1
|
Hirsch M, Immisch I, Knake S, Schulze-Bonhage A. A Prospective Longitudinal Study of the Effects of Eslicarbazepine Acetate Treatment on Bone Density and Metabolism in Patients with Focal-Onset Epilepsy. CNS Drugs 2023; 37:973-980. [PMID: 37921919 PMCID: PMC10667382 DOI: 10.1007/s40263-023-01045-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Eslicarbazepine acetate (ESL) is a third-generation anti-seizure medication for patients with focal-onset epilepsy. There are known short-term impacts of classic enzyme-inducing drugs on bone health. For oxcarbazepine, which like ESL is a less potent inducer of cytochrome P450 (CYP450) than carbamazepine, some studies have shown that treatment is associated with increased bone metabolic parameters. The effects of ESL on bone health have not been systematically evaluated so the objective of this study was to investigate whether adverse effects of ESL on bone mineral density (BMD) could be measured after a 12-month exposure period. In addition, the effects of ESL on bone turnover were investigated using laboratory indicators of bone metabolism. METHODS BONAPARTE was a prospective, longitudinal, observational study that enrolled patients with focal-onset epilepsy with or without secondary generalization who started treatment with ESL, either as adjunctive treatment or monotherapy, at two tertiary epilepsy centres in Germany between February 2018 and July 2020. Standardised osteodensitometry and biochemical bone metabolism parameters at the time of ESL initiation and 1 year after continuation of therapy were assessed. Comparisons between biochemical and densitometric parameters at baseline and after 12 months of treatment were performed using the paired samples t test. RESULTS In total, 26 patients (15 male; mean age 41.4 ± 12.5 years) newly treated with ESL were evaluated. Six of these patients had osteopenia at baseline. The mean daily dose of ESL at the 12-month follow-up was 1438 ± 1406 mg. At the group level, there were no significant effects of treatment with ESL on laboratory markers or on BMD. Mean values of BMD in g/cm2 at baseline and after 12 months of ESL treatment were 1.17 (± 0.16) and 1.16 (± 0.16) in the lumbar spine, and 0.98 (± 0.15) and 0.96 (± 0.15) in the proximal femur, respectively. Intra-individually, two patients developed de novo osteopenia measured at the femoral neck associated with relevant changes in bone metabolic parameters. CONCLUSION Neither osteodensitometry nor bone metabolism parameters showed significant group effects after 1 year of treatment with ESL. Individual fluctuations were observed, however, which may warrant monitoring for longer follow-up periods. The study was registered in the German register for clinical studies under the number DRKS00010430 with the official name BONAPARTE.
Collapse
Affiliation(s)
- Martin Hirsch
- Faculty of Medicine, Epilepsy Center, University of Freiburg, Breisacherstrasse 64, 79106, Freiburg, Germany.
| | - Ilka Immisch
- Department of Neurology, Epilepsy Center Hessen, Klinik und Poliklinik für Neurologie, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Susanne Knake
- Department of Neurology, Epilepsy Center Hessen, Klinik und Poliklinik für Neurologie, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Andreas Schulze-Bonhage
- Faculty of Medicine, Epilepsy Center, University of Freiburg, Breisacherstrasse 64, 79106, Freiburg, Germany
| |
Collapse
|
2
|
LoPinto-Khoury C. Long-Term Effects of Antiseizure Medications. Semin Neurol 2022; 42:583-593. [PMID: 36216358 DOI: 10.1055/a-1958-0802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Most patients with epilepsy will benefit from seizure control with one of an array of chronic antiseizure medications. Knowledge of the potential long-term effects of these medications is critical to prevent adverse consequences on overall health. Antiseizure medications vary in their capacities to affect the brain and peripheral nerves, hormones, bone mineralization, cardiovascular risk, renal health, hepatic, hematological, and dermatological systems. Understanding of pathophysiology and population risk has evolved, although most of the data available are still on older generation antiseizure medications such as phenytoin, carbamazepine, and valproic acid. The enzyme-inducing properties of some antiseizure medications make their effects on cardiovascular risk and bone health detrimental. Few clear guidelines exist for monitoring long-term effects of medication therapy for epilepsy. When selecting an antiseizure medication, consideration should be given to the individual patient's risks of adverse consequences on other organ systems. During monitoring of patients on chronic therapy, screening tools such as metabolic panels and bone density measurements can help stratify risk and guide management.
Collapse
Affiliation(s)
- Carla LoPinto-Khoury
- Department of Neurology, Lewis Katz Temple School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
3
|
A Survey Study on the Status of Somatic Symptoms in Young and Middle-Aged Patients with Mental Illness during Long-Term Hospitalization. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:1110941. [PMID: 35935323 PMCID: PMC9329028 DOI: 10.1155/2022/1110941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/15/2022] [Accepted: 06/18/2022] [Indexed: 11/17/2022]
Abstract
Psychiatric disorders include severe psychiatric disorders and those in general with some psychiatric disorders having a clear etiology or in which a significant psychiatric predisposing factor is present. Whereas, psychiatric disorders precisely refer to those characterized by mild depression and mild anxiety and appear to affect a large number of people in any community. It has been reported that the disease is highly prevalent and has a huge impact on the individual, family, and community levels, resulting in a heavy burden on the healthcare system of a country. To explore the status of somatic symptoms in young and middle-aged psychiatric patients during long-term hospitalization, a total of 114 young and middle-aged psychiatric patients with prolonged hospitalization (more than 5 years) were included. Data information of the hospitalized patients was recorded, including preadmission somatic symptoms, electrocardiogram (ECG), echocardiogram, abdominal ultrasound, and blood tests. In addition, a homemade questionnaire was administered, and general information about the patients was also collected, including gender, age, current medication use, and duration of medication use. Correlations between cardiometabolic disease, osteoporosis, and long-term oral antipsychotic medication were analyzed in these young and middle-aged patients. The prevalence of comorbid somatic symptoms was 77.2%, and concomitant disorders included mainly cardiometabolic disorders, osteoporosis, pulmonary infections, cerebrovascular disorders, digestive disorders, fractures, and skin conditions. The incidence of somatic symptoms caused by long-term use of antipsychotic drugs was about 88.6%, and the incidence of concomitant somatic symptoms was higher in young and middle-aged psychiatric patients who were hospitalized for a long time. The current study observed a high prevalence of somatic symptoms in young and middle-aged patients with long-term inpatient psychiatric illness. Endocrine and metabolic disorders, particularly dyslipidemia, may trigger a range of deleterious effects. In addition to this, there is a high incidence of osteoporosis. Special attention should be paid to the side effects of antipsychotic drugs, and appropriate measures are needed to make early diagnosis and provide early treatment to reduce the occurrence of cardiometabolic diseases and osteoporosis.
Collapse
|
4
|
YULUĞ B, ÖZŞİMŞEK A, ÖZDEMİR ÖKTEM E. Investigation of the Effect of Antiepileptics on Vitamin D and Calcium Levels. ACTA MEDICA ALANYA 2022. [DOI: 10.30565/medalanya.1116431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: The purpose of our study is to investigate Vitamin D and calcium levels in epilepsy patients using different antiepileptic agents and to investigate the relationship between vitamin D levels and various factors such as the type of antiepileptic agent, patient age and gender.
Methodology: This retrospective case-control study enrolled a total of 290 participants, including 141 epilepsy patients followed up in AlanyaAlaaddinKeykubat University neurology outpatient clinic and 150 healthy individuals who applied to the neurology outpatient clinic for different reasons from January 2018 to January 2021. Demographics, detailed history, use of medications, duration of antiepileptic use, plasma 25-hydroxy Vitamin D and calcium levels of all participants were recorded.
Results: The average Vitamin D level was 15.46 in the epilepsy group and 16.95 in the control group. Vitamin D level did not differ significantly by group (p>0.05). No significant relationship was found between age and vitamin D levels in both groups, and Vitamin D levels were statistically significantly lower in women in the epilepsy group. Vitamin D level was below 20 in 69.6% of healthy control group, 78.9% of carbamazepine users, 62.5% of lacosamide users, all lamotrigine users, 66.7% of levatiracetam users, and 72.4% of sodium valproate users. There was no significant relationship between Vitamin D level and the drug used (p>0.05).There was a significant relationship only between calcium level and carbamazepine (p
Collapse
|
5
|
Zhuo L, Zhang Y. Effects of new antiseizure medication on bone metabolism and bone mineral density in children: A meta-analysis. Front Pediatr 2022; 10:1015691. [PMID: 36458136 PMCID: PMC9705372 DOI: 10.3389/fped.2022.1015691] [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: 08/10/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the effect of new antiseizure medication on bone metabolism and bone mineral density in children. METHODS The Chinese and English databases (PubMed, EMBASE, Cochrane Library, CNKI, Wanfang and VIP) were systematically searched for observational studies evaluating the effects of new antiseizure medication on bone metabolism and bone mineral density in children with epilepsy. The effects of new antiseizure medication on serum calcium, phosphorus, alkaline phosphatase, bone alkaline phosphatase, parathyroid hormone, 25-hydroxyvitamin D and bone mineral density in children were systematically evaluated. RESULTS After systematic retrieval and screening, 12 studies with high literature quality (including 629 epileptic children and 627 control subjects) were included in the systematic evaluation. Meta-analysis showed that new antiseizure medication decreased bone mineral density (MD: -0.05, 95%CI, -0.09, -0.02; P = 0.004). From different kinds of antiseizure medication, levetiracetam can reduce blood phosphorus concentration in children (MD: -0.04; 95%CI, -0.07, -0.01). Oxcarbazepine increased serum alkaline phosphatase in children (MD:17.98; 95%CI, 10.43,25.53; P < 0.00001), and the increase intensity was significantly higher than that of levetiracetam (MD: 7.66; 95%CI, 0.29, 15.02; P = 0.04). In addition, oxcarbazepine can cause a significant increase in parathyroid hormone in children (MD: 7.52; 95%CI, 3.37,11.66; P = 0.0004), and 25 - hydroxyvitamin D was reduced, and the difference was statistically significant (MD:-2.18; 95%CI, -3.23, -1.13; P = 0.00006). However, the effects of new antiseizure medication on serum calcium and bone alkaline phosphatase in children were not statistically significant. CONCLUSION New antiseizure medication have different effects on bone metabolism and bone mineral density in children with epilepsy, and the effects of different types of new antiseizure medication are different.
Collapse
Affiliation(s)
- La Zhuo
- Department of Pharmacy, Maternal and Child Health Hospital of Inner Mongolia Autonomous Region, Hohhot City, China
| | - Yong Zhang
- Department of Clinical Pharmacy, Children's Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
6
|
Impact of carbamazepine on vitamin D levels: A meta-analysis. Epilepsy Res 2021; 178:106829. [PMID: 34847425 DOI: 10.1016/j.eplepsyres.2021.106829] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 11/15/2021] [Accepted: 11/24/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE There are longstanding concerns about the impact of enzyme-inducing anti-seizure medications (ASMs) on vitamin D, an important molecule in both bone metabolism and inflammation pathways. The relationship between chronic use of carbamazepine and vitamin D levels has been studied, but no comprehensive review to inform practitioners and policymakers is currently available. We performed a meta-analysis on studies that measured 25-hydroxyvitamin D (25OHD) levels in persons taking carbamazepine to determine whether this drug significantly reduces circulating 25OHD. PRINCIPAL RESULTS From a literature search of the terms "carbamazepine" and "vitamin D", we identified 12 studies that measured 25OHD levels in persons on carbamazepine monotherapy groups and controls. Persons taking carbamazepine had significantly lower 25OHD levels than persons not taking carbamazepine. The average 25OHD levels of carbamazepine-treated patients across all studies was 21.8 ng/mL (IQR 15.4,26.0) whereas 25OHD levels of control subjects was 28.0 ng/mL (IQR 20.8,30.4). The weighted difference of means was 4.00 ng/mL of 25OHD. Neither age nor sex nor duration of carbamazepine therapy had a significant impact on this finding. The effect was similar irrespective of whether the comparator group consisted of healthy controls or epilepsy patients taking non-inducing medications. MAJOR CONCLUSIONS Carbamazepine use is associated with a reduction of 25OHD levels. In combination with other literature establishing the problematic metabolic effects of carbamazepine, this meta-analysis provides additional evidence in favor of the use of alternative ASMs as first-line agents. At minimum, vitamin D supplementation should be strongly considered for patients prescribed carbamazepine.
Collapse
|
7
|
Womble PD, Hodges SL, Nolan SO, Binder MS, Holley AJ, Herrera R, Senger S, Kwok E, Narviaz DA, Faust A, Hernandez-Zegada CJ, Kwon RY, Lugo JN. A vitamin D enriched diet attenuates sex-specific behavioral deficits, increases the lifespan, but does not rescue bone abnormalities in a mouse model of cortical dysplasia. Epilepsy Behav 2021; 124:108297. [PMID: 34509882 DOI: 10.1016/j.yebeh.2021.108297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
Individuals who experience recurrent spontaneous seizures often show behavioral and physiological comorbidities. Those with epilepsy are at a high risk of bone fractures (independent of seizure-related falls) and show a higher rate of a diagnosis of Autism Spectrum Disorder. The neural subset-specific (NS) Pten knockout (KO) mouse has an epilepsy phenotype, has been characterized to show autistic-like deficits, and has an osteoporosis phenotype. The current study examined the effect of a vitamin D enriched diet (20,000 IU VD) in the NS-Pten KO and wildtype mice. Mice were placed onto a vitamin D enriched diet at 4 weeks of age and maintained on that diet throughout testing. Behavioral testing began at 6 weeks of age and included tests for general activity, anxiety, repetitive behaviors, social behaviors, and memory. Results indicated that a vitamin D diet attenuated hypoactivity levels in male KO mice (p < 0.05). In a social partition task, vitamin D increased sociability in male wildtype mice, (p < 0.05). Most significantly, vitamin D fortified diet increased percent survival in KO animals and decreased the level of microglia marker IBA-1 and mTOR (mammalian target of rapamycin) downstream targets pS6 and pAKT. A high vitamin D diet did not reverse bone deficits in male or female KO mice. Overall, these findings suggest that a vitamin D enriched diet had a significant impact on the behavioral phenotype of NS-Pten KO mice, suggesting that dietary manipulations could be a potential therapeutic option for autistic-like behavior.
Collapse
Affiliation(s)
- Paige D Womble
- Department of Psychology and Neuroscience, Baylor University, Waco, TX 76706, USA
| | - Samantha L Hodges
- Institute of Biomedical Studies, Baylor University, Waco, TX 76706, USA
| | - Suzanne O Nolan
- Department of Psychology and Neuroscience, Baylor University, Waco, TX 76706, USA
| | - Matthew S Binder
- Department of Psychology and Neuroscience, Baylor University, Waco, TX 76706, USA
| | - Andrew J Holley
- Department of Psychology and Neuroscience, Baylor University, Waco, TX 76706, USA
| | - Rebecca Herrera
- Department of Psychology and Neuroscience, Baylor University, Waco, TX 76706, USA
| | - Savannah Senger
- Department of Psychology and Neuroscience, Baylor University, Waco, TX 76706, USA
| | - Eliesse Kwok
- Department of Psychology and Neuroscience, Baylor University, Waco, TX 76706, USA
| | - David A Narviaz
- Department of Psychology and Neuroscience, Baylor University, Waco, TX 76706, USA
| | - Amanda Faust
- Department of Psychology and Neuroscience, Baylor University, Waco, TX 76706, USA
| | | | - Ronald Y Kwon
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98104, USA
| | - Joaquin N Lugo
- Department of Psychology and Neuroscience, Baylor University, Waco, TX 76706, USA; Institute of Biomedical Studies, Baylor University, Waco, TX 76706, USA.
| |
Collapse
|
8
|
Wakeman M. A Literature Review of the Potential Impact of Medication on Vitamin D Status. Risk Manag Healthc Policy 2021; 14:3357-3381. [PMID: 34421316 PMCID: PMC8373308 DOI: 10.2147/rmhp.s316897] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/12/2021] [Indexed: 12/23/2022] Open
Abstract
In recent years, there has been a significant increase in media coverage of the putative actions of vitamin D as well as the possible health benefits that supplementation might deliver. However, the potential effect that medications may have on the vitamin D status is rarely taken into consideration. This literature review was undertaken to assess the degree to which vitamin D status may be affected by medication. Electronic databases were searched to identify literature relating to this subject, and study characteristics and conclusions were scrutinized for evidence of potential associations. The following groups of drugs were identified in one or more studies to affect vitamin D status in some way: anti-epileptics, laxatives, metformin, loop diuretics, angiotensin-converting enzyme inhibitors, thiazide diuretics, statins, calcium channel blockers, antagonists of vitamin K, platelet aggregation inhibitors, digoxin, potassium-sparing diuretics, benzodiazepines, antidepressants, proton pump inhibitors, histamine H2-receptor antagonists, bile acid sequestrants, corticosteroids, antimicrobials, sulphonamides and urea derivatives, lipase inhibitors, hydroxychloroquine, highly active antiretroviral agents, and certain chemotherapeutic agents. Given that the quality of the data is heterogeneous, newer, more robustly designed studies are required to better define likely interactions between vitamin D and medications. This is especially so for cytochrome P450 3A4 enzyme (CYP3A4)-metabolized medications. Nevertheless, this review suggests that providers of health care ought to be alert to the potential of vitamin D depletions induced by medications, especially in elderly people exposed to multiple-drug therapy, and to provide supplementation if required.
Collapse
Affiliation(s)
- Michael Wakeman
- Faculty of Health and Wellbeing, University of Sunderland, Sunderland, SR1 3SD, UK
| |
Collapse
|
9
|
Eryavuz Onmaz D, Abusoglu S, Ozturk B, Abusoglu G, Yerlikaya FH, Unlu A. Determination of serum carbamazepine and its metabolite by validated tandem mass spectrometric method and the effect of carbamazepine on various hematological and biochemical parameters. J Pharm Biomed Anal 2021; 205:114299. [PMID: 34388672 DOI: 10.1016/j.jpba.2021.114299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The study aimed to develop a validated LC-MS / MS method for the measurement of carbamazepine and carbamazepine-10,11-epoxide (CBZE) levels, to compare the carbamazepine concentrations measured by AbSciex API 3200 LC-MS/MS and Beckman Coulter Emit® 2000 immunoassay and to investigate the effect of carbamazepine concentrations on various hematological and biochemical parameters. METHODS For the measurement of carbamazepine and CBZE levels, a validated LC-MS / MS method was developed. Serum carbamazepine levels of patients were measured by AbSciex API 3200 LC-MS / MS and Beckman Coulter Emit® 2000 immunoassay. Biochemical, hematological parameters, and hormone levels were measured by Beckman-Coulter AU 5800 (Beckman Coulter, Brea, USA), Beckman Coulter LH 780 (Beckman Coulter, Miami, FL, USA), and Cobas 6000 (Roche Diagnostics, Germany) analyzers, respectively. RESULTS The imprecision values for all analytes were less than 7.0 %. The correlation coefficient between the methods was 0.981 (95 % confidence interval: 0.975 to 0.985). Linear regression analysis demonstrated highly significant associations of carbamazepine concentrations with albumin (B = -0.300, p = 0.040), calcium (B = -0.262, p = 0.004), phosphorus (B = -0.241, p = 0.022), WBC (B = -0.288, p = <0.001), PLT (B = -0.236, p = 0.003), RBC (B = -0.257, p = 0.001), NEU% (B = -0.289, p = <0.001), LYM% (B = -0.268, p = 0.001), D vitamini (B = -0.344, p = 0.006) levels. CONCLUSIONS A robust, rapid, and simple method has been developed. Our study revealed that carbamazepine and its metabolite have a significant correlation and likely impact on bone metabolism, blood cell counts, serum protein, albumin levels, and electrolyte concentrations.
Collapse
Affiliation(s)
- Duygu Eryavuz Onmaz
- Department of Biochemistry, Selcuk University Faculty of Medicine, Konya, Turkey.
| | - Sedat Abusoglu
- Department of Biochemistry, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Bahadir Ozturk
- Department of Biochemistry, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Gulsum Abusoglu
- Department of Medical Laboratory Techniques, Selcuk University Vocational School of Health, Konya, Turkey
| | | | - Ali Unlu
- Department of Biochemistry, Selcuk University Faculty of Medicine, Konya, Turkey
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
The effect of levetiracetam and oxcarbazepine monotherapy on thyroid hormones and bone metabolism in children with epilepsy: A prospective study. Epilepsy Behav 2020; 113:107555. [PMID: 33242769 DOI: 10.1016/j.yebeh.2020.107555] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/02/2020] [Accepted: 10/09/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Long-term treatment with certain antiepileptic drugs may lead to thyroid function disturbances or alterations in bone metabolism; the data on the effects of new antiepileptic drugs on this are limited and conflicting, especially in children with epilepsy. Therefore, the aim of this study was to investigate the effects of levetiracetam and oxcarbazepine on thyroid hormone levels and bone metabolism in children with epilepsy. METHODS A total of 51 children with new-onset partial epilepsy were selected. They were randomly treated with either levetiracetam (n = 25), or oxcarbazepine (n = 26) monotherapy. Eight of the 51 patients were excluded for failing to take the drug continuously or failing to undergo a regular review. Thus, 43 patients were finally included (levetiracetam: 23 patients, oxcarbazepine: 20 patients). A control group consisting of age- and sex-matched healthy subjects (n = 20) was included for comparison. Serum triiodothyronine, tetraiodothyronine, free triiodothyronine, free thyroxine, thyroid-stimulating hormone, calcium, phosphorus, alkaline phosphatase, osteocalcin, parathyroid hormone, and 25-hydroxyvitamin D levels and bone mineral density values were measured before and at 6 and 12 months after therapy in all groups. RESULTS At baseline, thyroid hormone levels, bone metabolism index, and bone mineral density values did not differ between the control group and the drug-treated groups. Levetiracetam-treated patients showed no significant changes in thyroid hormone levels, bone metabolism, and bone mineral density during the 12-month follow-up period compared with baseline values. In the oxcarbazepine group, compared to baseline values, serum free thyroxine levels decreased after 12 months of treatment (Z = -3.115, p = 0.002), and after 6 and 12 months of treatment, calcium levels decreased (Z = -3.705, p < 0.001 and Z = -3.884, p < 0.001, respectively) and parathyroid hormone levels increased (Z = -3.698, p < 0.001 and Z = -3.921, p < 0.001, respectively); however, all other parameters did not differ from baseline values. CONCLUSION Our data show that levetiracetam treatment has no significant effect on thyroid function and bone metabolism in children with epilepsy. Long-term use of oxcarbazepine may reduce serum free thyroxine levels, resulting in impaired thyroid function, and may reduce serum calcium and increase parathyroid hormone levels, leading to bone metabolism disorders.
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Liu A, Gu Q, Wang M. Effects of levetiracetam and lacosamide on therapeutic efficacy and neural function in patients with epilepsy. Exp Ther Med 2020; 20:3687-3694. [PMID: 32905038 PMCID: PMC7465612 DOI: 10.3892/etm.2020.9126] [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: 03/06/2020] [Accepted: 07/16/2020] [Indexed: 12/27/2022] Open
Abstract
The present study aimed to investigate the effects of levetiracetam tablets and lacosamide (LCM) on therapeutic efficacy and neural function in patients with epilepsy. We assigned 252 patients with refractory partial seizures admitted to our hospital to receive either levetiracetam tablets [120 patients, the control group (CG)] or levetiracetam tablets combined with LCM [132 patients, the joint group (JG)]. The bone mineral density and neural function between the two groups at 6 months before and after treatment were compared. The total response rate was higher in the JG than in the CG (P<0.05). There was no significant difference in the comparison of the multiple indexes between the two groups before treatment (P>0.05). The frequency of seizures was reduced after treatment in the two groups, however, it was lower in the JG compared with the CG (P<0.05). The levels of neurological indicators were significantly reduced after treatment in the two groups (P<0.05), however, the reduction was more marked in the JG than in the CG. The bone mineral density (BMD) of the femoral neck decreased after treatment in the two groups (P<0.05), but there was no difference between the two groups after treatment (P>0.05). The calcium content decreased after treatment in the two groups (P<0.05), but there was no difference between the two groups after treatment (P>0.05). The comparison of other bone metabolism markers between the two groups exhibited no significant differences. The combination therapy greatly increased the quality of life score and the 1-year drug retention rate. To sum up, levetiracetam tablets combined with LCM significantly enhanced the therapeutic effect and improved the neural function in patients with refractory partial seizures, however this therapy may cause a slight adverse effect on BMD and bone metabolism in the short term.
Collapse
Affiliation(s)
- Airong Liu
- Hong Kong Middle Road Clinic, Integrated Chinese and Western Medicine Hospital of Qingdao (The 5th People's Hospital of Qingdao), Qingdao, Shandong 266073, P.R. China
| | - Qiuling Gu
- Hong Kong Middle Road Clinic, Integrated Chinese and Western Medicine Hospital of Qingdao (The 5th People's Hospital of Qingdao), Qingdao, Shandong 266073, P.R. China
| | - Mingjing Wang
- Hong Kong Middle Road Clinic, Integrated Chinese and Western Medicine Hospital of Qingdao (The 5th People's Hospital of Qingdao), Qingdao, Shandong 266073, P.R. China
| |
Collapse
|
14
|
Jésus P, Godet B, Darthou-Pouchard L, Fayemendy P, Abdallah-Lebeau F, Villeneuve O, Marcon C, Gimenez L, Preux PM, Couratier P, Desport JC. Vitamin D status among patients with drug-resistant and non-drug-resistant epilepsy. INT J VITAM NUTR RES 2020; 90:205-209. [PMID: 32167416 DOI: 10.1024/0300-9831/a000459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background & Aims: Epilepsy affects nearly 70 million people worldwide. Vitamin D deficiency may influence the balance of certain epilepsies. The purpose of this study was to determine the vitamin D status and anthropometric measurements of people with epilepsy (PWE), according to their pharmacosensitivity. Methods: Forty-six PWE, with or without drug resistance, underwent nutritional assessment after giving consent. Weight, body mass index (BMI), triceps skinfold thickness (TSF), fat mass (FM) and free fat mass (FFM) by bioelectrical impedance analysis were measured. Serum vitamin D was determined without supplementation. Deficiency was defined as a level < 30 ng/mL. Statistical analysis involved Student t test, ANOVA and Chi2. Results: Patients were aged 44.5 ± 14.3 years, with 60.9% of drug-resistance. BMI was 28.7 ± 7.0, 2.2% were malnourished and 30.4% obese according to the BMI. The average vitamin D level was 15.3 ± 9.9 ng/mL, with 87.0% of deficiency, and 40.0% of severe deficiency (<10 ng/mL). The TSF was higher in drug-resistant cases (p = 0.03). There was no link between drug resistance and anthropometric measurements, FM, FFM or vitamin D concentration. Conclusions: Although limited in size, this study showed that PWE are more often obese. Vitamin D deficiency is more common than in the general population, with a much higher prevalence of severe deficiency.
Collapse
Affiliation(s)
- Pierre Jésus
- Nutrition Unit, University Hospital of Limoges, Limoges, France.,INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,Univ. Limoges, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Bertrand Godet
- Neurology Department, University Hospital of Limoges, Limoges, France.,INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,Univ. Limoges, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | | | | | | | | | - Claire Marcon
- Neurology Department, University Hospital of Limoges, Limoges, France
| | - Laetitia Gimenez
- Neurology Department, University Hospital of Limoges, Limoges, France
| | - Pierre Marie Preux
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,Univ. Limoges, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Philippe Couratier
- Neurology Department, University Hospital of Limoges, Limoges, France.,INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,Univ. Limoges, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Jean Claude Desport
- Nutrition Unit, University Hospital of Limoges, Limoges, France.,INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.,Univ. Limoges, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Sumbul O, Aygun H. The effect of vitamin D 3 and paricalcitol on penicillin-induced epileptiform activity in rats. Epilepsy Res 2019; 159:106262. [PMID: 31887643 DOI: 10.1016/j.eplepsyres.2019.106262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/11/2019] [Accepted: 12/21/2019] [Indexed: 12/17/2022]
Abstract
AIM Epilepsy is a disease characterized by seizures which impair human life considerably. Vitamin D is of different systemic effects on metabolism and its deficiency is known to have a high prevalence among epilepsy patients. Paricalcitol, a vitamin D receptor agonist, has relatively fewer side effects. This study aimed to investigate the anticonvulsant effect of vitamin D3 (cholecalciferol) and paricalcitol on penicillin-induced epileptiform activity. METHOD 21 male Wistar rat weighing 180-240 g were used. After anesthetized by 1.25 g/kg urethane intraperitoneally (i.p.), rats were placed in the stereotaxic frame and tripolar electrodes were placed on the skull. The single microinjection of penicillin (2.5 μl, 500 IU, i.c.) into left sensorimotor cortex induced epileptiform activity. A single dose of 60.000 IU/kg (i.p.) vitamin D3 was administered 14 days before intracortical penicillin (500 IU) injection. Paricalcitol (10 μg/kg, i.p.) was administered 30 min before intracortical penicillin (500 IU) administration and recorded for the following 180 min. RESULTS Vitamin D3 pretreatment and paricalcitol diminished the frequency of epileptiform activity (p < 0.001) without changing the amplitude (p > 0.05) compared to the penicillin-injected group. Vitamin D3 pretreatment and paricalcitol led to an important delay in the onset of penicillin-induced epileptiform activity (p < 0.001 and p < 0.05, respectively). Vitamin D3 increased the latency of penicillin-induced epileptic activity compared to paricalcitol group (p < 0.001). CONCLUSION Results indicate that vitamin D3 and paricalcitol decreased the frequency and increased the latency of the penicillin-induced epileptic activity. Vitamin D3 was more effective than paricalcitol.
Collapse
Affiliation(s)
- Orhan Sumbul
- Department of Neurology, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Hatice Aygun
- Department of Physiology, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey.
| |
Collapse
|
17
|
Mintzer S, Constantino T, Gidal B, Bhargava P, Grinnell T, Blum D. Markers of bone and lipid metabolism with eslicarbazepine acetate monotherapy. Epilepsy Res 2019; 158:106216. [PMID: 31675622 DOI: 10.1016/j.eplepsyres.2019.106216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/27/2019] [Accepted: 10/13/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the impact of eslicarbazepine acetate (ESL) monotherapy on markers of bone and lipid metabolism. METHODS We conducted a post-hoc analysis of data pooled from two Phase III, dose-blind, conversion-to-ESL (1600 mg and 1200 mg) monotherapy studies in patients with focal seizures. Laboratory measurements included lipids (total cholesterol [TC]; high-density lipoprotein cholesterol [HDL-C]; low-density lipoprotein cholesterol; and triglycerides) and markers of bone metabolism (alkaline phosphatase; 25-hydroxyvitamin D; osteocalcin; and parathyroid hormone [PTH]); measurements were taken at baseline, Week 18, and Month 12, and analyzed according to enzyme-inducing antiepileptic drugs (EIAEDs) use at baseline (+EIAED and -EIAED subgroups). RESULTS Data from 337 treatment-compliant patients were used for the Week 18 analyses (+EIAED subgroup, n = 119; -EIAED subgroup, n = 218); data from 161 treatment-compliant patients were used for the Month 12 analyses (+EIAED subgroup, n = 53; -EIAED subgroup, n = 108). At baseline, alkaline phosphatase and PTH concentrations were higher in the + EIAED versus -EIAED subgroup. Changes from baseline in markers of bone turnover were generally insignificant, except for some elevation in alkaline phosphatase in the -EIAED subgroup (18 weeks and 12 months) and osteocalcin in both subgroups (18 weeks only). Regarding lipids, TC and HDL-C concentrations were higher in the + EIAED versus -EIAED subgroup at baseline. Concentrations of markers of lipid metabolism fell in the + EIAED group and rose in the -EIAED group, reaching very similar values that were intermediate between the -EIAED and + EIAED baseline values. CONCLUSIONS Based on this retrospective analysis, ESL seems to have had only a modest and primarily clinically insignificant impact on plasma lipids. More prospective data are needed to definitively ascertain the effects of ESL on bone metabolism.
Collapse
Affiliation(s)
- Scott Mintzer
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Tawnya Constantino
- Department of Neurology, Intermountain Neuroscience Institute at IMC, Murray, UT, USA.
| | - Barry Gidal
- School of Pharmacy and Department of Neurology, University of Wisconsin-Madison, Madison, WI, USA.
| | | | - Todd Grinnell
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.
| | - David Blum
- Sunovion Pharmaceuticals Inc., Marlborough, MA, USA.
| |
Collapse
|
18
|
Mäkinen J, Rainesalo S, Raitanen J, Saarinen J, Sandell S, Peltola J. Discontinuation of carbamazepine due to concerns of long-term consequences of enzyme induction. Epilepsia Open 2018; 3:340-347. [PMID: 30187004 PMCID: PMC6119761 DOI: 10.1002/epi4.12227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2018] [Indexed: 12/19/2022] Open
Abstract
Objective Treatment with carbamazepine (CBZ), a potent enzyme inducer, is known to affect the lipid profile, steroid, and vitamin D metabolism. Consequently, it has been postulated that patients on CBZ should be switched to noninducing antiepileptic drugs (AEDs). However, little is known about the seizure outcome following a CBZ switch in seizure‐free patients. We aimed to address this issue using a controlled observational study design. Methods Fifty‐eight patients taking CBZ for focal epilepsy were assessed for discontinuing CBZ treatment due to concerns of long‐term adverse‐effects; 34 discontinued its therapy and 24 continued with CBZ. Six‐month seizure freedom was the primary end point. Furthermore, serum samples (total cholesterol (TC), low‐density lipoprotein (LDL), high‐density lipoprotein (HDL), triglycerides, sex hormone–binding globulin (SHBG), free testosterone, and 25‐hydroxyvitamin D levels from before and at least 3 months after discontinuation or continuation were obtained from all patients. Results Seizure‐free patients had a 5‐fold elevated odds of seizure recurrence if CBZ was discontinued (95% confidence interval [CI 0.51–49.3; p = 0.17). A significant decrease in serum levels of TC, LDL, HDL, and SHBG as well as a significant increase in that of free testosterone were found in the discontinuation group compared with those who continued CBZ. Nonsignificant changes in triglycerides and vitamin D levels were detected. Significance Discontinuation of CBZ in seizure‐free patients seems to carry a moderate, but legitimate, risk of relapse. Conversely, our results indicate that CBZ might have unfavorable effects on serum levels of TC, LDL, HDL, SHBG, and free testosterone.
Collapse
Affiliation(s)
- Jussi Mäkinen
- Department of Neurology Tampere University Hospital Tampere Finland
| | - Sirpa Rainesalo
- Department of Neurology Tampere University Hospital Tampere Finland
| | - Jani Raitanen
- Faculty of Social Sciences University of Tampere Tampere Finland.,UKK Institute for Health Promotion Tampere Finland
| | - Jukka Saarinen
- Department of Neurology Vaasa Central Hospital Vaasa Finland
| | - Satu Sandell
- Department of Neurology Seinäjoki Central Hospital Seinäjoki Finland
| | - Jukka Peltola
- Department of Neurology University of Tampere and Tampere University Hospital Tampere Finland
| |
Collapse
|
19
|
Kanda J, Izumo N, Kobayashi Y, Onodera K, Shimakura T, Yamamoto N, E Takahashi H, Wakabayashi H. Effects of the antiepileptic drugs topiramate and lamotrigine on bone metabolism in rats. Biomed Res 2018; 38:297-305. [PMID: 29070779 DOI: 10.2220/biomedres.38.297] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Long-term treatment with antiepileptic drugs (AED) is associated with an elevated risk of bone fracture due to decreased bone mineral density (BMD). Phenytoin has been shown to affect bone metabolism adversely, whereas newly developed AEDs have not been studied. This study evaluated the effects of topiramate and lamotrigine on bone metabolism in rats. Five-week-old male Sprague-Dawley rats were treated orally with phenytoin (20 mg/kg), topiramate (5 or 20 mg/kg), or lamotrigine (2 or 10 mg/kg) daily for 12 weeks. Phenytoin reduced bone strength, measured by maximum load to failure of the femoral mid-diaphysis, along with reduced femur total BMD. Serum tartrate-resistant acid phosphatase-5b levels significantly increased after phenytoin treatment, while serum osteocalcin levels decreased after topiramate 20 mg/kg treatment. Furthermore, osteoblast surface and bone mineralizing surface were significantly lowered by topiramate. Lamotrigine treatment did not affect bone strength, BMD, or bone turnover. We demonstrated that phenytoin treatment significantly increased bone resorption and lowered BMD and bone strength. Since lamotrigine did not affect bone metabolism, it can be concluded that lamotrigine is safety medicine for bone health. Topiramate was associated with decreased bone formation, which may affect bone strength and BMD with chronic use. Thus, patients taking topiramate should be monitored for changes in BMD to avoid risk of fracture.
Collapse
Affiliation(s)
- Junkichi Kanda
- Department of Clinical Pharmacotherapy, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences
| | - Nobuo Izumo
- General Health Medical Center, Yokohama University of Pharmacy
| | | | - Kenji Onodera
- Department of Clinical Pharmacotherapy and Pharmacy, Bethel Epilepsy Centre
| | | | - Noriaki Yamamoto
- Niigata Bone Science Institute, Niigata Rehabilitation Hospital.,Division of Orthopedic Surgery, Niigata Rehabilitation Hospital
| | | | - Hiroyuki Wakabayashi
- Department of Clinical Pharmacotherapy, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences
| |
Collapse
|
20
|
Garip Ustaoglu S, Evis Z, Ilbay G, Boskey AL, Severcan F. Side-Effects of Convulsive Seizures and Anti-Seizure Therapy on Bone in a Rat Model of Epilepsy. APPLIED SPECTROSCOPY 2018; 72:689-705. [PMID: 28905646 DOI: 10.1177/0003702817734617] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The severe sole effects of seizures on the cortical part of bone were reported in our previous study. However, the side effects of anti-epileptic drug therapy on bones has not been differentiated from the effects of the convulsive seizures, yet. This study provides the first report on differentiation of the effects of seizures and carbamazepine (a widely used antiepileptic drug) therapy on bones; 50 mg/kg/day drug was given to genetically induced absence epileptic rats for five weeks. Distinct bone regions including cortical, trabecular, and growth plate in each of tibia, femur, and spine tissues were studied using Fourier transform infrared (FT-IR) imaging and Vickers microhardness test. Blood levels of vitamin D and bone turnover biomarkers were also measured. According to the FT-IR imaging results, both seizure and carbamazepine-treated groups, more dominantly the drug-treated group, had lower mineral content with altered collagen crosslinks and higher crystallinity, implying reduced bone strength. Lower microhardness values also supported lower mechanical strength in bones. The most affected bone tissue and region from seizures and treatment was found as the spine and cortical, respectively. While there was a reduction in vitamin D and calcium levels in both seizure and carbamazepin-treated groups, significantly elevated PTH and bone turnover biomarkers were only seen in the drug-treated group.
Collapse
Affiliation(s)
- Sebnem Garip Ustaoglu
- 1 Department of Biochemistry, 187458 Middle East Technical University , Ankara, Turkey
- 2 Department of Medical Biochemistry, 187458 Faculty of Medicine, Altinbas University, Istanbul, Turkey
| | - Zafer Evis
- 3 Department of Engineering Sciences, Middle East Technical University, Ankara, Turkey
| | - Gul Ilbay
- 4 Department of Physiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Adele Ludin Boskey
- 5 25062 Mineralized Tissue Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Feride Severcan
- 6 Department of Biological Sciences, 187458 Middle East Technical University , Ankara, Turkey
- 7 Department of Biophysics, 187458 Faculty of Medicine, Altinbas University, Istanbul, Turkey
| |
Collapse
|
21
|
Miratashi Yazdi SA, Abbasi M, Miratashi Yazdi SM. Epilepsy and vitamin D: a comprehensive review of current knowledge. Rev Neurosci 2018; 28:185-201. [PMID: 27988507 DOI: 10.1515/revneuro-2016-0044] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/24/2016] [Indexed: 12/29/2022]
Abstract
Vitamin D has been considered as neurosteroid, and its pivotal role in neuroprotection, brain development, and immunomodulation has been noticed in studies; however, our knowledge regarding its role in neurological disorders is still developing. The potential role of vitamin D in the pathophysiology and treatment of epilepsy, as one the most prevalent neurological disorders, has received less attention in recent years. In this article, we review the possible relationship between vitamin D and epilepsy from different aspects, including the action mechanism of vitamin D in the central nervous system and ecological and epidemiological findings. We also present the outcome of studies that evaluated the level of vitamin D and the impact of administrating vitamin D in epileptic patients or animal subjects. We also review the current evidence on interactions between vitamin D and antiepileptic drugs.
Collapse
|
22
|
Potential risk factors for vitamin D levels in medium- and long-term use of antiepileptic drugs in childhood. Acta Neurol Belg 2017; 117:447-453. [PMID: 28386818 DOI: 10.1007/s13760-017-0775-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
Antiepileptic drugs (AED) have potential side effects through vitamin-D. Prevalence of vitamin D insufficiency and potential risk factors for the longitudinal changes of vitamin D levels compared to its baseline levels under AED treatment were investigated in this study. This retrospective study includes patients whose AED therapy were started in only autumn months, between 2000 and 2014. Detailed assessment of neurologic diagnosis and brain MRI findings, ambulatory status, types and durations of AED treatment, and baseline bone health blood tests (vitamin-D, alkaline phosphatase, calcium, and phosphate levels) were obtained on all patients. Vitamin-D deficiency was defined as 25(OH)D <20 ng/mL, while vitamin-D insufficiency was defined as 25(OH)D between 21 and 29 ng/mL. A total of 172 children (mean age 9.6 ± 4.3 years) were followed up 5.3 years in average (range 1-14.7). The mean baseline 25(OH)D level was decreased from 24.4 ± 11.6 to 19.6 ± 10.7 ng/mL at the last follow up. The mean change in the vitamin-D levels (ΔD-vitamin) was -4.8 ng/mL (p = 0.003). The rate of vitamin-D deficiency was 54% and insufficiency was 25%. Multivariate logistic regression analysis identified only long-term use of AEDs as a risk factor for the longitudinal decrease. Monotherapy with valproic acid (n = 45), carbamazepine (n = 20), levetiracetam (n = 10) and phenobarbital (n = 12) was compared with each other. There was no difference in terms of longitudinal changes in 25(OH)D levels. In the treatment of childhood epilepsy, 25(OH)D levels should be monitored, especially when long-term AED used, in order to prevent D-hypovitaminosis.
Collapse
|
23
|
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]
|
24
|
Shiek Ahmad B, O'Brien TJ, Gorelik A, Hill KD, Wark JD. Bone Mineral Changes in Epilepsy Patients During Initial Years of Antiepileptic Drug Therapy. J Clin Densitom 2016; 19:450-456. [PMID: 27553750 DOI: 10.1016/j.jocd.2016.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/22/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022]
Abstract
Antiepileptic drug (AED) therapy is associated with decreased bone mineral density; however, the time course for this development is unclear. The aim of this study was to evaluate bone mineral changes during the initial years of AED therapy in AED-naive, newly diagnosed epilepsy patients compared with non-AED users. In 49 epilepsy patients newly started on AEDs and in 53 non-AED users of both genders, bone mineral density (BMD) and bone mineral content were measured using dual-energy X-ray absorptiometry at baseline (within the first year of therapy) and at least 1 yr later. Bone changes between the 2 assessments, adjusted for age, height, and weight, were calculated as the annual rate of change. The median duration of AED therapy was 3.5 mo at baseline and 27.6 mo at follow-up. No overall difference was found in mean BMD and bone mineral content measures between user and nonuser cohorts in both cross-sectional baseline and the annual rate of change (p > 0.05). However, users on carbamazepine monotherapy (n = 11) had an increased annual rate of total hip (-2.1% vs -0.8%, p = 0.020) and femoral neck BMD loss (-2.1% vs -0.6%, p = 0.032) compared to nonusers. They also had a marginally higher rate of femoral neck BMD loss (-2.1%, p = 0.049) compared with valproate (-0.1%, n = 13) and levetiracetam users (+0.6%, n = 13). During the initial years of AED treatment for epilepsy, no difference was found in bone measures between AED users as a group and nonuser cohorts. However, the data suggested that carbamazepine monotherapy was associated with increased bone loss at the hip regions, compared to users of levetiracetam or valproate and nonusers. Larger studies of longer duration are warranted to better delineate the bone effects of specific AEDs, with further consideration of the role of early dual-energy X-ray absorptiometry scanning and careful AED selection in potentially minimizing the impact on bone health in these patients.
Collapse
Affiliation(s)
- Baemisla Shiek Ahmad
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Terence John O'Brien
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
| | - Alexandra Gorelik
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Melbourne EpiCentre, The Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
| | - Keith David Hill
- School of Physiotherapy and Exercise Science, Curtin University, Western Australia, Australia
| | - John Dennis Wark
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Victoria, Australia; Bone and Mineral Medicine, The Royal Melbourne Hospital, Victoria, Australia.
| |
Collapse
|
25
|
Lossius MI, Nakken KO, Mowinckel P, Taubøll E, Gjerstad L. Favorable change of lipid profile after carbamazepine withdrawal. Acta Neurol Scand 2016; 134:219-23. [PMID: 26592200 DOI: 10.1111/ane.12534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Patients treated with carbamazepine (CBZ) have increased serum levels of total cholesterol (TC), high-density lipoproteins (HDL), and low-density lipoproteins (LDL). We aimed to investigate whether these changes of serum lipids are reversible after CBZ withdrawal. MATERIAL AND METHODS We used a prospective, randomized double-blinded design. A total of 160 patients who had been seizure free on anti-epileptic drug monotherapy for more than 2 years were included and randomized to withdrawal or not. The intervention was completed by 150 (80 females, 53%) patients. Serum samples from before and 4 months after completed withdrawal or no withdrawal were obtained from 130 patients (63 females, 48%). Of these, 84 were treated with CBZ, 28 with valproate, nine with phenytoin, four with phenobarbital, and five with lamotrigine. Of the patients who had been treated with CBZ, 47 were randomized to the withdrawal group, and 37 were randomized to the non-withdrawal group. RESULTS Among the CBZ-treated patients, a significant decrease in serum levels of TC, LDL, and apolipoprotein B (ApoB) were found in the withdrawal group compared with the non-withdrawal group. Mean differences in change were as follows: TC 0.68 mmol/l (P = 0.005, CL - 1.15 to -0.21); LDL - 0.67 mmol/l (P = 0.001, CL - 1.03 to -0.29); ApoB - 0.13 g/l (P = 0.02, CL - 0.23 to -0.03). No significant changes in HDL, apolipoprotein A, and C-reactive protein were detected. CONCLUSION Our results indicate that CBZ may have unfavorable effects on serum levels of TC, LDL, and ApoB. However, these changes seem to be reversible even after years of treatment.
Collapse
Affiliation(s)
- M. I. Lossius
- National Centre for Epilepsy; Division of Surgery and Clinical Neuroscience; Oslo University Hospital; Oslo Norway
| | - K. O. Nakken
- National Centre for Epilepsy; Division of Surgery and Clinical Neuroscience; Oslo University Hospital; Oslo Norway
| | - P. Mowinckel
- Department of Paediatrics; Division Woman and Child; Oslo University Hospital; Oslo Norway
| | - E. Taubøll
- Department of Neurology; Division of Surgery and Clinical Neuroscience; Oslo University Hospital; Oslo Norway
- Faculty of Medicine; University of Oslo; Oslo Norway
| | - L. Gjerstad
- Department of Neurology; Division of Surgery and Clinical Neuroscience; Oslo University Hospital; Oslo Norway
- Faculty of Medicine; University of Oslo; Oslo Norway
| |
Collapse
|
26
|
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.
Collapse
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.
| |
Collapse
|
27
|
Hakami T, O'Brien TJ, Petty SJ, Sakellarides M, Christie J, Kantor S, Todaro M, Gorelik A, Seibel MJ, Yerra R, Wark JD. Monotherapy with Levetiracetam Versus Older AEDs: A Randomized Comparative Trial of Effects on Bone Health. Calcif Tissue Int 2016; 98:556-65. [PMID: 26842957 DOI: 10.1007/s00223-016-0109-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
Abstract
Long-term anti-epileptic drug (AED) therapy is associated with increased fracture risk. This study tested whether substituting the newer AED levetiracetam has less adverse effects on bone than older AEDs. An open-label randomized comparative trial. Participants had "failed" initial monotherapy for partial epilepsy and were randomized to substitution monotherapy with levetiracetam or an older AED (carbamazepine or valproate sodium). Bone health assessments, performed at 3 and 15 months, included areal bone mineral density (aBMD) and content at lumbar spine (LS), total hip (TH), forearm (FA), and femoral neck (FN), radial and tibial peripheral quantitative computed tomography and serum bone turnover markers. Main outcomes were changes by treatment group in aBMD at LS, TH, and FA, radial and tibial trabecular BMD and cortical thickness. 70/84 patients completed assessments (40 in levetiracetam- and 30 in older AED group). Within-group analyses showed decreases in both groups in LS (-9.0 %; p < 0.001 in levetiracetam vs. -9.8 %; p < 0.001 in older AED group), FA (-1.46 %; p < 0.001 vs. -0.96 %; p < 0.001, respectively) and radial trabecular BMD (-1.46 %; p = 0.048 and -2.31 %; p = 0.013, respectively). C-terminal telopeptides of type I collagen (βCTX; bone resorption marker) decreased in both groups (-16.1 %; p = 0.021 vs. -15.2 %; p = 0.028, respectively) whereas procollagen Ι N-terminal peptide (PΙNP; bone formation marker) decreased in older AED group (-27.3 %; p = 0.008). The treatment groups did not differ in any of these measures. In conclusion, use of both levetiracetam and older AEDs was associated with bone loss over 1 year at clinically relevant fracture sites and a reduction in bone turnover.
Collapse
Affiliation(s)
- Tahir Hakami
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, 4th Floor Clinical Sciences Building Royal Parade, The Royal Melbourne Hospital, Parkville, 3050, VIC, Australia
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Terence J O'Brien
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, 4th Floor Clinical Sciences Building Royal Parade, The Royal Melbourne Hospital, Parkville, 3050, VIC, Australia
| | - Sandra J Petty
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, 4th Floor Clinical Sciences Building Royal Parade, The Royal Melbourne Hospital, Parkville, 3050, VIC, Australia
| | - Mary Sakellarides
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, 4th Floor Clinical Sciences Building Royal Parade, The Royal Melbourne Hospital, Parkville, 3050, VIC, Australia
| | - Jemma Christie
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, 4th Floor Clinical Sciences Building Royal Parade, The Royal Melbourne Hospital, Parkville, 3050, VIC, Australia
| | - Susan Kantor
- Bone Densitometry Unit, The Royal Melbourne Hospital, Melbourne, Australia
| | - Marian Todaro
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, 4th Floor Clinical Sciences Building Royal Parade, The Royal Melbourne Hospital, Parkville, 3050, VIC, Australia
| | - Alexandra Gorelik
- The Melbourne EpiCentre, The Royal Melbourne Hospital, Melbourne, Australia
| | - Markus J Seibel
- Bone Research Program, ANZAC Research Institute, The University of Sydney, Sydney, Australia
| | - Raju Yerra
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
| | - John D Wark
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, 4th Floor Clinical Sciences Building Royal Parade, The Royal Melbourne Hospital, Parkville, 3050, VIC, Australia.
- Bone & Mineral Medicine, The Royal Melbourne Hospital, Melbourne, Australia.
| |
Collapse
|
28
|
Mintzer S, Miller R, Shah K, Chervoneva I, Nei M, Skidmore C, Sperling MR. Long-term effect of antiepileptic drug switch on serum lipids and C-reactive protein. Epilepsy Behav 2016; 58:127-32. [PMID: 27074299 PMCID: PMC4875871 DOI: 10.1016/j.yebeh.2016.02.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/11/2016] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Prior studies have shown that switching patients from inducing antiepileptic drugs (AEDs) to lamotrigine, levetiracetam, or topiramate reduces serum lipids and C-reactive protein (CRP). These studies were all of short duration, and some drugs, such as zonisamide, have not been investigated. METHODS We recruited 41 patients taking phenytoin or carbamazepine who were being switched to zonisamide, lamotrigine, or levetiracetam. We measured serum lipids and CRP before the switch, >6weeks after, and >6months after. An untreated control group (n=14) underwent similar measurement. We combined these data with those of our previous investigation (n=34 patients and 16 controls) of a very similar design. RESULTS There were no differences in outcome measures between the two inducing AEDs nor among the three noninducing AEDs. Total cholesterol (TC), atherogenic lipids, and CRP were higher under inducer treatment than in controls. All measures were elevated under inducer treatment relative to noninducer treatment, including TC (24mg/dL higher, 95% CI: 17.5-29.9, p<0.001) and CRP (72% higher, 95% CI: 41%-111%, p<0.001). The difference between drug treatments was clinically meaningful for atherogenic lipids (16%, 95% CI: 11%-20%, p<0.001) but small for high-density lipoprotein cholesterol (5%, 95% CI: 1%-9%, p<0.05). All measures were stable between 6weeks and 6months after drug switch. CONCLUSIONS We demonstrate that switching from inducing to noninducing AEDs produces an enduring reduction in serum lipids and CRP. These results provide further evidence that inducing AEDs may be associated with elevated vascular disease risk. These are the first vascular risk marker data in patients taking zonisamide, which shows a profile similar to that of other noninducing AEDs.
Collapse
Affiliation(s)
- Scott Mintzer
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, United States.
| | | | | | - Inna Chervoneva
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | | | | | | |
Collapse
|
29
|
Aksoy D, Güveli BT, Ak PD, Sarı H, Ataklı D, Arpacı B. Effects of Oxcarbazepine and Levetiracetam on Calcium, Ionized Calcium, and 25-OH Vitamin-D3 Levels in Patients with Epilepsy. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2016; 14:74-8. [PMID: 26792043 PMCID: PMC4730931 DOI: 10.9758/cpn.2016.14.1.74] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/01/2015] [Accepted: 08/25/2015] [Indexed: 11/20/2022]
Abstract
Objective The primary objective of the present study was to further elucidate the effects of oxcarbazepine (OXC) and levetiracetam (LEV) monotherapies on the bone health status of patients with epilepsy. Methods This study included 48 patients who attended our epilepsy outpatient clinic, had a diagnosis of epilepsy, and were undergoing either OXC or LEV monotherapy and 42 healthy control subjects. The demographic and clinical features of the patients, including gender, age, onset of disease, daily drug dosage, and duration of disease, were noted. Additionally, the calcium, ionized calcium, and 25-OH vitamin-D3 levels of the participants were prospectively evaluated. Results The 25-OH vitamin-D3, calcium, and ionized calcium levels of the patients taking OXC were significantly lower than those of the control group. These levels did not significantly differ between the patients taking LEV and the control group, but there was a significant negative relationship between daily drug dose and ionized calcium levels in the LEV patients. Conclusion In the present study, anti-epileptic drugs altered the calcium, ionized calcium, and 25-OH vitamin-D3 levels of epilepsy patients and resulted in bone loss, abnormal mineralization, and fractures. These findings suggest that the calcium, ionized calcium, and 25-OH vitamin-D3 levels of patients with epilepsy should be regularly assessed.
Collapse
Affiliation(s)
- Duygu Aksoy
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey
| | - Betül Tekin Güveli
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey
| | - Pelin Doğan Ak
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey
| | - Hüseyin Sarı
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey
| | - Dilek Ataklı
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey
| | - Baki Arpacı
- Department of Neurology, Bakirkoy Education and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey
| |
Collapse
|
30
|
Hamed SA. Markers of bone turnover in patients with epilepsy and their relationship to management of bone diseases induced by antiepileptic drugs. Expert Rev Clin Pharmacol 2015; 9:267-86. [DOI: 10.1586/17512433.2016.1123617] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
31
|
Markers of bone turnover in patients with epilepsy and their relationship to management of bone diseases induced by antiepileptic drugs. Expert Rev Clin Pharmacol 2015. [PMID: 26589104 DOI: org/10.1586/17512433.2016.1123617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Data from cross-sectional and prospective studies revealed that patients with epilepsy and on long-term treatment with antiepileptic drugs (AEDs) are at increased risk for metabolic bone diseases. Bone diseases were reported in about 50% of patients on AEDs. Low bone mineral density, osteopenia/osteoporosis, osteomalacia, rickets, altered concentration of bone turnover markers and fractures were reported with phenobarbital, phenytoin, carbamazepine, valproate, oxcarbazepine and lamotrigine. The mechanisms for AEDs-induced bone diseases are heterogeneous and include hypovitaminosis D, hypocalcemia and direct acceleration of bone loss and/or reduction of bone formation. This article reviews the evidence, predictors and mechanisms of AEDs-induced bone abnormalities and its clinical implications. For patients on AEDs, regular monitoring of bone health is recommended. Prophylactic administration of calcium and vitamin D is recommended for all patients. Treatment doses of calcium and vitamin D and even anti-resorptive drug therapy are reserved for patients at high risk of pathological fracture.
Collapse
|
32
|
Sonmez FM, Donmez A, Namuslu M, Canbal M, Orun E. Vitamin D Deficiency in Children With Newly Diagnosed Idiopathic Epilepsy. J Child Neurol 2015; 30:1428-32. [PMID: 25637647 DOI: 10.1177/0883073814566627] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 12/03/2014] [Indexed: 11/17/2022]
Abstract
Several studies have shown a link between vitamin D deficiency and epilepsy. This study includes 60 newly diagnosed idiopathic epilepsy patients and 101 healthy controls (between the ages of 5 and 16). Each group was also divided into two subgroups according to seasonal changes in terms of months of longer versus shorter daylight. We retrospectively evaluated the levels of calcium, phosphorus, alkaline phosphatase, parathyroid hormone, and 25-OH vitamin-D3 in the study participants. Levels below 20 ng/ml were defined as vitamin D deficiency and levels of 20-30 ng/ml as insufficiency. There were no significant differences in age, gender distribution and levels of calcium, phosphorus, alkaline phosphatase and parathyroid hormone between the groups. The level of 25-OH vitamin-D3 in the patient group was significantly lower when compared to the control group (p < 0.05) (14.07 ± 8.12 and 23.38 ± 12.80 ng/ml, respectively). This difference also held true when evaluation was made according to seasonal evaluation (12.38 ± 6.53 and 17.64 ± 1.14 in shorter daylight and 18.71 ± 9.87 and 30.82 ± 1.04 in longer daylight).
Collapse
Affiliation(s)
| | - Ahsen Donmez
- Department of Pediatrics, Turgut Ozal University, Ankara, Turkey
| | - Mehmet Namuslu
- Department of Biochemistry, Turgut Ozal University, Ankara, Turkey
| | - Metin Canbal
- Department of Family Medicine, Turgut Ozal University, Ankara, Turkey
| | - Emel Orun
- Department of Pediatrics, Turgut Ozal University, Ankara, Turkey
| |
Collapse
|
33
|
Effect of cholecalciferol on the anticonvulsant action of some second generation antiepileptic drugs in the mouse model of maximal electroshock. Pharmacol Rep 2015; 67:875-80. [DOI: 10.1016/j.pharep.2015.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/20/2015] [Accepted: 01/22/2015] [Indexed: 01/06/2023]
|
34
|
Vesco AT, Lehmann J, Gracious BL, Arnold LE, Young AS, Fristad MA. Omega-3 Supplementation for Psychotic Mania and Comorbid Anxiety in Children. J Child Adolesc Psychopharmacol 2015; 25:526-34. [PMID: 26288263 PMCID: PMC4576937 DOI: 10.1089/cap.2013.0141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Therapeutic benefits of omega-3 fatty acids (Ω3) for mood disorders, psychosis, and anxiety have been reported in the literature. The purpose of the present article is to provide a literature review of Ω3 supplementation for affective disorders and to illustrate the benefits of Ω3 with a case presentation of a young girl with a history of bipolar disorder-type 1 with psychotic features and generalized anxiety disorder. METHODS Reviewed literature includes treatment studies of the impact of Ω3 on child mood disorders supplemented by review of meta-analyses within the adult mood disorders literature. The subject of this case report participated in 11 in-depth diagnostic and functional assessments over 5 years as part of an unrelated study. Three years were presupplementation and 2 years were with supplementation with no other medication changes, thus making a naturalistic multiple-baseline single-subject experiment. RESULTS Augmentation over a 2 year period was notable for clinically significant and sustained improvement in depressive, manic, and psychotic symptoms. CONCLUSION Ω3 supplementation may be a safe, adjunct intervention for treating bipolar disorder in children and adolescents, even in the presence of psychotic and anxious features. The 2 year follow-up in this case offers hope of an accumulating and enduring benefit. Further research into mechanisms of Ω3 action and of combination treatment with other well-known interventions for mood disorders would be beneficial.
Collapse
Affiliation(s)
- Anthony T. Vesco
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Jennifer Lehmann
- Department of Psychology, Case Western Reserve University, Cleveland, Ohio
| | - Barbara L. Gracious
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Nationwide Children's Hospital, Columbus, Ohio
| | - L. Eugene Arnold
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Andrea S. Young
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Mary A. Fristad
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Department of Psychology, The Ohio State University, Columbus, Ohio
| |
Collapse
|
35
|
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.
Collapse
Affiliation(s)
- Peter Vestergaard
- Departments of Clinical Medicine and Endocrinology, Aalborg University Hospital, Mølleparkvej 4, 9100, Aalborg, Denmark,
| |
Collapse
|
36
|
Beringer A, Vaillancourt R, Villarreal G, Vadeboncoeur C. The use of natural health products by paediatric patients in respite care. Paediatr Child Health 2015; 20:23-9. [PMID: 25722640 DOI: 10.1093/pch/20.1.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine the use and potential interactions of natural health products (NHPs) with conventional medications in children with life-limiting illnesses. METHODS The present study was a retrospective medical record review of palliative care patients <18 years of age who were admitted for respite care to a Canadian paediatric hospice between January 1, 2008 and December 31, 2013. The NHPs were identified according to Health Canada's inclusion criteria. RESULTS A total of 106 children were included in the present study. Eighty-two (77.4%) had used one or more NHPs: 60 (56%) used vitamins and minerals; 45 (42.5%) used other products including probiotics, omega-3, organic acids and essential fatty acids; 34 (32.1%) used everyday consumer products; 12 (11.3%) used herb or plant-based remedies; and one (0.9%) used homeopathic remedies. Thirty-nine potential NHP-medication and 10 potential NHP-NHP interactions were identified. A considerable number of patients (n=54) used at least one medication and NHP, or two NHPs with potential interactions. The most common type of interaction was pharmacokinetic: decreasing blood concentrations of the medication, NHP or both (43.9% of NHP users); and enhancing the blood concentration of an NHP for NHP-NHP interactions (22% of NHP users). CONCLUSION A high proportion of patients in respite care use NHPs. Most used NHPs and medications that have potential interactions, although there were no adverse clinical manifestations in the present study. It is important to educate health care professionals about NHPs, the evidence available and lack thereof. This could reduce the most serious interactions and improve the alliance between parents and health care providers to balance the potential risks and benefits of NHPs.
Collapse
Affiliation(s)
- Audrey Beringer
- Pharmaceutical and Biological Sciences Institute, Claude Bernard Lyon, University of Pharmacy, Lyon, France; ; Department of Clinical Pharmacy
| | | | | | | |
Collapse
|
37
|
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.
Collapse
|
38
|
Hamrick I, Schrager S, Nye AM. Treatment of osteoporosis: current state of the art. Wien Med Wochenschr 2014; 165:54-64. [DOI: 10.1007/s10354-014-0335-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/11/2014] [Indexed: 01/21/2023]
|
39
|
New antiepileptic drugs and women. Seizure 2014; 23:585-91. [DOI: 10.1016/j.seizure.2014.05.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/08/2014] [Accepted: 05/10/2014] [Indexed: 12/26/2022] Open
|
40
|
Miziak B, Błaszczyk B, Chrościńska-Krawczyk M, Danilkiewicz G, Jagiełło-Wójtowicz E, Czuczwar SJ. The problem of osteoporosis in epileptic patients taking antiepileptic drugs. Expert Opin Drug Saf 2014; 13:935-46. [PMID: 24821596 DOI: 10.1517/14740338.2014.919255] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Epilepsy is a common neurological disorder associated with recurrent seizures. Therapy with antiepileptic drugs (AEDs) helps achieve seizure remission in approximately 70% of epileptic patients. Treatment with AEDs is frequently lifelong and there are reports suggesting its negative influence on bone health. This is especially important in terms of general occurrence of osteoporosis, affecting over 50 million people worldwide. AREAS COVERED This study refers to two main groups of AEDs: hepatic enzyme inducers (carbamazepine, oxcarbazepine, phenobarbital, phenytoin, primidone and topiramate) and non-inducers (clobazam, clonazepam, ethosuximide, gabapentin, lacosamide, lamotrigine, levetiracetam, pregabalin, tiagabine, valproate, vigabatrin and zonisamide). Some reports indicate that enzyme inducers may exert a more negative influence on bone mineral density (BMD) compared to non-inducers. Bone problems may appear in both sexes during AED therapy, although women are additionally burdened with postmenopausal osteoporosis. Supplementation of vitamin D and calcium in patients on AEDs is recommended. EXPERT OPINION Apart from enzyme inducers, valproate (an even enzyme inhibitor) may also negatively affect BMD. However, the untoward effects of AEDs may depend upon their doses and duration of treatment. Although the problem of supplementation of vitamin D and calcium in epileptic patients on AEDs is controversial, there are recommendations to do so.
Collapse
Affiliation(s)
- Barbara Miziak
- Medical University, Department of Pathophysiology , Jaczewskiego 8, PL 20-090 Lublin , Poland
| | | | | | | | | | | |
Collapse
|
41
|
Simko J, Fekete S, Gradosova I, Malakova J, Zivna H, Valis M, Palicka V, Zivny P. The effect of topiramate and lamotrigine on rat bone mass, structure and metabolism. J Neurol Sci 2014; 340:80-5. [DOI: 10.1016/j.jns.2014.02.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 02/06/2014] [Accepted: 02/25/2014] [Indexed: 01/13/2023]
|
42
|
Abstract
OPINION STATEMENT Elderly people are one of the fastest-growing populations in the United States, and the incidence of epilepsy in older people is much higher than in other population subgroups. This age group is the most vulnerable because of the increased incidence of multiple medical comorbidities, including stroke. The diagnosis of epilepsy is extremely challenging and often delayed in this age group because of an atypical presentation. Seizures are manifest through extremely vague complaints, such as episodes of altered mental status or memory lapses. Once the diagnosis is established by careful history taking and diagnostic testing, anticonvulsants are the mainstay of treatment. The choice of anticonvulsants in elderly patients requires careful evaluation of medical comorbidities, which vary on an individual basis. This subgroup also is more susceptible to adverse effects because of the physiologic changes in the body due to older age, which affect the pharmacokinetics of most anticonvulsants. The ideal drug in this age group should have linear pharmacokinetics, fewer adverse effects, minimal or no drug-drug interactions, no enzyme induction/inhibition, a long half-life, and minimal protein binding, and should be cost-effective. As such, there is no ideal drug for this patient population, although both older- and newer-generation anticonvulsants are used for long-term treatment. Most newer anticonvulsants have the advantage of a favorable pharmacokinetic profile, minimal or no drug-drug interactions, and fewer adverse events, as well as being well tolerated. The older anticonvulsants still are widely used, because the newer anticonvulsants are much more expensive.
Collapse
|
43
|
Abstract
Epilepsy is one of the most common neurologic disorders in childhood that often requires long term treatment with antiepileptic drugs. Both antiepileptic treatment and the comorbidities associated with epilepsy have a negative impact on bone health in growing children. Given the fact that vitamin D deficiency is a major public health problem worldwide, clinicians caring for children with chronic diseases should be aware of effects of the medication on the bone metabolism. Yet, vitamin D deficiency due to antiepileptic treatment is an overlooked issue among neurologists. In this review, we briefly describe vitamin D metabolism and the effect of vitamin D in the brain. We also discuss the literature in terms of vitamin D deficiency and antiepileptic treatment in the pediatric population.
Collapse
Affiliation(s)
- Ayşe Nurcan Cebeci
- Derince Training and Research Hospital, Pediatric Endocrinology Clinic, Kocaeli, Turkey
| | | |
Collapse
|
44
|
Abstract
PURPOSE This study was to evaluate the relationship of 25(OH)D3 levels with anticonvulsant use and other possible factors in epileptic children and adolescents. MATERIALS AND METHODS We studied 143 patients with epilepsy (90 boys, 53 girls; 11.21±4.49 years), who had been treated with anticonvulsants for more than 1 year. Patients who had taken multiple vitamins before the blood test and those who have the limitation of physical activity (wheelchair-bound) were excluded from the study. We evaluated the difference in vitamin D status according to the type and number of anticonvulsants taken and other factors such as gender, age, intelligence and seizure variables. RESULTS For patients with mental retardation or developmental delay, 25(OH)D3 levels were lower than the levels in patients with normal intelligence quotient levels (p=0.03). 25(OH)D3 levels were lower in patients who had taken anticonvulsants for more than 2 years as compared to those who had taken them for less than 2 years (p=0.03). Those taking oxcarbazepine had significantly lower vitamin D levels than patients taking valproic acid (p=0.01). However, no effects of number of anticonvulsants taken were detectable. More than two-thirds of the patients were diagnosed with osteopenia or osteoporosis in patients showing either vitamin D insufficiency or deficiency. CONCLUSION The possibility of vitamin D deficiency can be considered in pediatric patients taking anticonvulsants if they have mental retardation or developmental delay or if they have been taking anticonvulsants for more than 2 years or taking hepatic enzyme inducing drugs.
Collapse
Affiliation(s)
- Jung-Hyun Baek
- Department of Pediatrics, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 152-703, Korea.
| | | | | | | | | |
Collapse
|
45
|
Elliott JO. Possible methods for the prevention of bone loss in persons with epilepsy. Expert Rev Neurother 2014; 9:797-812. [DOI: 10.1586/ern.09.35] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
46
|
|
47
|
Lee HS, Wang SY, Salter DM, Wang CC, Chen SJ, Fan HC. The impact of the use of antiepileptic drugs on the growth of children. BMC Pediatr 2013; 13:211. [PMID: 24354857 PMCID: PMC3878248 DOI: 10.1186/1471-2431-13-211] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 12/14/2013] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND This study investigated whether long-term treatment with antiepileptic drugs (AEDs) had negative effects on statural growth and serum calcium levels in children with epilepsy in Taiwan. METHODS Children with epilepsy treated with one prescription of AEDs (monotherapy) for at least 1 year were selected. The AEDs included valproic acid (VPA; Deparkin) in 27 children (11 boys and 16 girls) aged 4-18 years, oxcarbazepine (Trileptal) in 30 children (15 boys and 15 girls) aged 5-18 years, topiramate (Topamax) in 19 children (10 boys and 9 girls) aged 6-18 years, and lamotrigine (Lamicta) in eight children (5 boys and 3 girls) aged 5-13 years. Patients with a history of febrile convulsions were selected as the controls. RESULTS One year of VPA treatment significantly impaired the statural growth of pediatric patients with epilepsy (p < 0.005) compared with the control group. The underlying mechanism may have been due to the direct effect of VPA on the proliferation of growth plate chondrocytes rather than alterations of serum calcium. CONCLUSIONS These results raise serious concerns about the growth of pediatric epilepsy patients who use AEDs, and potentially the need to closely monitor growth in children with epilepsy and adolescents under AED treatment, especially VPA.
Collapse
Affiliation(s)
| | | | | | | | | | - Hueng-Chuen Fan
- Department of Paediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| |
Collapse
|
48
|
Abstract
Several disorders, both systemic and those of the nervous system, have been linked with vitamin D deficiency. Neurological disorders with a vitamin D link include but are not limited to multiple sclerosis, Alzheimer and Parkinson disease, as well as cerebrovascular disorders. Epilepsy which is the second leading neurological disorder received much less attention. We review evidence supporting a link between vitamin D and epilepsy including those coming from ecological as well as interventional and animal studies. We also assess the literature on the interaction between antiepileptic drugs and vitamin D. Converging evidence indicates a role for vitamin D deficiency in the pathophysiology of epilepsy.
Collapse
Affiliation(s)
- András Holló
- 1National Institute for Medical Rehabilitation , Budapest , Hungary
| | | | | |
Collapse
|
49
|
The effect of levetiracetam on rat bone mass, structure and metabolism. Epilepsy Res 2013; 107:56-60. [DOI: 10.1016/j.eplepsyres.2013.08.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 06/25/2013] [Accepted: 08/08/2013] [Indexed: 11/15/2022]
|
50
|
Early detection of bone metabolism changes under different antiepileptic drugs (ED-BoM-AED) – A prospective multicenter study. Epilepsy Res 2013; 106:417-22. [DOI: 10.1016/j.eplepsyres.2013.06.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 05/14/2013] [Accepted: 06/28/2013] [Indexed: 01/15/2023]
|