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Leandro-Merhi VA, de Almeida Souza Tedrus GM, Jacober de Moraes GG, Ravelli MN. Interaction between vitamin D level, antiseizure medications (ASM) and seizure control in epilepsy adult patients. Rev Neurol (Paris) 2023; 179:1111-1117. [PMID: 37758540 DOI: 10.1016/j.neurol.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE To investigate vitamin D levels and factors associated with seizure control in adult patients with epilepsy (APE). METHOD Cross-sectional study with APE in routine outpatient follow-up at a neurology clinic. Clinical variables, antiseizure medications (ASM) and vitamin D were investigated. Data were analyzed using the Chi2 or Fisher's exact tests, Mann-Whitney, Spearman's correlation coefficient, ROC curve and univariate and multiple logistic regression analysis. RESULTS Mean age was 46.5±15.1 years and disease duration was 27.5±17.0 years; 52.7% (n=49) of patients used one ASM and 47.3% (n=44) used≥2 ASM. There was a significant difference in the level of vitamin D according to the number of ASM and it was higher in patients who used a single ASM (26.02±10.22 versus 22.50±8.69; P=0.048). In the logistic regression, when vitamin D level was set at 20ng/mL, the chance of seizure control for patients using a single ASM was 6.99 times greater than for those using≥2 ASM. When vitamin D level was set at 40ng/mL, the number of ASM did not modify seizure control. There was no correlation between vitamin D and disease duration, patient age and age at the time of the first seizure. In the logistic regression, it was observed that satisfactory levels of vitamin D did not modify potential seizure control. CONCLUSION Thirty-three percent (33%) of patients presented with vitamin D deficiency (values below 20ng/mL) and 80% had vitamin D levels below what is recommended (30ng/mL). The use of ASM, when associated with different levels of vitamin D, modified the probability of seizure control in APE. Vitamin D levels and intrinsic epilepsy factors are associated with failure to effectively control seizures.
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Affiliation(s)
| | | | | | - M N Ravelli
- Department of Neurology (SMPH), University of Wisconsin, Madison, USA.
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Güler H, Esen EE, Balcıoğlu E, Göktepe Ö, Yılmaz H, Yay AH, Nisari M, Al Ö, Uçar S, Güçlü Ekinci HK, Tokpınar A, Yılmaz S. Bone development in offspring of pregnant rats treated with carbamazepine: Evaluation by three different methods. Epilepsia 2022; 63:3066-3077. [PMID: 36168801 DOI: 10.1111/epi.17422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study was carried out to determine the effect of intrauterine carbamazepine (CBZ) exposure on fetal bone development during pregnancy. METHODS In the study, 24 female Wistar pregnant rats were used. Rats were 20 weeks old. They had an average body weight of 150-200 g. Pregnant rats were randomly selected and divided (n = 6) into a control group, low-dose CBZ (10 mg/kg/day) group, medium-dose CBZ (25 mg/kg/day) group, and high-dose CBZ (50 mg/kg/day) group. The ossification length (mm) and ossification area (mm2 ) of the long bones of the fetuses in the experimental and control groups were calculated. The densities of alkaline phosphatase (AP) and tartrate-resistant acid phosphatase (TRAP) were analyzed. The ossification regions of the femurs of the fetuses were examined under a light microscope. Microstructural images of the femurs were evaluated with scanning electron microscope photographs. The densities of minerals involved in the ossification process were analyzed. RESULTS According to the results of the study, all three doses of CBZ caused loss of ossification areas, and it was observed that this bone loss also increased statistically significantly depending on the dose increase (p < .05). Calcium concentration decreased in the CBZ groups. When the electron microscope images were examined, it was determined that the cartilage matrix of the CBZ groups was thinned. In the histological evaluation of the groups, narrowing of the primary bone collar and smaller bone spicules in the ossification region compared to the control group were noted due to the increase in dose in the CBZ groups. In immunohistochemical staining, it was observed that the TRAP and AP expression values of the femurs were the lowest in the CBZ groups. These decreases were also statistically significant when compared with the control group. SIGNIFICANCE It was revealed with both microscopic and macroscopic findings that exposure to intrauterine CBZ negatively affected ossification and bone growth.
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Affiliation(s)
- Hatice Güler
- Basic Medical Sciences, Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Eda Esra Esen
- Basic Medical Sciences, Department of Anatomy, Sütçü İmam University, Kahramanmaraş, Turkey
| | - Esra Balcıoğlu
- Basic Medical Sciences, Department of Histology-Embryology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Özge Göktepe
- Basic Medical Sciences, Department of Histology-Embryology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Halil Yılmaz
- Basic Medical Sciences, Department of Anatomy, Ordu University, Ordu, Turkey
| | - Arzu Hanım Yay
- Basic Medical Sciences, Department of Histology-Embryology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehtap Nisari
- Basic Medical Sciences, Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Özge Al
- Basic Medical Sciences, Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Sümeyye Uçar
- Basic Medical Sciences, Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Hilal Kübra Güçlü Ekinci
- Basic Medical Sciences, Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Adem Tokpınar
- Basic Medical Sciences, Department of Anatomy, Ordu University, Ordu, Turkey
| | - Seher Yılmaz
- Basic Medical Sciences, Department of Anatomy, Yozgat Bozok University, Yozgat, Turkey
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The Effects of Osteoporotic and Non-osteoporotic Medications on Fracture Risk and Bone Mineral Density. Drugs 2021; 81:1831-1858. [PMID: 34724173 PMCID: PMC8578161 DOI: 10.1007/s40265-021-01625-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 12/26/2022]
Abstract
Osteoporosis is a highly prevalent bone disease affecting more than 37.5 million individuals in the European Union (EU) and the United States of America (USA). It is characterized by low bone mineral density (BMD), impaired bone quality, and loss of structural and biomechanical properties, resulting in reduced bone strength. An increase in morbidity and mortality is seen in patients with osteoporosis, caused by the approximately 3.5 million new osteoporotic fractures occurring every year in the EU. Currently, different medications are available for the treatment of osteoporosis, including anti-resorptive and osteoanabolic medications. Bisphosphonates, which belong to the anti-resorptive medications, are the standard treatment for osteoporosis based on their positive effects on bone, long-term experience, and low costs. However, not only medications used for the treatment of osteoporosis can affect bone: several other medications are suggested to have an effect on bone as well, especially on fracture risk and BMD. Knowledge about the positive and negative effects of different medications on both fracture risk and BMD is important, as it can contribute to an improvement in osteoporosis prevention and treatment in general, and, even more importantly, to the individual's health. In this review, we therefore discuss the effects of both osteoporotic and non-osteoporotic medications on fracture risk and BMD. In addition, we discuss the underlying mechanisms of action.
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Grunze A, Amann BL, Grunze H. Efficacy of Carbamazepine and Its Derivatives in the Treatment of Bipolar Disorder. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:433. [PMID: 33946323 PMCID: PMC8146840 DOI: 10.3390/medicina57050433] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: This review is dedicated to the use of carbamazepine and its derivatives oxcarbazepine and eslicarbazepine in bipolar disorder and their relative strengths in treating and preventing new depressive or manic episodes. This paper will discuss the evidence of their efficacy relative to the polarity of relapse from controlled acute and maintenance/relapse prevention studies in bipolar patients. Materials and Methods: A Medline search was conducted for controlled acute and maintenance studies with carbamazepine, oxcarbazepine, and eslicarbazepine in bipolar disorder. In addition, abstracts reporting on controlled studies with these medications from key conferences were taken into consideration. Results: Information was extracted from 84 articles on the acute and prophylactic efficacy of the medications under consideration. They all appear to have stronger efficacy in treating acute mania than depression, which also translates to better protection against manic than depressive relapses for carbamazepine. Still, there is a paucity of controlled acute studies on bipolar depression for all and, with the exception of carbamazepine, a lack of long-term monotherapy maintenance data. For eslicarbazepine, the efficacy in bipolar disorder remains largely unknown. Especially with carbamazepine, tolerability issues and drug-drug interactions need to be kept in mind. Conclusions: Two of the medications discussed in this review, carbamazepine and oxcarbazepine, match Class A criteria according to the criteria proposed by Ketter and Calabrese, meaning acute antimanic efficacy, prevention of manic relapses, and not causing or worsening depression.
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Affiliation(s)
- Anna Grunze
- Psychiatrisches Zentrum Nordbaden, 69168 Wiesloch, Germany;
| | - Benedikt L. Amann
- Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, 08019 Barcelona, Spain;
- Department of Psychiatry Autonomous, University of Barcelona, CIBERSAM, 28029 Madrid, Spain
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall, 74523 Schwäbisch Hall, Germany
- Paracelsus Medical University, 90419 Nuremberg, Germany
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