced osteoclast activity in Hdac3 conditional knockout mice. Thus, HDAC3 controls the temporal and spatial expression of tissue-remodeling genes and inflammatory responses in chondrocytes to ensure proper endochondral ossification during development.
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Affiliation(s)
- Lomeli R Carpio
- Mayo Graduate School, Mayo Clinic, Rochester, MN 55905, USA. Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Meghan E McGee-Lawrence
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA. Institute of Regenerative and Reparative Medicine, Augusta University, Augusta, GA 30912, USA
| | - Megan M Weivoda
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Daniel D Poston
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA. Creighton University, Omaha, NE 68102, USA
| | - Amel Dudakovic
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Ming Xu
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, USA
| | - Tamar Tchkonia
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, USA
| | - James L Kirkland
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, USA
| | - Andre J van Wijnen
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Merry Jo Oursler
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA. Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Jennifer J Westendorf
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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Abstract
The involvement of the epigenome in complex diseases is becoming increasingly clear and more feasible to study due to new genomic and computational technologies. Moreover, therapies altering the activities of proteins that modify and interpret the epigenome are available to treat cancers and neurological disorders. Many additional uses have been proposed for these drugs based on promising preclinical results, including in arthritis models. Understanding the effects of epigenomic drugs on the skeleton is of interest because of its importance in maintaining overall health and fitness. In this review, we summarize ongoing advancements in how one class of epigenetic modifiers, histone deacetylases (Hdacs), controls normal cartilage development and homeostasis, as well as recent work aimed at understanding the alterations in the expression and activities of these enzymes in osteoarthritis (OA). We also review recent studies utilizing Hdac inhibitors and discuss the potential therapeutic benefits and limitations of these drugs for preventing cartilage destruction in OA.
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Fan HC, Lee HS, Chang KP, Lee YY, Lai HC, Hung PL, Lee HF, Chi CS. The Impact of Anti-Epileptic Drugs on Growth and Bone Metabolism. Int J Mol Sci 2016; 17:E1242. [PMID: 27490534 PMCID: PMC5000640 DOI: 10.3390/ijms17081242] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/20/2016] [Accepted: 07/28/2016] [Indexed: 12/13/2022] Open
Abstract
Epilepsy is a common neurological disorder worldwide and anti-epileptic drugs (AEDs) are always the first choice for treatment. However, more than 50% of patients with epilepsy who take AEDs have reported bone abnormalities. Cytochrome P450 (CYP450) isoenzymes are induced by AEDs, especially the classical AEDs, such as benzodiazepines (BZDs), carbamazepine (CBZ), phenytoin (PT), phenobarbital (PB), and valproic acid (VPA). The induction of CYP450 isoenzymes may cause vitamin D deficiency, hypocalcemia, increased fracture risks, and altered bone turnover, leading to impaired bone mineral density (BMD). Newer AEDs, such as levetiracetam (LEV), oxcarbazepine (OXC), lamotrigine (LTG), topiramate (TPM), gabapentin (GP), and vigabatrin (VB) have broader spectra, and are safer and better tolerated than the classical AEDs. The effects of AEDs on bone health are controversial. This review focuses on the impact of AEDs on growth and bone metabolism and emphasizes the need for caution and timely withdrawal of these medications to avoid serious disabilities.
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Affiliation(s)
- Hueng-Chuen Fan
- Department of Pediatrics, Tungs' Taichung Metroharbor Hospital, Wuchi, 435 Taichung, Taiwan.
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, 356 Miaoli, Taiwan.
| | - Herng-Shen Lee
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, 813 Kaohsiung, Taiwan.
| | - Kai-Ping Chang
- Department of Pediatrics, Taipei Veterans General Hospital, 112 Taipei, Taiwan.
| | - Yi-Yen Lee
- Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, 112 Taipei, Taiwan.
- Faculty of Medicine, National Yang-Ming University, 112 Taipei, Taiwan.
| | - Hsin-Chuan Lai
- Department of Pediatrics, Tungs' Taichung Metroharbor Hospital, Wuchi, 435 Taichung, Taiwan.
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, 356 Miaoli, Taiwan.
| | - Pi-Lien Hung
- Department of Pediatrics, Kaohsiung Chang Gung Medical Center, 833 Kaohsiung, Taiwan.
| | - Hsiu-Fen Lee
- Department of Pediatrics, Taichung Veterans General Hospital, 407 Taichung, Taiwan.
| | - Ching-Shiang Chi
- Department of Pediatrics, Tungs' Taichung Metroharbor Hospital, Wuchi, 435 Taichung, Taiwan.
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, 356 Miaoli, Taiwan.
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Bone health and vitamin D status in young epilepsy patients on valproate monotherapy. Clin Neurol Neurosurg 2016; 146:52-6. [DOI: 10.1016/j.clineuro.2016.04.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 01/28/2016] [Accepted: 04/25/2016] [Indexed: 11/19/2022]
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Effect of antiepileptic drug (valproic acid) on children growth. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2016. [DOI: 10.1016/j.epag.2016.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lin CM, Fan HC, Chao TY, Chu DM, Lai CC, Wang CC, Chen SJ. Potential effects of valproate and oxcarbazepine on growth velocity and bone metabolism in epileptic children- a medical center experience. BMC Pediatr 2016; 16:61. [PMID: 27142370 PMCID: PMC4855910 DOI: 10.1186/s12887-016-0597-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 04/21/2016] [Indexed: 11/18/2022] Open
Abstract
Background Children with longstanding use of antiepileptic drugs (AEDs) are susceptible to developing low bone mineral density and an increased fracture risk. However, the literature regarding the effects of AEDs on growth in epileptic children is limited. The aim of this study was to investigate the potential effects of valproate (VPA) and/or oxcarbazepine (OXC) therapy on growth velocity and bone metabolism. Methods Seventy-three ambulatory children (40 boys and 33 girls) with epilepsy, aged between 1 and 18 years (mean age 9.8 ± 4.1 years), were evaluated for growth velocity before and for 1 year after VPA and/or OXC treatment. The bone resorption marker serum tartrate-resistant acid phosphatase 5b (TRAcP5b) and the bone formation marker serum bone-specific alkaline phosphatase (BAP) were measured post-AEDs therapy for 1 year. Results The difference in growth velocity (ΔHt) and body weight change (ΔWt) between pre- and post-AEDs treatment were -1.0 ± 2.8 cm/year (P < 0.05) and 0.1 ± 3.9 kg/year (P = 0.84), respectively. The study population had serum TRAcP5b-SDS of -1.6 ± 1.2 and BAP-SDS of 1.7 ± 3.7 compared with sex- and age-matched healthy children. Significant correlation between serum TRAcP 5b and BAP activities was noted (r = 0.60, p < 0.001). There was a positive correlation between growth velocity and serum TRAcP 5b activity after AED treatment (r = 0.42, p < 0.01). No correlation was found between ΔHt, ΔWt, serum TRAcP 5b, BAP activity and types of AEDs. Conclusion Growth velocity was significantly decreased in epileptic children after 1 year of VPA and/or OXC treatment. The effect of VPA and/or OXC therapy on dysregulation of bone metabolism might play a crucial role in physical growth. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0597-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chien-Ming Lin
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, No.161, Cheng-Kung Road, Section 6, Nei-Hu, Taipei, 114, Taiwan
| | - Hueng-Chuen Fan
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan.,Department of Pediatrics, Tungs' Taichung MetroHarbor Hospital, No.699, Section 1, Zhongqi Road, Wuqi Township, Taichung, 435, Taiwan
| | - Tsu-Yi Chao
- Graduate Institute of Medical Sciences, National Defense Medical Center, No.161, Cheng-Kung Road, Section 6, Nei-Hu, Taipei, 114, Taiwan.,Division of Hematology/Oncology, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, No.291, Zhongzheng Road, Zhonghe District, New Taipei City, 235, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, No.252, Wu Hsing Street, Taipei, 110, Taiwan
| | - Der-Ming Chu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan
| | - Chi-Chieh Lai
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan
| | - Chih-Chien Wang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan
| | - Shyi-Jou Chen
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No.325, Cheng-Kung Road, Section 2, Nei-Hu, Taipei, 114, Taiwan.
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Abstract
The increased rate of fractures associated with epilepsy has been long recognised but remains incompletely understood. Study quality and study results have varied, with some but not all studies showing bone diseases including osteoporosis and/or osteomalacia, and a high prevalence of vitamin D insufficiency and deficiency are also noted. Falls risk can also be higher in patients with epilepsy taking anti-epileptic medications, potentially leading to fracture. Larger research collaborations are recommended to further advance understanding in this field, particularly to examine underlying genetic and pharmacogenomic associations of epilepsy and anti-epileptic medication usage and its association with bone diseases and fractures, as well as further investigation into optimal management of bone health in epilepsy.
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Affiliation(s)
- Sandra J Petty
- Melbourne Brain Centre, The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia.
- Melbourne Brain Centre at The Royal Melbourne Hospital, The Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.
- Academic Centre, Ormond College, Parkville, VIC, Australia.
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.
- Department of Neurology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.
- Department of Neurology, Western Health, Sunshine, VIC, Australia.
- Department of Medical Education, The University of Melbourne, Parkville, VIC, Australia.
| | - Helen Wilding
- St Vincent's Hospital Library Service, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - John D Wark
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
- Bone and Mineral Medicine, The Royal Melbourne Hospital, Parkville, VIC, Australia
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Calcium and Vitamin D Supplement Prescribing Practices among Providers Caring for Children with Autism Spectrum Disorders: Are We Addressing Bone Health? AUTISM RESEARCH AND TREATMENT 2016; 2016:6763205. [PMID: 27042348 PMCID: PMC4799806 DOI: 10.1155/2016/6763205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/25/2016] [Accepted: 02/09/2016] [Indexed: 11/17/2022]
Abstract
Children with autism spectrum disorders (ASD) have several risk factors for low bone mineral density. The gluten-free, casein-free (GFCF) diet is a complementary therapy sometimes used in ASD that raises concerns for the adequacy of calcium and vitamin D intake. This study evaluated the prescribing practices of calcium and vitamin D supplements and the practice of checking 25-hydroxy vitamin D (25(OH)D) levels by providers in 100 children with ASD, 50 of whom were on the GFCF diet. Fifty-two percent and 46% of children on the GFCF diet were on some form of vitamin D and calcium supplements, respectively, compared to 18% and 14% of those not on this diet. Twenty-four percent of children in the GFCF group had a documented 25(OH)D level compared to none in the non-GFCF group. The data highlight a gap in calcium and vitamin D supplement prescribing practices among providers caring for children with ASD as well as a gap in the practice of checking 25(OH)D levels.
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Goldberg-Stern H, Itzhaki T, Landau Z, de Vries L. Endocrine Effects of Valproate versus Carbamazepine in Males with Epilepsy: A Prospective Study. Horm Res Paediatr 2016; 83:332-9. [PMID: 25792241 DOI: 10.1159/000375374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 01/16/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To prospectively evaluate the long-term impact of valproate (VPA) versus carbamazepine (CBZ) on anthropometric, hormonal, and metabolic parameters in young male patients treated for epilepsy. METHODS Of 61 boys with newly diagnosed epilepsy followed up, 24 were excluded from analysis (17 were lost to follow-up and 7 changed therapy within <1 year). Findings were compared by time, treatment (VPA or CBZ), and epilepsy type (generalized or partial) as well as against a matched control group with adequately treated hypothyroidism. RESULTS Twenty-four boys were treated with VPA and 13 with CBZ. The weight-standard deviation score (SDS) significantly increased during the first 6 months of treatment (p < 0.001), irrespective of the drug type, but decreased between the first and the last visit (p = 0.01). In patients with generalized epilepsy, there was a slight decrease in height- and weight-SDS between the first and the last visit (p = 0.04 and p = 0.01, respectively). The height-SDS at the last visit was comparable to the parental height-SDS. The mean age at puberty onset was 11.2 and 11.4 years in the study and the control group, respectively (p = 0.08). There were no significant differences in the other parameters by treatment or epilepsy type. CONCLUSIONS Long-term therapy with VPA or CBZ has no significant endocrinological or metabolic adverse effect on male children and adolescents with epilepsy.
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Affiliation(s)
- Hadassa Goldberg-Stern
- Epilepsy Service, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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Arora E, Singh H, Gupta YK. Impact of antiepileptic drugs on bone health: Need for monitoring, treatment, and prevention strategies. J Family Med Prim Care 2016; 5:248-253. [PMID: 27843822 PMCID: PMC5084542 DOI: 10.4103/2249-4863.192338] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Epilepsy is the most common neurological disorder affecting approximately 50 million people worldwide. In India, overall prevalence of epilepsy is reported to be 5.59/1000 population. Antiepileptic drugs (AEDs) constitute the main-stay of treatment with a large number of AEDs available in the market. High incidence of adverse effects is a major limitation with AEDs. One of the major concerns is significant metabolic effects on the bone. However, little attention has been paid to this issue because most of the bone effects remain subclinical for a long time and may take years to manifest clinically. The main effects include hypocalcemia, hypophosphatemia, reduced serum levels of Vitamin D, increase in parathormone (PTH) levels, and alterations in bone turnover markers. The CYP450 enzyme-inducing AEDs such as phenytoin, phenobarbital, carbamazepine, and primidone are the most common AEDs associated with bone disorders while the data regarding the effect of valproate and newer AEDs such as lamotrigine, gabapentin, vigabatrin, levetiracetam, and topiramate on bone metabolism and bone density are scanty and controversial. Deficiency of Vitamin D is commonly described as a cause for the bone loss in epileptic patients while others being decreased absorption of calcium, increased PTH levels, and inhibition of calcitonin secretion, etc. However, there are no formal practical guidelines for the management of bone disease among those taking AEDs. Evidence-based strategies regarding monitoring, prevention, and treatment of bone diseases in patients on AED therapy are needed.
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Affiliation(s)
- Ekta Arora
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Harmanjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Yogendra Kumar Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
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Bradley EW, Carpio LR, van Wijnen AJ, McGee-Lawrence ME, Westendorf JJ. Histone Deacetylases in Bone Development and Skeletal Disorders. Physiol Rev 2015; 95:1359-81. [PMID: 26378079 PMCID: PMC4600951 DOI: 10.1152/physrev.00004.2015] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Histone deacetylases (Hdacs) are conserved enzymes that remove acetyl groups from lysine side chains in histones and other proteins. Eleven of the 18 Hdacs encoded by the human and mouse genomes depend on Zn(2+) for enzymatic activity, while the other 7, the sirtuins (Sirts), require NAD2(+). Collectively, Hdacs and Sirts regulate numerous cellular and mitochondrial processes including gene transcription, DNA repair, protein stability, cytoskeletal dynamics, and signaling pathways to affect both development and aging. Of clinical relevance, Hdacs inhibitors are United States Food and Drug Administration-approved cancer therapeutics and are candidate therapies for other common diseases including arthritis, diabetes, epilepsy, heart disease, HIV infection, neurodegeneration, and numerous aging-related disorders. Hdacs and Sirts influence skeletal development, maintenance of mineral density and bone strength by affecting intramembranous and endochondral ossification, as well as bone resorption. With few exceptions, inhibition of Hdac or Sirt activity though either loss-of-function mutations or prolonged chemical inhibition has negative and/or toxic effects on skeletal development and bone mineral density. Specifically, Hdac/Sirt suppression causes abnormalities in physiological development such as craniofacial dimorphisms, short stature, and bone fragility that are associated with several human syndromes or diseases. In contrast, activation of Sirts may protect the skeleton from aging and immobilization-related bone loss. This knowledge may prolong healthspan and prevent adverse events caused by epigenetic therapies that are entering the clinical realm at an unprecedented rate. In this review, we summarize the general properties of Hdacs/Sirts and the research that has revealed their essential functions in bone forming cells (e.g., osteoblasts and chondrocytes) and bone resorbing osteoclasts. Finally, we offer predictions on future research in this area and the utility of this knowledge for orthopedic applications and bone tissue engineering.
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Affiliation(s)
- Elizabeth W Bradley
- Mayo Clinic, Departments of Orthopedic Surgery and of Biochemistry and Molecular Biology, and Mayo Graduate School, Rochester, Minnesota; and Georgia Regents University, Department of Cellular Biology and Anatomy, Augusta, Georgia
| | - Lomeli R Carpio
- Mayo Clinic, Departments of Orthopedic Surgery and of Biochemistry and Molecular Biology, and Mayo Graduate School, Rochester, Minnesota; and Georgia Regents University, Department of Cellular Biology and Anatomy, Augusta, Georgia
| | - Andre J van Wijnen
- Mayo Clinic, Departments of Orthopedic Surgery and of Biochemistry and Molecular Biology, and Mayo Graduate School, Rochester, Minnesota; and Georgia Regents University, Department of Cellular Biology and Anatomy, Augusta, Georgia
| | - Meghan E McGee-Lawrence
- Mayo Clinic, Departments of Orthopedic Surgery and of Biochemistry and Molecular Biology, and Mayo Graduate School, Rochester, Minnesota; and Georgia Regents University, Department of Cellular Biology and Anatomy, Augusta, Georgia
| | - Jennifer J Westendorf
- Mayo Clinic, Departments of Orthopedic Surgery and of Biochemistry and Molecular Biology, and Mayo Graduate School, Rochester, Minnesota; and Georgia Regents University, Department of Cellular Biology and Anatomy, Augusta, Georgia
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Bűdi T, Tóth K, Nagy A, Szever Z, Kiss Á, Temesvári M, Háfra E, Garami M, Tapodi A, Monostory K. Clinical significance of CYP2C9-status guided valproic acid therapy in children. Epilepsia 2015; 56:849-55. [DOI: 10.1111/epi.13011] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Tamás Bűdi
- 2nd Department of Pediatrics; Semmelweis University; Budapest Hungary
| | - Katalin Tóth
- Research Center for Natural Sciences; Hungarian Academy of Sciences; Budapest Hungary
| | - Andrea Nagy
- Heim Pál Children's Hospital; Budapest Hungary
| | | | - Ádám Kiss
- Research Center for Natural Sciences; Hungarian Academy of Sciences; Budapest Hungary
| | - Manna Temesvári
- Research Center for Natural Sciences; Hungarian Academy of Sciences; Budapest Hungary
| | - Edit Háfra
- Research Center for Natural Sciences; Hungarian Academy of Sciences; Budapest Hungary
| | - Miklós Garami
- 2nd Department of Pediatrics; Semmelweis University; Budapest Hungary
| | | | - Katalin Monostory
- Research Center for Natural Sciences; Hungarian Academy of Sciences; Budapest Hungary
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Vestergaard P. Effects of antiepileptic drugs on bone health and growth potential in children with epilepsy. Paediatr Drugs 2015; 17:141-50. [PMID: 25567416 DOI: 10.1007/s40272-014-0115-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Bone health may be impaired in children with epilepsy. OBJECTIVES Our objective was to characterize bone mineral density (BMD) and bone growth in children receiving antiepileptic drugs (AEDs) and to assess the effects of co-morbidity, vitamin D deficiency, and type of drugs used. DATA SOURCES Data were sourced from PubMed, Embase, and Web of Science. ELIGIBILITY CRITERIA Cross-sectional, cohort, case-control, or randomized controlled trials reporting BMD or parameters of bone growth. PARTICIPANTS Children with epilepsy compared with controls. INTERVENTIONS AEDS or ketogenic diet. STUDY APPRAISAL The studies were evaluated by one author. SYNTHESIS METHODS Studies were categorized as reporting reduced BMD or not at any skeletal site as outcome. A logistic regression was performed for age, percent boys, study design, type of AED, co-morbidity or not, and signs of vitamin D deficiency/osteomalacia or not. RESULTS Carbamazepine and valproate were analyzed as monotherapy in 11 studies, and for both drugs a limited decrease in BMD seemed present. For oxcarbazepine, levetiracetam, phenytoin, phenobarbital, and topiramate, only one study with monotherapy was found for each drug, none of which reported decreased bone density. Polytherapy with AEDs seemed to be associated with a larger decrease in bone density than was monotherapy. Although few studies were available on bone growth, these did indicate that bone growth may be impaired among users of AEDs. Ketogenic diet may be associated with decreased bone density. The main determinant of normal BMD was absence of vitamin D deficiency/osteomalacia. LIMITATIONS The studies differed in skeletal sites studied and most were cross-sectional. No head-to-head comparisons of AEDs were performed. Children treated with polytherapy or ketogenic diet may have more complicated and severe disease than those treated with monotherapy. The underlying cause of epilepsy and vitamin D deficiency may contribute to impaired bone growth and density. CONCLUSIONS Reduced bone density, impaired bone growth, and vitamin D deficiency may be seen in children treated with drugs against epilepsy. IMPLICATIONS Measures to correct vitamin D deficiency, calcium intake should be taken.
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Affiliation(s)
- Peter Vestergaard
- Departments of Clinical Medicine and Endocrinology, Aalborg University Hospital, Mølleparkvej 4, 9100, Aalborg, Denmark,
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Paragliola RM, Prete A, Kaplan PW, Corsello SM, Salvatori R. Treatment of hypopituitarism in patients receiving antiepileptic drugs. Lancet Diabetes Endocrinol 2015; 3:132-40. [PMID: 24898833 DOI: 10.1016/s2213-8587(14)70081-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Evidence suggests that there may be drug interactions between antiepileptic drugs and hormonal therapies, which can present a challenge to endocrinologists dealing with patients who have both hypopituitarism and neurological diseases. Data are scarce for this subgroup of patients; however, data for the interaction of antiepileptic drugs with the pituitary axis have shown that chronic use of many antiepileptic drugs, such as carbamazepine, oxcarbazepine, and topiramate, enhances hepatic cytochrome P450 3A4 (CYP3A4) activity, and can decrease serum concentrations of sex hormones. Other antiepileptic drugs increase sex hormone-binding globulin, which reduces the bioactivity of testosterone and estradiol. Additionally, the combined oestrogen-progestagen contraceptive pill might decrease lamotrigine concentrations, which could worsen seizure control. Moreover, sex hormones and their metabolites can directly act on neuronal excitability, acting as neurosteroids. Because carbamazepine and oxcarbazepine can enhance the sensitivity of renal tubules, a reduction in desmopressin dose might be necessary in patients with central diabetes insipidus. Although the effects of antiepileptic drugs in central hypothyroidism have not yet been studied, substantial evidence indicates that several antiepileptic drugs can increase thyroid hormone metabolism. However, although it is reasonable to expect a need for a thyroxine dose increase with some antiepileptic drugs, the effect of excessive thyroxine in lowering seizure threshold should also be considered. There are no reports of significant interactions between antiepileptic drugs and the efficacy of human growth hormone therapy, and few data are available for the effects of second-generation antiepileptic drugs on hypopituitarism treatment.
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Affiliation(s)
- Rosa Maria Paragliola
- Unit of Endocrinology, Facoltà di Medicina Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Prete
- Unit of Endocrinology, Facoltà di Medicina Università Cattolica del Sacro Cuore, Rome, Italy
| | - Peter W Kaplan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore MD, USA
| | | | - Roberto Salvatori
- Department of Medicine, Division of Endocrinology, Metabolism and Diabetes and Pituitary Center, Johns Hopkins University School of Medicine, Baltimore MD, USA.
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Longitudinal change of vitamin D status in children with epilepsy on antiepileptic drugs: prevalence and risk factors. Pediatr Neurol 2015; 52:153-9. [PMID: 25492388 DOI: 10.1016/j.pediatrneurol.2014.10.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 10/04/2014] [Accepted: 10/08/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Our aim was to evaluate the prevalence and risk factors of vitamin D deficiency and the changes of vitamin D level among children with epilepsy on antiepileptic drugs. METHODS The levels of serum 25-hydroxy vitamin D were measured at the start of antiepileptic drugs and at 6- to 12-month intervals in children with epilepsy taking antiepileptic drugs in Pusan National University Children's Hospital. Vitamin D deficiency was defined as 25-hydroxy vitamin D levels <20 ng/mL and insufficiency between 21 and 29 ng/mL. RESULTS A total of 143 children (103 boys and 40 girls) with the mean age of 7.4 ± 5.4 years were included. The mean follow-up duration was 1.8 ± 0.8 years. At the start of antiepileptic drugs and the last follow-up, vitamin D deficiency or insufficiency was recognized in 56.6% (81 of 143) and 79.0% (113 of 143), respectively (P < 0.01). The mean value of initial 25-hydroxy vitamin D was 31.1 ± 14.7 ng/mL, which was significantly decreased to 20.2 ± 14.9 ng/mL (P < 0.01) in the last follow-up. Polytherapy (-16.0 ± 13.6 ng/mL), longer duration of ≥2 years (-23.5 ± 9.1 ng/mL), tube feeding (-18.2 ± 14.5 ng/mL), and overweight with body mass index of eighty-fifth percentile or greater (-17.0 ± 12.1 ng/mL) had a significant negative effect for the longitudinal change of 25-hydroxy vitamin D. Age, etiologies, seizure outcomes, and type of antiepileptic drugs (enzyme-inducing versus nonenzyme-inducing antiepileptic drugs) did not affect the longitudinal decrease of 25-hydroxy vitamin D. CONCLUSIONS A high proportion of these children on antiepileptic drugs had hypovitaminosis D and a significant decrease between the initial and the last follow-up. Polytherapy and longer duration of antiepileptic drugs, tube feeding, and overweight were independently associated with longitudinally significant decrease of 25-hydroxy vitamin D.
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Goldberg-Stern H, Yaacobi E, Phillip M, de Vries L. Endocrine effects of valproic acid therapy in girls with epilepsy: a prospective study. Eur J Paediatr Neurol 2014; 18:759-65. [PMID: 25139344 DOI: 10.1016/j.ejpn.2014.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 05/20/2014] [Accepted: 07/11/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND/AIM It is controversial whether the endocrine dysfunction in epilepsy patients is caused by the epilepsy itself, the antiepileptic therapy, or both. We prospectively evaluated the long-term impact of valproic acid monotherapy compared to other anti-epileptic drugs on anthropometric, metabolic, hormonal, and ultrasonographic parameters in girls with epilepsy. METHODS Fifty-seven female patients with epilepsy who had started therapy at mean age of 11.5 ± 3.3 years, 42 with valproic acid (mean dose 13.1 ± 7.0 mg/kg/day and 15 with other anti-epileptic agents were followed for a mean of 3.2 years (range 1.0-8.5 years) in our center. Clinical, hormonal and transabdominal pelvic ultrasound data were collected at 3 time points: before and 6-12 months after onset of anti-epileptic drug treatment; and at the last visit while patients were still taking anti-epileptic drugs. RESULTS There were no significant between-group differences regarding changes in height, body mass index standard deviation score, levels of glucose and insulin, or lipid and endocrine profile from first to last visits. Mean thyroid-stimulating hormone level increased significantly between first and last visit only in the valproic acid group (p < 0.001), with no significant difference in free T4 level over time or between groups. The rate of clinical polycystic ovary syndrome for the valproic acid group (11%) was comparable to that reported in healthy controls (5-10%). CONCLUSIONS Administration of valproic acid had no adverse effect on body weight, metabolic status or endocrine function over an average follow-up of 3.2 years. Valproic acid appears to be safe for use in girls with epilepsy.
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Affiliation(s)
- Hadassa Goldberg-Stern
- Epilepsy Service, Department of Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eyal Yaacobi
- Department of Pediatrics, Assaf Harofeh Medical Center, Zriffin, Israel
| | - Moshe Phillip
- Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat de Vries
- Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Anwar MJ, Radhakrishna K, Vohora D. Phenytoin and sodium valproate but not levetiracetam induce bone alterations in female mice. Can J Physiol Pharmacol 2014; 92:507-11. [DOI: 10.1139/cjpp-2013-0504] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Adverse effects on the bone are amongst the potentially adverse clinical consequences with antiepileptic drugs (AEDs). This study compared the effects of 3 AEDs (phenytoin (PHT), sodium valproate (SVP), and levetiracetam (LTM)) on the bones of a Swiss strain of albino female mice. Drugs were administered daily for 4 months at doses that produced plasma concentrations corresponding to the clinically relevant therapeutic ranges. PHT and SVP (but not LTM) significantly lowered the bone mineral density (BMD) of lumbar vertebrae (L2–L4) as evaluated by dual-energy X-ray absorptiometry (DEXA) scan. The findings were supported by histopathology of vertebral (lumbar) bone and analysis of bone turnover markers. While both PHT and SVP reduced alkaline phosphatase (ALP) and hydroxyproline (HxP) in lumbar vertebrae, and elevated tartarate-resistant acid phosphatase (TRAP) and urinary excretion of calcium, LTM did not affect any of these markers of bone turnover, indicating that the drug might be a safer option in female epileptic patients prone to bone changes.
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Affiliation(s)
- Md. Jamir Anwar
- Department of Pharmacology, Faculty of Pharmacy, Jamia Hamdard, Hamdard University, New Delhi 110062, India
| | - K.V. Radhakrishna
- Department of Clinical Research, National Institute of Nutrition (NIN), Tarnaka, Hyderabad 500007, India
| | - Divya Vohora
- Department of Pharmacology, Faculty of Pharmacy, Jamia Hamdard, Hamdard University, New Delhi 110062, India
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