Association between serum vitamin D status and the anti-seizure treatment in Chinese children with epilepsy

Abstract

ObjectiveTo compare the serum 25-OH-VitD levels, the major marker of vitamin D (VitD) status, between healthy children and children with epilepsy before initiation of and during anti-seizure medications (ASMs) treatment and to evaluate the potential influence factors on 25-OH-VitD levels. Another major aim was to assess the potential role of VitD supplementation.MethodsFor comparison, we finally enrolled and collected data from 6,338 healthy children presenting to Health Care Department and 648 children visiting primary care pediatricians with symptoms of epilepsy in Children’s Hospital of Nanjing Medical University from January 2019 to June 2021. The demographic and biochemical characteristics of each child were extracted from the hospital information system.ResultsSerum 25-OH-VitD levels in 648 children with epilepsy were significantly lower than those of 6,338 healthy children (P < 0.0001), and the percentage of VitD insufficiency and deficiency status in pediatric patients was 49.19%. Of note, the serum 25-OH-VitD levels in children with newly diagnosed epilepsy before receiving any ASMs treatment were also significantly lower than those in healthy controls. Interestingly, ASMs therapy, alone or in combination, did not consistently reduce baseline serum VitD levels in children with epilepsy. The lower serum VitD levels in pediatric patients than those in healthy children might be related to the disease itself, rather than the ASMs treatment. As expected, VitD supplementation substantially increased the serum 25-OH-VitD levels (P < 0.0001). More critically, children with epilepsy receiving VitD supplementation achieved good seizure control in our study.SignificanceIn this retrospective study, the childhood epilepsy before initiation of and during ASMs treatment decreased the serum 25-OH-VitD concentrations, suggesting a clear association between epileptic disease and the risk of VitD deficiency. ASMs coadministration and long-term valproic acid treatment did not worse VitD-deficiency status, but in the small group receiving VitD supplementation, there was a significant improvement in reduction of seizure frequency. Therefore, pediatric clinicians are urged to raise public awareness of epilepsy-associated VitD deficiency.

Nutritional interventions for the prevention and treatment of neurological disorders such as anxiety, bipolar disorder, depression, epilepsy, multiple sclerosis, and schizophrenia

“…However, although some studies of patients with epilepsy have identi ied a therapeutic bene it of vitamin B6 supplementation in terms of improved clinical outcomes, this is not the case for every patient [212][213][214][215][216][217][218]. Multiple studies have identi ied vitamin D de iciencies among pediatric and adult patients with epilepsy [219][220][221][222]. In one clinical trial involving 23 patients with epilepsy administered 4,000 IU/day of vitamin D3 was for 4 weeks followed by 16,000 IU/day for 4 weeks to one group and a placebo followed by 8,000 IU/day of vitamin D3 to another.…”

“…Studies using animal models of epilepsy have found vitamin D to have anticonvulsive effects and knocking out the vitamin D receptor signi icantly increases seizure frequency in mouse models of epilepsy [224]. Another study of 648 children with epilepsy found improved seizure control with vitamin D supplementation [222].…”

The causal effect of serum 25‐hydroxyvitamin D levels on epilepsy: A two‐sample Mendelian randomization study

“…27 Most observational studies have shown that 25 (OH) D level is decreased by taking antiepileptic drugs, and 25 (OH) D supplementation can reduce seizure frequency . 6,28,29 However, some studies have shown that 25 (OH) D supplementation does not reduce seizure frequency in patients with drug-resistant epilepsy. 8 As can be seen from the above, there is a contradiction in whether 25 (OH) D prevents epilepsy or controls seizure frequency in observational studies.…”

Hormonal Changes in Women with Epilepsy

“…43 In Chinese pediatric patients, a comparable outcome of seizure control was observed following the administration of Vitamin D supplementation, with the proportion of individuals achieving seizure-free rising from an initial 49% to a final 76%. 44 According to its molecular structure, bioactivation in the nervous system, and mechanism of action, Vitamin D3 can be classified as a neurosteroid hormone rather than a vitamin. 45 The presence of the Vitamin D activating 1-α-hydroxylase enzyme and Vitamin D receptor (VDR) has been observed in various brain structures, including neuronal and glial cells.…”