Alkaline phosphatase and its isoenzyme activity for the evaluation of bone metabolism in children receiving anticonvulsant monotherapy

Abstract

This study aimed to investigate whether carbamazepine, sodium valproate or phenobarbital as monotherapy in ambulatory epileptic children with adequate sun exposure have some effect on their bone metabolism based on the determination of total serum alkaline phosphatase (AP) levels and its bone isoenzyme activity. Blood samples were obtained from 118 epileptic children (37 on carbamazepine, 47 on sodium valproate and 34 on phenobarbital) and from corresponding healthy controls matched for age, gender and anthropometric parameters. AP and its liver, bone and intestinal isoenzyme levels, other common biochemical markers of bone and liver metabolism and drug levels were measured in the study participants. Patients on carbamazepine or phenobarbital had significantly elevated AP levels accompanied by increased bone and liver isoenzyme activity compared to controls. An increase of bone AP isoenzyme values, correlated with the duration of treatment ( r= 0.49, P= 0.002), was found in children on sodium valproate without, however, a concomitant significant elevation of total AP values. We conclude that children who receive antiepileptic drugs as monotherapy, even when residing in a Mediterranean country with adequate sunlight, may have their bone metabolism affected as indicated by the elevated levels of bone AP isoenzyme. This isoenzyme, but not total AP values, could therefore be used as a marker for the selection of patients who would be benefited by a thorough evaluation of their bone metabolism profile.

Investigation of the Effects of Edaravone on Valproic Acid Induced Tissue Damage in Pancreas

“…VPA therapy may cause an increase in serum calcium concentrations and bone resorption (28). Voudris et al investigated different kinds of antiepileptics and reported increased activity of ALP enzymes in bone, kidney and intestine tissues in patients who had anticonvulsant monotherapy versus control group (29). Also Giray et al (30) detected increased ALP activity in the serum samples of VPA treated patients.…”

Effects of antiepileptic drugs on bone mineral density and bone metabolism in children: A meta-analysis

“…The initial search yielded 1603 research reports, of which 228 were excluded due to identical title or authors; 1056 were excluded due to ineligible study design (including non-human studies, review articles, case reports, comment, letter, experimental study, and/or fractureonly outcome). After full-text screening, 22 studies were included (Chung and Ahn, 1994;Baer et al, 1997;Akin et al, 1998;Kafali et al, 1999;Erbayat Altay et al, 2000;Verrotti et al, 2002;Voudris et al, 2002;Ecevit et al, 2004;Oner et al, 2004;Babayigit et al, 2006;Kumandas et al, 2006;Nicolaidou et al, 2006;El-Hajj Fuleihan et al, 2008;Nettekoven et al, 2008;Gniatkowska-Nowakowska, 2010;Rauchenzauner et al, 2010;Babacan et al, 2012;Dimić et al, 2013;Razazizan et al, 2013;Turan et al, 2014). Table 1 summarizes the characteristics of the included studies published between 1994 and 2014.…”

Edaravone ameliorates valproate-induced gingival toxicity by reducing oxidative-stress, inflammation and tissue damage

“…Anticonvulsant drugs cause changes in bone metabolism and calcium levels and these drugs may lead to a decrease in bone mass (39). In previous studies increased ALP activities were reported in serum and different tissues (40,41). Consistent with these results, unsignificantly increased ALP activity was found in vPA group compared to controls.…”