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Ghimire U, Kandel R, Ko SW, Adhikari JR, Kim CS, Park CH. Electrochemical technique to develop surface-controlled polyaniline nano-tulips (PANINTs) on PCL-reinforced chitosan functionalized (CS-f-Fe 2O 3) scaffolds for stimulating osteoporotic bone regeneration. Int J Biol Macromol 2024; 264:130608. [PMID: 38447840 DOI: 10.1016/j.ijbiomac.2024.130608] [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: 12/14/2023] [Revised: 02/15/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
Bone defects pose significant challenges in orthopedic surgery, often leading to suboptimal outcomes and complications. Addressing these challenges, we employed a three-electrode electrochemical system to fabricate surface-controlled polyaniline nano-tulips (PANINTs) decorated polycaprolactone (PCL) reinforced chitosan functionalized iron oxide nanoparticles (CS-f-Fe2O3) scaffolds. These structures were designed to emulate the natural extracellular matrix (ECM) and promote enhanced osseointegration by establishing a continuous interface between host bone and graft, thereby improving both biological processes and mechanical stability. In vitro experiments demonstrated that PANINTs-PCL/CS-f-Fe2O3 substrates significantly promoted the proliferation, differentiation, and spontaneous outgrowth and extension of MC3T3-E1 cell activity. The nanomaterials exhibited increased cell viability and osteogenic differentiation, as evidenced by elevated expression of bone-related markers such as ALP, ARS, COL-I, RUNX2, and SPP-I, as determined by qRT-PCR. Our findings underscore the regenerative potential of in situ cell culture systems for bone defects, emphasizing the targeted stimulation of essential cell subpopulations to facilitate rapid bone tissue regeneration.
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Affiliation(s)
- Upasana Ghimire
- Department of Bionanotechnology and Bioconvergence Engineering, Graduate School, Jeonbuk National University, Jeonju 561-756, Republic of Korea
| | - Rupesh Kandel
- Department of Bionanotechnology and Bioconvergence Engineering, Graduate School, Jeonbuk National University, Jeonju 561-756, Republic of Korea; Division of Mechanical Design Engineering, Jeonbuk National University, Jeonju 561-756, Republic of Korea.
| | - Sung Won Ko
- Department of Bionanotechnology and Bioconvergence Engineering, Graduate School, Jeonbuk National University, Jeonju 561-756, Republic of Korea; Department of Bionanosystem Engineering, Graduate School, Jeonbuk National University, Jeonju 561-756, Republic of Korea
| | - Jhalak Raj Adhikari
- Division of Mechanical Design Engineering, Jeonbuk National University, Jeonju 561-756, Republic of Korea
| | - Cheol Sang Kim
- Department of Bionanosystem Engineering, Graduate School, Jeonbuk National University, Jeonju 561-756, Republic of Korea; Division of Mechanical Design Engineering, Jeonbuk National University, Jeonju 561-756, Republic of Korea.
| | - Chan Hee Park
- Department of Bionanotechnology and Bioconvergence Engineering, Graduate School, Jeonbuk National University, Jeonju 561-756, Republic of Korea; Division of Mechanical Design Engineering, Jeonbuk National University, Jeonju 561-756, Republic of Korea.
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Li Q, Zhang Z, Fang J. Hormonal Changes in Women with Epilepsy. Neuropsychiatr Dis Treat 2024; 20:373-388. [PMID: 38436042 PMCID: PMC10906279 DOI: 10.2147/ndt.s453532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/17/2024] [Indexed: 03/05/2024] Open
Abstract
Epilepsy is a prevalent neurological disorder among women globally, often requiring long-term treatment. Hormonal fluctuations in women with epilepsy (WWE) can have reciprocal effects on epilepsy and antiseizure medications (ASMs), posing significant challenges for WWE. Notably, WWE commonly experience endocrine alterations such as thyroid dysfunctions, low bone metabolism, and reproductive hormone irregularities. On the one hand, the presence of hormones in women with epilepsy affects their susceptibility to epilepsy as well as the metabolism of antiseizure medications in various ways. On the other hand, epilepsy itself and the use of antiseizure medications impact the production, secretion, and metabolism of hormones, resulting in low fertility, increased risk of pregnancy complications, negative offspring outcomes, and so on. In order to develop more precise treatment strategies in the future, it is necessary to comprehend the explicit relationships between hormones, epilepsy, and antiseizure medications, as well as to elucidate the currently known mechanisms underlying these interactions.
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Affiliation(s)
- Qiwei Li
- Department of Neurology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, 322000, People’s Republic of China
| | - Zhiyun Zhang
- Department of Neurology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, 322000, People’s Republic of China
- Department of Neurology, The Mianyang Central Hospital, Mianyang, Sichuan Province, 621000, People’s Republic of China
| | - Jiajia Fang
- Department of Neurology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, 322000, People’s Republic of China
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Parveen B, Penumallu NR, Shaik AR, Parveen A, Parveen R, Vohora D. The impact of antiseizure medication on bone heath: A systematic review of animal studies. Epilepsy Res 2024; 200:107302. [PMID: 38280331 DOI: 10.1016/j.eplepsyres.2024.107302] [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: 10/11/2023] [Revised: 12/01/2023] [Accepted: 01/11/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Antiseizure medications (ASMs) are known to potentially impact bone health, but existing literature presents conflicting results regarding their specific effects on bone mineralization, metabolism, and quality. OBJECTIVE This systematic review aims to establish a consensus regarding the influence of ASMs on bone health based on existing preclinical studies. METHODS Following SYRCLE and PRISMA guidelines, we conducted a systematic search in PubMed, Science Direct, and Google Scholar to identify relevant studies. Ultimately, 21 articles were selected for inclusion in this review. RESULTS Among the chosen studies, approximately half involved Wistar rats as experimental subjects. Levetiracetam and sodium valproate were the most frequently investigated drugs, with a typical treatment duration of 10-12 weeks. These studies exhibited a low risk of bias in aspects like sequence generation, random housing, random outcome assessment, and reporting bias. However, blinding in performance, allocation concealment, and detection were often rated as having a high risk of bias. The collective findings suggest that prolonged ASM use leads to reduced bone mineral density, altered bone turnover marker levels (including hypovitaminosis D, hypocalcemia, and secondary hyperparathyroidism), deterioration of bone microarchitecture, and decreased mechanical strength. CONCLUSION The adverse effects on bone associated with ASMs are not limited to enzyme-inducing drugs, as newer generation ASMs may also contribute to these effects. Hypovitaminosis D alone may not be solely responsible for ASM-induced bone issues, suggesting the involvement of other mechanisms. Furthermore, substantial variations were observed in the results of different preclinical studies on individual ASMs, highlighting the need to standardize animal study methodologies to enhance reproducibility and reduce variation.
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Affiliation(s)
- Bushra Parveen
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India; Centre of Excellence in Unani Medicine (Pharmacognosy & Pharmacology), Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India.
| | - Naveen Reddy Penumallu
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India; Centre of Excellence in Unani Medicine (Pharmacognosy & Pharmacology), Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Abdul Rahaman Shaik
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Abida Parveen
- Centre of Excellence in Unani Medicine (Pharmacognosy & Pharmacology), Bioactive Natural Product Laboratory, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Rabea Parveen
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Divya Vohora
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India.
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Guo X, Zhu Y, Ying C, Xu K, Hong Y. The impact of serum magnesium and calcium on the risk of epilepsy: A mendelian randomization study. CNS Neurosci Ther 2023; 29:3062-3067. [PMID: 37144591 PMCID: PMC10493656 DOI: 10.1111/cns.14248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 02/18/2023] [Accepted: 04/19/2023] [Indexed: 05/06/2023] Open
Abstract
AIMS To investigate the causal role of serum magnesium and calcium in epilepsy or any of its subtypes through Mendelian randomization (MR) approach. METHODS Single nucleotide polymorphisms (SNPs) associated with serum magnesium and calcium were used as the instrumental variables. MR analyses were performed using the summary-level data for epilepsy extracted from International League Against Epilepsy Consortium (15,212 cases and 29,677 controls) to obtain the causal estimates. The analyses were replicated using FinnGen data (7224 epilepsy cases and 208,845 controls), and a meta-analysis was then conducted. RESULTS The result of combined analyses showed that higher serum magnesium concentrations was associated with a reduced risk of overall epilepsy (odds ratios [OR] = 0.28, 95% confidence interval [CI], 0.12-0.62, p = 0.002). In ILAE, higher serum magnesium was suggestively associated with reduced risks of focal epilepsy (OR = 0.25, 95% CI 0.10-0.62, p = 0.003). However, the results cannot be repeated in sensitivity analyses. As for serum calcium, the results did not reach statistical significance with overall epilepsy (OR = 0.60, 95% CI, 0.31-1.17, p = 0.134). However, genetically predicted serum calcium concentrations showed an inverse association with risk of generalized epilepsy (OR = 0.35, 95% CI, 0.17-0.74, p = 0.006). CONCLUSION The current MR analysis did not support a causal relationship between serum magnesium and epilepsy, but showed a causally negative association between genetically determined serum calcium and generalized epilepsy.
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Affiliation(s)
- Xiaoming Guo
- Department of NeurosurgeryThe Second Affiliated Hospital, Zhejiang University School of MedicineHangzhouChina
- Department of NeurosurgeryTongde Hospital of Zhejiang ProvinceHangzhouChina
| | - Yueli Zhu
- Department of GeriatricsThe First Affiliated Hospital, Zhejiang University School of MedicineHangzhouChina
| | - Caidi Ying
- Department of NeurosurgeryThe Second Affiliated Hospital, Zhejiang University School of MedicineHangzhouChina
| | - Ke Xu
- Department of NeurosurgeryThe Second Affiliated Hospital, Zhejiang University School of MedicineHangzhouChina
| | - Yuan Hong
- Department of NeurosurgeryThe Second Affiliated Hospital, Zhejiang University School of MedicineHangzhouChina
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Miziak B, Czuczwar SJ. Editorial: Epilepsy and endocrine function. Front Endocrinol (Lausanne) 2023; 14:1288784. [PMID: 37842313 PMCID: PMC10569419 DOI: 10.3389/fendo.2023.1288784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023] Open
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Abdelrahman Ali MA, Sweed HS, Allam MF, Aly WW, Mohamed Matter AH, Abdelalim Elshabrawy WE. Proportion and Risk Factors of Silent Vertebral Fractures Among Egyptian Females With Fragility Hip Fracture Presenting to the Emergency Room of Ain Shams University Hospitals. Cureus 2023; 15:e46214. [PMID: 37905273 PMCID: PMC10613479 DOI: 10.7759/cureus.46214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Background Fragility fractures caused by osteoporosis are known to increase the risk of further fragility fractures. Also, several factors have been associated with an increasing risk of fracture in postmenopausal women with osteoporosis, as prior fracture, advancing age, low bone mineral density (BMD), greater risk or history of falls certain, pharmacologic therapies such as glucocorticoids, and medical conditions increase the risk of secondary osteoporosis and related fractures through their direct impact on bone density or structure. Menstrual history including age at menarche menopause and a history of amenorrhea is documented as a predicting osteoporotic fracture. Objective The aim of the current study is to find the proportion of hidden vertebral fractures among Egyptian females with fragility hip fracture. Patients and methods A cross-sectional study was conducted on patients who presented to the orthopedic emergency room (ER) of Ain Shams University Hospitals in Cairo, Egypt, from September 2020 to September 2021. Our inclusion criteria include females aged 40 years or older, who presented to the ER with fragility hip fractures. A simple random sample of females fulfilling our inclusion criteria for osteoporotic hip fracture was thoroughly investigated. Conventional lateral and anteroposterior radiographs of the dorsolumbar spine were obtained excluding those with high-impact fractures or pathological fractures. Results During the study period, a total of 43,935 persons presented to the orthopedic ER, of whom 30,901 were females, comprising 70.03% of total orthopedic ER visits. A sample of 150 females met our inclusion criteria. Results showed that 16 of our 150 cases had concomitant vertebral fracture, meaning that 10.7% of cases had hidden vertebral fracture at the time of osteoporotic hip fracture, as diagnosed by the screening lumbosacral plain X-rays. Older age at menarche, younger age at menopause, and amenorrhea are shown to be risk factors for hidden vertebral fracture in Egyptian females. Conclusion Osteoporosis is a complex and costly disease. Osteoporotic fractures may be largely preventable, as environmental factors are open to intervention, and effective pharmacological agents are available. Concomitant hidden vertebral fracture is prevalent among females with osteoporotic hip fractures, and those who had later menarche, earlier menopause, and menstrual irregularities have a higher incidence of developing associated vertebral fracture, which warrants identification and management to evade complications and mortality.
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Affiliation(s)
| | | | | | - Walaa W Aly
- Geriatrics, Ain Shams University, Cairo, EGY
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Mancera Alzate JM, Rodriguez Vélez LM. [Vitamin D deficiency in patients with epilepsy: consideration to take into account]. NUTR HOSP 2023; 40:905-906. [PMID: 37409727 DOI: 10.20960/nh.04737] [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] [Indexed: 07/07/2023] Open
Abstract
Introduction
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Affiliation(s)
- Juan Martin Mancera Alzate
- Departamento de Medicina Física y Rehabilitación. Universidad del Valle. Hospital Universitario del Valle ESE
| | - Lina María Rodriguez Vélez
- Departamento de Medicina Física y Rehabilitación. Universidad del Valle. Hospital Universitario del Valle ESE
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Evaluation of the effect of antiepileptic drugs on mandibular bone quality by fractal analysis. Oral Radiol 2023:10.1007/s11282-023-00671-0. [PMID: 36786955 DOI: 10.1007/s11282-023-00671-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/21/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES Antiepileptic drugs (AEDs) are used to control seizures in epilepsy and their long-term use is common. AED use has been associated with decreased bone mineral density. The aim of this study is to determine the effect of AEDs on mandibular bone quality using fractal analysis and panoramic morphometric indices. METHODS In this study, dental and medical records of 132 patients (66 AED users and 66 control group) were used. Fractal analysis (FA), the panoramic mandibular index (PMI), mandibular cortical width (MCW), and Klemetti index (KI) measurements were performed on panoramic radiographs. RESULTS In all metrics, the mean values of the study group were significantly lower than the control group (p < 0.000). There is a statistically significant difference between the study and control groups in terms of KI distribution (p < 0.000). The mean fractal dimension (FD) values in each measured region of the female patients in the study group were found to be significantly lower than the female patients in the control group (p < 0.05). The mean FD values measured in ROI-2 and ROI-3 of male patients in the study group were found to be significantly lower than male patients in the control group (p < 0.05). CONCLUSION The side effects of AEDs on bone metabolism were shown in this study. Dentists examining patients with epilepsy should be careful about osteoporotic changes in the jaws.
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Huang K, Wang Z, He Z, Li Y, Li S, Shen K, Zhu G, Liu Z, Lv S, Zhang C, Yang H, Yang X, Liu S. Downregulated formyl peptide receptor 2 expression in the epileptogenic foci of patients with focal cortical dysplasia type IIb and tuberous sclerosis complex. Immun Inflamm Dis 2022; 10:e706. [PMID: 36301030 PMCID: PMC9597500 DOI: 10.1002/iid3.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022] Open
Abstract
Background Focal cortical dysplasia type IIb (FCDIIb) and tuberous sclerosis complex (TSC) show persistent neuroinflammation, which promotes epileptogenesis and epilepsy progression, suggesting that endogenous resolution of inflammation is inadequate to relieve neuronal network hyperexcitability. To explore the potential roles of formyl peptide receptor 2 (FPR2), which is a key regulator of inflammation resolution, in epilepsy caused by FCDIIb and TSC, we examined the expression and cellular distribution of FPR2. Method The expression of FPR2 and nuclear factor‐κB (NF‐κB) signaling pathway was examined by real‐time PCR, western blots, and analyzed via one‐way analysis of variance. The distribution of FPR2 was detected using immunostaining. The expression of resolvin D1 (RvD1, the endogenous ligand of FPR2) was observed via enzyme‐linked immunosorbent assay. Pearson's correlation test was used to evaluate the correlation between the expression levels of FPR2 and RvD1 and the clinical variants. Results The expression of FPR2 was significantly lower in FCDIIb (p = .0146) and TSC (p = .0006) cortical lesions than in controls, as was the expression of RvD1 (FCDIIb: p = .00431; TSC: p = .0439). Weak FPR2 immunoreactivity was observed in dysmorphic neurons (DNs), balloon cells (BCs), and giant cells (GCs) in FCDIIb and TSC tissues. Moreover, FPR2 was mainly distributed in dysplastic neurons; it was sparse in microglia and nearly absent in astrocytes. The NF‐κB pathway was significantly activated in patients with FCDIIb and TSC, and the protein level of NF‐κB was negatively correlated with the protein level of FPR2 (FCDIIb: p = .00395; TSC: p = .0399). In addition, the protein level of FPR2 was negatively correlated with seizure frequency in FCDIIb (p = .0434) and TSC (p = .0351) patients. Conclusion In summary, these results showed that the expression and specific distribution of FPR2 may be involved in epilepsy caused by FCDIIb and TSC, indicating that downregulation of FPR2 mediated the dysfunction of neuroinflammation resolution in FCDIIb and TSC.
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Affiliation(s)
- Kaixuan Huang
- Department of Neurosurgery, Epilepsy Research Center of PLA, Xinqiao HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Zhongke Wang
- Department of NeurosurgeryArmed Police Hospital of ChongqingChongqingChina
| | - Zeng He
- Department of Neurosurgery, Epilepsy Research Center of PLA, Xinqiao HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Yang Li
- Department of Neurosurgery, Epilepsy Research Center of PLA, Xinqiao HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Shujing Li
- Department of Neurosurgery, Epilepsy Research Center of PLA, Xinqiao HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Kaifeng Shen
- Department of Neurosurgery, Epilepsy Research Center of PLA, Xinqiao HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Gang Zhu
- Department of Neurosurgery, Epilepsy Research Center of PLA, Xinqiao HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Zhonghong Liu
- Department of NeurosurgeryArmed Police Hospital of ChongqingChongqingChina
| | - Shengqing Lv
- Department of Neurosurgery, Epilepsy Research Center of PLA, Xinqiao HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Chunqing Zhang
- Department of Neurosurgery, Epilepsy Research Center of PLA, Xinqiao HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Hui Yang
- Department of Neurosurgery, Epilepsy Research Center of PLA, Xinqiao HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Xiaolin Yang
- Department of Neurosurgery, Epilepsy Research Center of PLA, Xinqiao HospitalArmy Medical University (Third Military Medical University)ChongqingChina
| | - Shiyong Liu
- Department of Neurosurgery, Epilepsy Research Center of PLA, Xinqiao HospitalArmy Medical University (Third Military Medical University)ChongqingChina
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Miziak B, Czuczwar SJ, Pluta R. Comorbid epilepsy and depression—pharmacokinetic and pharmacodynamic drug interactions. Front Pharmacol 2022; 13:988716. [PMID: 36278185 PMCID: PMC9585163 DOI: 10.3389/fphar.2022.988716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Major depressive disorder may be encountered in 17% of patients with epilepsy and in patients with drug-resistant epilepsy its prevalence may reach 30%. This indicates that patients with epilepsy may require antidepressant treatment.Purpose: Both pharmacodynamic and pharmacokinetic interactions between antiepileptic (antiseizure) and antidepressant drugs have been reviewed. Also, data on the adverse effects of co-administration of antiepileptic with antidepressant drugs have been added. This article was submitted to Neuropharmacology, a section of the journal Frontiers in Pharmacology.Methods: The review of relevant literature was confined to English-language publications in PUBMED databases. Table data show effects of antidepressants on the seizure susceptibility in experimental animals, results of pharmacodynamic interactions between antiepileptic and antidepressant drugs mainly derived from electroconvulsions in mice, as well as results concerning pharmacokinetic interactions between these drugs in clinical conditions.Conclusion: Antidepressant drugs may exert differentiated effects upon the convulsive threshold which may differ in their acute and chronic administration. Animal data indicate that chronic administration of antidepressants could reduce (mianserin, trazodone) or potentiate the anticonvulsant activity of some antiepileptics (fluoxetine, reboxetine, venlafaxine). There are also examples of neutral interactions (milnacipran).
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Affiliation(s)
- Barbara Miziak
- Department of Pathophysiology, Medical University, Lublin, Poland
| | - Stanisław J. Czuczwar
- Department of Pathophysiology, Medical University, Lublin, Poland
- *Correspondence: Stanisław J. Czuczwar, ; Ryszard Pluta,
| | - Ryszard Pluta
- Laboratory of Ischemic and Neurodegenerative Brain Research, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
- *Correspondence: Stanisław J. Czuczwar, ; Ryszard Pluta,
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Andersen NB, Jørgensen NR. Impaired bone health as a co-morbidity of epilepsy. Best Pract Res Clin Rheumatol 2022; 36:101755. [PMID: 35659828 DOI: 10.1016/j.berh.2022.101755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Increasing number of studies shows significant reductions in bone mineral density in patients with epilepsy treated with enzyme-inducing anti-seizure medications (EIASM), valproic acid, and newer anti-seizure medications (ASM). ASM seems to be a specific risk factor for the development of osteoporosis affecting 11%-31% of patients with epilepsy and leads to 2 to 6 times increased risk of fractures compared to the background population. Treatment with ASM clearly contributes to epilepsy-associated bone disease. Yet, the exact pathophysiological mechanism has not been established; however, several hypotheses were suggested, especially in relation to EIASM. As the long-lasting medical treatment, often in polytherapy, has shown negative effects on bone health, it indicates the need for guidelines for the prevention and management of bone disease to be included in the follow-up of patients with epilepsy. An algorithm for following bone status during the treatment has been suggested based on Danish national guidelines.
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Affiliation(s)
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Molteberg E, Taubøll E, Kverneland M, Iversen PO, Selmer KK, Nakken KO, Hofoss D, Thorsby PM. Substantial early changes in bone and calcium metabolism among adult pharmacoresistant epilepsy patients on a modified Atkins diet. Epilepsia 2022; 63:880-891. [PMID: 35092022 PMCID: PMC9304173 DOI: 10.1111/epi.17169] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/28/2021] [Accepted: 01/06/2022] [Indexed: 01/10/2023]
Abstract
Objective The aim of this study was to investigate whether the modified Atkins diet (MAD), a variant of the ketogenic diet, has an impact on bone‐ and calcium (Ca) metabolism. Methods Two groups of adult patients with pharmacoresistant epilepsy were investigated. One, the diet group (n = 53), was treated with MAD for 12 weeks, whereas the other, the reference group (n = 28), stayed on their habitual diet in the same period. All measurements were performed before and after the 12 weeks in both groups. We assessed bone health by measuring parathyroid hormone (PTH), Ca, 25‐OH vitamin D (25‐OH vit D), 1,25‐OH vitamin D (1,25‐OH vit D), phosphate, alkaline phosphatase (ALP), and the bone turnover markers procollagen type 1 N‐terminal propeptide (P1NP) and C‐terminal telopeptide collagen type 1 (CTX‐1). In addition, we examined the changes of sex hormones (estradiol, testosterone, luteinizing hormone, follicle‐stimulating hormone), sex hormone‐binding globulin, and leptin. Results After 12 weeks of MAD, we found a significant reduction in PTH, Ca, CTX‐1, P1NP, 1,25‐OH vit D, and leptin. There was a significant increase in 25‐OH vit D. These changes were most pronounced among patients <37 years old, and in those patients with the highest body mass index (≥25.8 kg/m²), whereas sex and type of antiseizure medication had no impact on the results. For the reference group, the changes were nonsignificant for all the analyses. In addition, the changes in sex hormones were nonsignificant. Significance Twelve weeks of MAD treatment leads to significant changes in bone and Ca metabolism, with a possible negative effect on bone health as a result. A reduced level of leptin may be a triggering mechanism. The changes could be important for patients on MAD, and especially relevant for those patients who receive treatment with MAD at an early age before peak bone mass is reached.
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Affiliation(s)
- Ellen Molteberg
- National Center for Epilepsy Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | - Erik Taubøll
- Faculty of Medicine University of Oslo Oslo Norway
- Department of Neurology Oslo University Hospital Oslo Norway
| | | | - Per Ole Iversen
- Faculty of Medicine University of Oslo Oslo Norway
- Department of Nutrition University of Oslo Oslo Norway
- Department of Hematology Oslo University Hospital Oslo Norway
| | - Kaja Kristine Selmer
- National Center for Epilepsy Oslo University Hospital Oslo Norway
- Department of Research and Innovation Division of Clinical Neuroscience Oslo University Hospital and University of Oslo Oslo Norway
| | - Karl Otto Nakken
- National Center for Epilepsy Oslo University Hospital Oslo Norway
| | - Dag Hofoss
- National Center for Epilepsy Oslo University Hospital Oslo Norway
| | - Per Medbøe Thorsby
- Hormone Laboratory Department of Medical Biochemistry and Biochemical Endocrinology and Metabolism Research Group Oslo University Hospital Oslo Norway
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Şimşek F, Ceylan M, Kızıltunç A, İyigün İ. The correlation between carbamazepine and valproic acid monotherapy with serum adiponectin and carnitine. Acta Neurol Belg 2021; 121:1823-1830. [PMID: 33242193 DOI: 10.1007/s13760-020-01552-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 11/10/2020] [Indexed: 12/18/2022]
Abstract
Antiepileptic drugs may cause systemic and metabolic side effects. The aim of our study was to investigate the effects of valproic acid and carbamazepine monotherapy used in the treatment of epilepsy patients on serum adiponectin and carnitine levels. The study included 60 patients, of which 30 patients receiving valproic acid monotherapy and 30 patients receiving carbamazepine monotherapy, who were followed up by the epilepsy outpatient clinic with the diagnosis of idiopathic epilepsy, and 30 healthy volunteers. Patients, who used drugs for at least 6 months, were selected. Venous blood samples were collected from the patients and healthy volunteers after their consent was obtained. Serum carnitine and adiponectin levels in the collected samples were measured using the ELISA method. Serum carnitine levels were 5166.55 ng/ml (± 1954.92) in patients receiving carbamazepine, 4224.56 ng/ml (± 2055.54) in patients using valproic acid, and 5802.64 ng/ml (± 3422.57) in the control group. Serum adiponectin levels were 13,606.51 ng/ml (± 5915.92) in patients using carbamazepine, 11,986.58 ng/ml (± 5367.82) in patients receiving valproic acid, and 14,033.43 ng/ml (± 5646.34) in the control group. In both groups, both serum carnitine and serum adiponectin levels were lower than the control group. There was a negative but insignificant correlation between the duration and dose of carbamazepine and valproic acid drug use and serum adiponectin and carnitine levels. There is a need for more extensive studies with larger sample size to investigate the effect of antiepileptic drugs used on serum adiponectin and carnitine levels.
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Affiliation(s)
- Fatma Şimşek
- Department of Neurology, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
| | - Mustafa Ceylan
- Department of Neurology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Ahmet Kızıltunç
- Department of Biochemistry, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - İbrahim İyigün
- Department of Neurology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Nieraad H, Pannwitz N, de Bruin N, Geisslinger G, Till U. Hyperhomocysteinemia: Metabolic Role and Animal Studies with a Focus on Cognitive Performance and Decline-A Review. Biomolecules 2021; 11:1546. [PMID: 34680179 PMCID: PMC8533891 DOI: 10.3390/biom11101546] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 12/18/2022] Open
Abstract
Disturbances in the one-carbon metabolism are often indicated by altered levels of the endogenous amino acid homocysteine (HCys), which is additionally discussed to causally contribute to diverse pathologies. In the first part of the present review, we profoundly and critically discuss the metabolic role and pathomechanisms of HCys, as well as its potential impact on different human disorders. The use of adequate animal models can aid in unravelling the complex pathological processes underlying the role of hyperhomocysteinemia (HHCys). Therefore, in the second part, we systematically searched PubMed/Medline for animal studies regarding HHCys and focused on the potential impact on cognitive performance and decline. The majority of reviewed studies reported a significant effect of HHCys on the investigated behavioral outcomes. Despite of persistent controversial discussions about equivocal findings, especially in clinical studies, the present evaluation of preclinical evidence indicates a causal link between HHCys and cognition-related- especially dementia-like disorders, and points out the further urge for large-scale, well-designed clinical studies in order to elucidate the normalization of HCys levels as a potential preventative or therapeutic approach in human pathologies.
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Affiliation(s)
- Hendrik Nieraad
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany; (N.P.); (N.d.B.); (G.G.)
| | - Nina Pannwitz
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany; (N.P.); (N.d.B.); (G.G.)
| | - Natasja de Bruin
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany; (N.P.); (N.d.B.); (G.G.)
| | - Gerd Geisslinger
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany; (N.P.); (N.d.B.); (G.G.)
- Pharmazentrum Frankfurt/ZAFES, Institute of Clinical Pharmacology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Uwe Till
- Former Institute of Pathobiochemistry, Friedrich-Schiller-University Jena, Nonnenplan 2, 07743 Jena, Germany;
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A novel index to assess low energy fracture risks in patients prescribed antiepileptic drugs. PLoS One 2021; 16:e0256093. [PMID: 34437569 PMCID: PMC8389492 DOI: 10.1371/journal.pone.0256093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/30/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To develop an index assessing the risks of low energy fractures (LEF) in patients prescribed antiepileptic drugs (AED) by exploring five previously suggested risk factors; age, gender, AED-type, epilepsy diagnosis and BMI. Methods In a population-based retrospective open cohort study we used real world data from the Electronic Health Register (EHR) in Region Kalmar County, Sweden. 23 209 patients prescribed AEDs at any time from January 2008 to November 2018 and 23 281 matching controls were followed from first registration in the EHR until the first documented LEF, disenrollment (or death) or until the end of the study period, whichever came first. Risks of LEF measured as hazard rate ratios in relation to the suggested risk factors and in comparison to matched controls were analyzed using Cox regression. The index was developed using a linear combination of the statistically significant variables multiplied by the corresponding regression coefficients. Results Data from 23 209 patients prescribed AEDs and 2084 documented LEFs during a follow-up time of more than 10 years resulted in the Kalmar Epilepsy Fracture Risk Index (KEFRI). KEFRI = Age-category x (1.18) + Gender x (-0.51) + AED-type x (0.29) + Epilepsy diagnosis-category x (0.31) + BMI-category x (-0.35). All five previously suggested risk factors were confirmed. Women aged 75 years and older treated with an inducing AED against epilepsy and BMIs of 25 kg/m2 or below had 48 times higher LEF rates compared to men aged 50 years or younger, treated with a non-inducing AED for a condition other than epilepsy and BMIs above 25 kg/m2. Conclusion The KEFRI is the first weighted multifactorial assessment tool estimating risks of LEF in patients prescribed AEDs and could serve as a feasible guide within clinical practice.
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Matuszewska A, Nowak B, Nikodem A, Merwid-Ląd A, Wiatrak B, Tomkalski T, Jędrzejuk D, Szeląg E, Sozański T, Danielewski M, Jawień P, Ceremuga I, Szandruk-Bender M, Bolanowski M, Filipiak J, Szeląg A. Antiepileptic Stiripentol May Influence Bones. Int J Mol Sci 2021; 22:7162. [PMID: 34281215 PMCID: PMC8269345 DOI: 10.3390/ijms22137162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 12/12/2022] Open
Abstract
Bone structure abnormalities are increasingly observed in patients chronically treated with antiepileptic drugs (AEDs). The majority of the available data concern older conventional AEDs, while the amount of information regarding newer AEDs, including stiripentol, is limited. The aim of the study was to assess the effect of stiripentol on bones. For 24 weeks, male Wistar rats, received 0.9% sodium chloride (control group) or stiripentol (200 mg/kg/day) (STP group). In the 16th week of the study, we detected lower serum PINP levels in the STP group compared to the control group. In the 24th week, a statistically significant lower 1,25-dihydroxyvitamin D3 level, higher inorganic phosphate level and higher neutrophil gelatinase-associated lipocalin (NGAL) levels in serum were found in the STP group compared to the control. Micro X-ray computed tomography of the tibias demonstrated lower bone volume fraction, lower trabecular thickness, higher trabecular pattern factor and a higher structure model index in the stiripentol group. Considering the results of this experiment on rats which suggests that long-term administration of stiripentol may impair the cancellous bone microarchitecture, further prospective human studies seem to be justified. However, monitoring plasma vitamin D, calcium, inorganic phosphate and kidney function in patients on long-term stiripentol therapy may be suggested.
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Affiliation(s)
- Agnieszka Matuszewska
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Beata Nowak
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Anna Nikodem
- Department of Mechanics, Materials and Biomedical Engineering, Wroclaw University of Science and Technology, ul. Ignacego Łukasiewicza 7/9, 50-371 Wrocław, Poland; (A.N.); (J.F.)
| | - Anna Merwid-Ląd
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Benita Wiatrak
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Tomasz Tomkalski
- Department of Endocrinology, Diabetology and Internal Medicine, Tadeusz Marciniak Lower Silesia Specialist Hospital—Centre for Medical Emergency, ul. Gen. Augusta Emila Fieldorfa 2, 54-049 Wrocław, Poland;
| | - Diana Jędrzejuk
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, wyb. Ludwika Pasteura 4, 50-367 Wrocław, Poland; (D.J.); (M.B.)
| | - Ewa Szeląg
- Department of Maxillofacial Orthopedics and Orthodontics Institute, Wroclaw University of Science and Technology, ul. Krakowska 26, 50-425 Wrocław, Poland;
| | - Tomasz Sozański
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Maciej Danielewski
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Paulina Jawień
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Ireneusz Ceremuga
- Department of Medical Biochemistry, Wroclaw Medical University, ul. Tytusa Chałubińskiego 10, 50-368 Wrocław, Poland;
| | - Marta Szandruk-Bender
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
| | - Marek Bolanowski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, wyb. Ludwika Pasteura 4, 50-367 Wrocław, Poland; (D.J.); (M.B.)
| | - Jarosław Filipiak
- Department of Mechanics, Materials and Biomedical Engineering, Wroclaw University of Science and Technology, ul. Ignacego Łukasiewicza 7/9, 50-371 Wrocław, Poland; (A.N.); (J.F.)
| | - Adam Szeląg
- Department of Pharmacology, Wroclaw Medical University, ul. Jana Mikulicza-Radeckiego 2, 50-345 Wrocław, Poland; (B.N.); (A.M.-L.); (B.W.); (T.S.); (M.D.); (P.J.); (M.S.-B.); (A.S.)
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Szałwińska K, Cyuńczyk M, Kochanowicz J, Witkowska AM. Dietary and lifestyle behavior in adults with epilepsy needs improvement: a case-control study from northeastern Poland. Nutr J 2021; 20:62. [PMID: 34187474 PMCID: PMC8243538 DOI: 10.1186/s12937-021-00704-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 05/13/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Several factors predispose individuals with epilepsy to chronic diseases. Among them, nutrition and lifestyle factors have not been sufficiently studied. Therefore, the aim of this study was to evaluate patients with epilepsy in terms of diet, body composition and physical activity compared to healthy sex- and age-matched subjects to investigate whether there are risk factors for nutritional deficiencies and risk factors for the development of metabolic diseases. METHODS The case-control study involved 60 epileptic male and female volunteers and 70 healthy controls matched according to age and sex. Medical information was collected during the study, and a detailed questionnaire regarding eating and lifestyle habits was conducted. Physical activity was evaluated using the International Physical Activity Questionnaire (IPAQ). Nutritional status was assessed by bioelectric impedance. Venous blood samples were taken for lipid and 25-hydroxyvitamin D3 (25(OH)D3) analyses. RESULTS A tendency toward an increase in LDL cholesterol was found in the individuals with epilepsy. Significantly higher body fat and insignificantly higher visceral fat were found in epileptic men than in healthy men. In epileptic women, a tendency toward a lower lean body mass was found. Patients with epilepsy were more sedentary, consumed less cottage cheese, fruit, pulses, nuts and seeds, vitamin C and potassium, and consumed more sugar-sweetened soda, fat and sodium than healthy people. On a positive note, individuals with epilepsy consumed less coffee and alcoholic beverages. More than 80% of the epileptic volunteers had diets that were low in folic acid, vitamin D and calcium, but a similar tendency was observed in the healthy volunteers. A higher percentage of the patients with epilepsy had diets that were low in niacin, vitamin C and potassium than the control group (25% vs. 7, 50% vs. 31% and 73 vs. 56%, respectively). A significantly lower serum concentration of 25(OH)D3 was observed in epileptic individuals and was found to be positively modulated by physical activity. CONCLUSIONS The results indicate that several behavior-related habits, which may predispose epileptic people to cardiovascular disease, need to be improved. For this reason, patients with epilepsy should be provided with more comprehensive medical care, including advice on nutrition and physical activity.
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Affiliation(s)
- Kamila Szałwińska
- Department of Food Biotechnology, Medical University of Białystok, Białystok, Poland
| | - Monika Cyuńczyk
- Department of Food Biotechnology, Medical University of Białystok, Białystok, Poland
| | - Jan Kochanowicz
- Department of Neurology, Medical University of Białystok, Białystok, Poland
| | - Anna M Witkowska
- Department of Food Biotechnology, Medical University of Białystok, Białystok, Poland.
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Yen WW, Falik N, Passfall LG, Krol O, Sanchez TE, Penny GS, Wham BC, Suneja N. Management of lower extremity orthopaedic injuries in epileptic patients: A systematic review. J Orthop 2021; 25:278-282. [PMID: 34121822 DOI: 10.1016/j.jor.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/02/2021] [Indexed: 11/30/2022] Open
Abstract
Lower-extremity injuries may occur during seizures. There is a lack of standardized guidelines when diagnosing and planning perioperative care. Databases were systematically screened using predefined search terms. Of the 13 patients included, seven (53.8%) involved bilateral femoral neck fractures. Associated fractures were observed in all cases with surgical intervention performed in eight (61.5%) patients. Eleven patients reported functional outcomes, with over a quarter (three of 11, [27.3%]) endorsing mild range of motion deficits or issues with ambulation. Post-seizure patients may require standardized diagnostic protocols to ensure prompt management with a specialized treatment approach that accommodates the nuances of their condition.
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Affiliation(s)
- Winston W Yen
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - Nouraiz Falik
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - Lara G Passfall
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - Oscar Krol
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - Thomas E Sanchez
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - Gregory S Penny
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - Bradley C Wham
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - Nishant Suneja
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
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Octanoic acid a major component of widely consumed medium-chain triglyceride ketogenic diet is detrimental to bone. Sci Rep 2021; 11:7003. [PMID: 33772066 PMCID: PMC7997977 DOI: 10.1038/s41598-021-86468-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 03/01/2021] [Indexed: 11/08/2022] Open
Abstract
Octanoic acid is a medium-chained saturated fatty acid found abundantly in the ketogenic dietary supplements containing medium chained triglycerides (MCT) along with decanoic acid. The MCT ketogenic diet is commonly consumed for weight loss but has also showcased neuroprotective potential against neurodegenerative disorders. However, recent clinical findings have reported a critical disadvantage with the long-term consumption of ketogenic diet i.e. bone loss. The following study was employed to investigate whether the two major components of MCT diet also possess bone loss potential as observed with classical ketogenic diet. Swiss albino mice aged between 10 and 12 weeks, were divided into 3 treatment groups that were administered with oral suspensions of octanoic acid, decanoic acid and a combination of both for 4 weeks. Bone specific markers, microarchitectural parameters, using micro computed tomography, and biomechanical strength were analyzed. Remarkably deleterious alterations in the trabecular bone microarchitecture, and on bone markers were observed in the octanoic acid treated groups. Our results suggest significant negative effects on bone health by octanoic acid. These findings require further investigation and validation in order to provide significant clinically relevant data to possibly modify dietary composition of the MCT ketogenic diet.
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Furukawa S, Kunii M, Doi H, Kondo N, Ogura A, Hirabuki K, Itoh T, Matsumoto N, Tanaka F, Katsuno M, Ito Y. Case Report: Severe Osteoporosis and Preventive Therapy in RNA Polymerase III-Related Leukodystrophy. Front Neurol 2021; 12:622355. [PMID: 33716926 PMCID: PMC7952608 DOI: 10.3389/fneur.2021.622355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/25/2021] [Indexed: 11/18/2022] Open
Abstract
RNA polymerase III (POLR3)-related leukodystrophy is an autosomal recessive form of leukodystrophy caused by homozygous or compound heterozygous mutations of the RNA polymerase III subunit genes, including subunit A (POLR3A). With respect to the manifestation triad, hypomyelination, hypodontia, and hypogonadotropic hypogonadism, it is also known as 4H leukodystrophy. Here, we report a 41-year-old woman of POLR3-related leukodystrophy by carrying compound heterozygous pathogenic variants of c.2554A>G (p.M852V) and c.2668G>T (p.V890F) in the POLR3A gene. She was amenorrheic and became a wheelchair user from the age of 15 years and suffered from multiple episodes of pathologic fractures, starting with a subtrochanteric fracture of the right femur after a tonic seizure at age 30 years. Head magnetic resonance imaging demonstrated hypomyelination and atrophies of the cerebellum, brainstem, and corpus callosum. Laboratory examination revealed a marked decrease of gonadotropins and estrogen, low bone density, and high bone resorption markers. Administration of anti-receptor activator of nuclear factor kappa-B ligand monoclonal antibody restored bone resorption markers to a normal level and prevented further pathological bone fractures. Our case emphasizes that osteoporosis should be recognized as a potential but serious complication in POLR3-related leukodystrophy. It may be feasible to prevent pathologic fractures by intensive osteoporosis therapy after endocrinological examinations and evaluation of bone metabolism.
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Affiliation(s)
- Soma Furukawa
- Department of Neurology, Toyota Memorial Hospital, Toyota, Japan.,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Misako Kunii
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroshi Doi
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Naohide Kondo
- Department of Neurology, Toyota Memorial Hospital, Toyota, Japan.,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Wellness Promotion Center, Corporate Human Resource, Fuji Xerox Co., Ltd, Ebina, Japan
| | - Aya Ogura
- Department of Neurology, Toyota Memorial Hospital, Toyota, Japan.,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Takayuki Itoh
- Faculty of Psychological and Physical Science, Aichi-Gakuin University, Nissin, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Fumiaki Tanaka
- Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Ito
- Department of Neurology, Toyota Memorial Hospital, Toyota, Japan
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21
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Metabolic bone disease in patients with epilepsy and the use of antiepileptic drugs - Insight from a Danish cross-sectional study. Seizure 2021; 86:29-34. [PMID: 33517239 DOI: 10.1016/j.seizure.2021.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Osteoporosis is a bone disorder defined by a decrease in bone mineral density (BMD) which can lead to an increased risk of fractures. Patients with epilepsy are more prone to having fractures. When accounting for seizure-related fractures, the epilepsy patient population still suffers from an increased risk of fractures. This can be attributed to adverse effects of antiepileptic drugs (AEDs). AIM The aim of this study was to investigate the association between the use of AEDs and decreased BMD in a large unselected population of Danish patients with epilepsy. METHOD The study was a cross-sectional study based on data retrieved from 835 patients visiting an outpatient Epilepsy Clinic in Glostrup, Denmark, from January 1st 2006 - January 31st 2018. The data included results from DXA-scans and demographic information. Logistic regression models and other statistical analyses were performed. RESULTS The results showed that the odds for having osteoporosis when taking EIAEDs were 2.2 (95 % CI: 1.2-3.8, P = 0.007) times higher than those taking NEIAEDs. Furthermore, the odds for having osteoporosis increased with duration of epilepsy (OR = 1.0, 95 % CI: 1.0 - 1.0, P = 0.001) and when the patients consume two AEDs compared to one AED (OR = 2.3, 95 % CI: 1.3-4.1, P < 0.001). Additionally, consuming three AEDs compared to one lead to a 2.3 times higher risk of having osteoporosis (95 % CI: 1.2-4.4, P = 0.01). CONCLUSION When accounted for many riskfactors, EIAEDs, polytherapy with AEDs and duration of epilepsy are correlated with osteoporosis. There is a need for using these known riskfactors as guidelines in indentifying patients at increased risk of developing osteoporosis.
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Boon P, Ferrao Santos S, Jansen AC, Lagae L, Legros B, Weckhuysen S. Recommendations for the treatment of epilepsy in adult and pediatric patients in Belgium: 2020 update. Acta Neurol Belg 2021; 121:241-257. [PMID: 33048338 PMCID: PMC7937601 DOI: 10.1007/s13760-020-01488-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/26/2020] [Indexed: 12/31/2022]
Abstract
To guide health care professionals in Belgium in selecting the appropriate antiepileptic drugs (AEDs) for their epilepsy patients, a group of Belgian epilepsy experts developed recommendations for AED treatment in adults and children (initial recommendations in 2008, updated in 2012). As new drugs have become available, others have been withdrawn, new indications have been approved and recommendations for pregnant women have changed, a new update was pertinent. A group of Belgian epilepsy experts (partly overlapping with the group in charge of the 2008/2012 recommendations) evaluated the most recent international guidelines and relevant literature for their applicability to the Belgian situation (registration status, reimbursement, clinical practice) and updated the recommendations for initial monotherapy in adults and children and add-on treatment in adults. Recommendations for add-on treatment in children were also included (not covered in the 2008/2012 publications). Like the 2008/2012 publications, the current update also covers other important aspects related to the management of epilepsy, including the importance of early referral in drug-resistant epilepsy, pharmacokinetic properties and tolerability of AEDs, comorbidities, specific considerations in elderly and pregnant patients, generic substitution and the rapidly evolving field of precision medicine.
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Affiliation(s)
- Paul Boon
- Reference Center for Refractory Epilepsy, Department of Neurology, Ghent University Hospital, Ghent, Belgium.
| | | | - Anna C Jansen
- Pediatric Neurology Unit, Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lieven Lagae
- Reference Center for Refractory Epilepsy, Pediatric Neurology, Department of Development and Regeneration, University Hospitals Leuven, Leuven, Belgium
| | - Benjamin Legros
- Department of Neurology, Reference Center for the Treatment of Refractory Epilepsy, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Sarah Weckhuysen
- Department of Neurology, Antwerp University Hospital, Antwerp, Belgium
- VIB-Center for Molecular Neurology, University of Antwerp, Antwerp, Belgium
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Zhang R, Yang M, Li Y, Liu H, Ren M, Tao ZS. Effect of alendronate on the femoral metaphyseal defect under carbamazepine in ovariectomized rats. J Orthop Surg Res 2021; 16:14. [PMID: 33407695 PMCID: PMC7788868 DOI: 10.1186/s13018-020-02151-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of antiepileptic drugs and estrogen deficiency put forward higher requirements for bone defect regeneration. The present study investigated the effects of alendronate (ALN) on femoral bone defect in ovariectomized (OVX) rats under the influence of carbamazepine (CBZ). METHODS One hundred female SD rats at 3 months of age were either sham-operated or OVX and divided into four groups: sham control (CON); OVX control (OVX); ovariectomized rats treated with CBZ via gavage (75 mg/kg/day; CBZ); ovariectomized rats treated with CBZ plus ALN (2 mg/kg/day; CBZ-ALN). A critical-sized femoral metaphyseal bone defect was established in all female SD rats. Animals from the CBZ and CBZ-ALN groups received drugs by gavage the day after bone defect surgery was performed. After the rats were sacrificed, the defected area located in the distal femur was harvested for evaluation by microcomputed tomography (micro-CT), hematoxylin and eosin (HE) staining, and Masson's trichrome staining. The samples were also analyzed by biomechanics and immunohistochemical evaluation (IHC). Besides, biochemical analysis evaluates all serum samples. RESULTS The present study showed that ovariectomy changed the microstructural parameters of bone. The use of CBZ further decreased femur bone mass while treatment with ALN prevented bone loss. Compared to OVX and CBZ groups, CBZ-ALN group promoted bone neoformation and enhanced the ultimate load of the femur bone. However, the group of CBZ-ALN did not return to normal levels compared with the CON group. Besides, we noticed that CBZ-ALN group reduced tartrate-resistant acid phosphatase-5b (Tracp-5b) expression and had no significant effect on the expression of osteocalcin (OCN) and type I collagen (Col-I) in IHC compared with CBZ group. Biochemical analysis results presented that systemic delivery of CBZ showed pernicious effects on bone formation and resorption in ovariectomized rats, with the worse effects on C-terminal crosslinked telopeptide of type I collagen (CTX-1). Besides, a significant decrease in CTX-1 levels was observed in CBZ-ALN group as compared to the group of CBZ. CONCLUSION These results demonstrated that ALN can effectively reverse the effects of CBZ on the microarchitectural properties of bone, and thus can have a positive effect on local bone neoformation in rats with osteoporosis. CLINICAL RELEVANCE The dose of 2 mg/kg ALN improves the negative effect of prescription of CBZ at 75 mg/kg and promotes bone neoformation of femoral bony deficits.
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Affiliation(s)
- Ruotian Zhang
- Department of Trauma Orthopedics, The First Affiliated Hospital of Wannan Medical College,Yijishan Hospital, No. 2, Zhe shan Xi Road, Anhui, 241001, Wuhu, People's Republic of China
| | - Min Yang
- Department of Trauma Orthopedics, The First Affiliated Hospital of Wannan Medical College,Yijishan Hospital, No. 2, Zhe shan Xi Road, Anhui, 241001, Wuhu, People's Republic of China.
| | - Yang Li
- Department of Trauma Orthopedics, The First Affiliated Hospital of Wannan Medical College,Yijishan Hospital, No. 2, Zhe shan Xi Road, Anhui, 241001, Wuhu, People's Republic of China
| | - Hedong Liu
- Department of Trauma Orthopedics, The First Affiliated Hospital of Wannan Medical College,Yijishan Hospital, No. 2, Zhe shan Xi Road, Anhui, 241001, Wuhu, People's Republic of China
| | - Maoxian Ren
- Department of Trauma Orthopedics, The First Affiliated Hospital of Wannan Medical College,Yijishan Hospital, No. 2, Zhe shan Xi Road, Anhui, 241001, Wuhu, People's Republic of China
| | - Zhou-Shan Tao
- Department of Trauma Orthopedics, The First Affiliated Hospital of Wannan Medical College,Yijishan Hospital, No. 2, Zhe shan Xi Road, Anhui, 241001, Wuhu, People's Republic of China
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Girish M, Mehan A, Venkatesh A. Should children on prolonged antiepileptic drug therapy undergo DEXA scanning to assess bone mineral density? Arch Dis Child 2021; 106:92-95. [PMID: 33032995 DOI: 10.1136/archdischild-2020-319695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Milind Girish
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Aman Mehan
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ashwin Venkatesh
- University of Cambridge School of Clinical Medicine, Cambridge, UK
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Guo Y, Lin Z, Huang Y, Yu L. Effects of valproate, lamotrigine, and levetiracetam monotherapy on bone health in newly diagnosed adult patients with epilepsy. Epilepsy Behav 2020; 113:107489. [PMID: 33220583 DOI: 10.1016/j.yebeh.2020.107489] [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: 07/01/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effects of valproate (VPA), lamotrigine (LTG), and levetiracetam (LEV) on bone turnover and bone mineral density (BMD) in newly diagnosed adult patients with epilepsy. METHODS Eligible adult patients who were newly diagnosed with epilepsy were treated with VPA, LTG, and LEV. The chemical indicators of bone metabolism and BMD were measured before treatment and 2 years after treatment with different antiseizure medication (ASM) monotherapies. Then, the differences in these parameters before and after treatment were analyzed. RESULTS One hundred twenty-four patients completed the 2 years follow-up; 43 received monotherapy with VPA, 32 received LTG, and 49 received LEV. Serum parathyroid hormone (PTH), bone alkaline phosphatase (B-ALP), and β-cross-linked C-telopeptide of type I collagen (β-CTX) levels were elevated in adult patients after 2 years of VPA administration; the serum procollagen I intact N-terminal peptide (PINP) level was noticeably higher in patients after LEV treatment than before treatment. Meanwhile, the BMD of the lumbar spine and femoral neck did not change in patients treated with VPA, LTG, and LEV. CONCLUSIONS Valproate altered bone turnover in adult patients with epilepsy, while LTG and LEV did not exert harmful effects on bone health in adult patients.
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Affiliation(s)
- Yi Guo
- Department of Neurology, The Sixth People's Hospital of Chengdu, No. 16 South Jianshe Road, Chengdu, Sichuan 610051, People's Republic of China
| | - Zhonghua Lin
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, 32# W. Sec 2, 1st Ring Rd, Chengdu, Sichuan 610072, People's Republic of China
| | - Yulan Huang
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, 32# W. Sec 2, 1st Ring Rd, Chengdu, Sichuan 610072, People's Republic of China.
| | - Liang Yu
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, 32# W. Sec 2, 1st Ring Rd, Chengdu, Sichuan 610072, People's Republic of China.
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Koo DL, Nam H. Effects of zonisamide monotherapy on bone health in drug-naive epileptic patients. Epilepsia 2020; 61:2142-2149. [PMID: 32944954 DOI: 10.1111/epi.16678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Alteration of bone strength is an adverse effect of antiepileptic drug treatment. We investigated the effects of zonisamide (ZNS) monotherapy on bone mineral density (BMD) and biomarkers of bone metabolism after 13 months of treatment in drug-naive epileptic patients. METHODS Fifty-nine patients with new onset drug-naive epilepsy were enrolled (29 women, 30 men; mean age = 31.5 ± 11.5 years). The BMD and T scores were measured at the lumbar spine and femoral neck by using dual-energy X-ray absorptiometry. Biomarkers specific for bone metabolism (bone-specific alkaline phosphatase, parathyroid hormone, osteocalcin, insulinlike growth factor-1, C-telopeptide, and vitamin D3 levels) were measured before and after long-term ZNS monotherapy. Analysis of covariance (ANCOVA) was used to estimate BMD and biomarkers of bone metabolism before and after ZNS therapy. Age, sex, treatment duration, and ZNS dosage were included as covariates for adjustment in the ANCOVA model. Furthermore, subgroup analyses were performed for each sex, and the effect size was calculated. RESULTS After 13 months of ZNS treatment, the BMD and T scores at the lumbar spine (L1-L4 level) and femoral neck were not significantly different. Moreover, the biochemical markers showed no significant differences after ZNS monotherapy. Women showed significantly decreased baseline BMD at the femoral neck compared to men (P = .026), although the mean age and body mass index were not significantly different between the sexes. No significant changes in BMD or biomarkers of bone metabolism were seen in either sex after 13 months of ZNS treatment. SIGNIFICANCE The results suggest that long-term ZNS monotherapy does not affect bone health in drug-naive patients with epilepsy negatively.
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Affiliation(s)
- Dae Lim Koo
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul, South Korea
| | - Hyunwoo Nam
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul, South Korea
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Management of antiepileptic drug-induced nutrition-related adverse effects. Neurol Sci 2020; 41:3491-3502. [PMID: 32661886 DOI: 10.1007/s10072-020-04573-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/02/2020] [Indexed: 12/28/2022]
Abstract
Although antiepileptic drugs (AEDs) are mainstay of the treatment of epilepsy, they are associated with significant adverse effects. The present study reviews the adverse effects of AEDs on some of the nutrition-related issues, including bone health, body weight, glucose and lipid metabolism, vitamin homeostasis, antioxidant defense system, and pregnancy. This paper also provides some nutritional recommendations for people with epilepsy. Patients with epilepsy should be regularly evaluated with regard to their nutrition status and any possible nutritional problems. Daily intake of adequate amounts of all nutrients from various sources should be encouraged, especially for vulnerable groups such as children, adolescents, elderly, and pregnant women. When necessary, preventative or therapeutic supplementation with appropriate micronutrients could be helpful. Graphical abstract.
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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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Zhang X, Zhong R, Chen Q, Li M, Lin W, Cui L. Effect of carbamazepine on the bone health of people with epilepsy: a systematic review and meta-analysis. J Int Med Res 2020; 48:300060520902608. [PMID: 32228127 PMCID: PMC7133082 DOI: 10.1177/0300060520902608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 01/07/2020] [Indexed: 01/11/2023] Open
Abstract
Importance Increasing evidence indicates that carbamazepine (CBZ) treatment in people with epilepsy (PWE) has adverse effects on bone health. Objective We conducted a meta-analysis to investigate the effect of CBZ on the bone health of PWE. Methods Two independent reviewers systematically searched PubMed and EMBASE for eligible studies. Standard mean deviations (SMDs) with 95% confidence intervals were used as a measure to investigate the effect of CBZ on bone-related outcomes in PWE. Results Levels of vitamin D (standardized mean difference [SMD]: −0.62, 95% CI: −0.89 to −0.35) and calcium (SMD: −0.38, 95% CI: −0.67 to −0.09) were significantly lower in the CBZ group than controls. Additionally, significantly higher alkaline phosphatase (SMD: 0.67, 95% CI: 0.52–0.82) was observed in patients using CBZ than controls. However, no significant difference in BMD was found between the two groups (SMD: −0.06, 95% CI: −0.55 to 0.43). Conclusion and significance: This study provided evidence that CBZ treatment has a negative effect on bone health in PWE. Clinical implications are that long-term CBZ treatment may not be a good choice for PWE with skeletal diseases or osteoporosis.
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Affiliation(s)
- Xinyue Zhang
- Department of Neurology, The First Hospital of Jilin University, Chang Chun, Ji Lin Provence, China
| | - Rui Zhong
- Department of Neurology, The First Hospital of Jilin University, Chang Chun, Ji Lin Provence, China
| | - Qingling Chen
- Department of Hepatology, The First Hospital of Jilin University, Chang Chun, Ji Lin Provence, China
| | - Mengmeng Li
- Department of Neurology, The First Hospital of Jilin University, Chang Chun, Ji Lin Provence, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Chang Chun, Ji Lin Provence, China
| | - Li Cui
- Department of Neurology, The First Hospital of Jilin University, Chang Chun, Ji Lin Provence, China
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