The bone mineral content alterations in pediatric patients medicated with levetiracetam, valproic acid, and carbamazepine

Serin, Hepsen Mine; Koç, Zehra Pınar; Temelli, Berfin; Esen, İhsan

doi:10.1016/j.yebeh.2015.06.025

Cited by 45 publications

(32 citation statements)

References 21 publications

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“…It is important to develop recommendations regarding indications to obtain a DXA scan in children with ASD, and in addition to known indications (coexisting inflammatory bowel disorders, celiac disease, use of chronic high dose steroids, prolonged immobilization), additional indications to consider include those with seizure disorder and on anti-seizure medications, as well as those with marked hypotonia. Data regarding the impact of antiseizure medications on vitamin D status and BMD are mixed (Serin et al 2015; Yaghini et al 2015); (Beniczky et al 2012; Babayigit et al 2006; Tekgul et al 2006; Rieger-Wettengl et al 2001) and the use of these medications is not an indication for DXA assessments. However, children with ASD and seizure may be at particular risk for low BMD.…”

Section: Resultsmentioning

confidence: 99%

Bone Density in Adolescents and Young Adults with Autism Spectrum Disorders

Ekhlaspour

Baskaran

Campoverde

et al. 2016

J Autism Dev Disord

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Patients with autism spectrum disorder (ASD) are at increased risk for fracture, and peri-pubertal boys with ASD have lower bone mineral density (BMD) than controls. Data are lacking regarding BMD in older adolescents with ASD. We compared BMD using dual-energy X-ray absorptiometry in 9 adolescents/young adults with ASD against 9 typically developing matched controls. Patients with ASD and controls were excluded if they had other underlying conditions that may affect bone. Compared to controls, patients with ASD had (i) lower femoral neck and hip BMD Z-scores, and (ii) lower spine, femoral neck and hip height adjusted BMD Z-scores even after controlling for BMI. Understanding the underlying pathophysiology will be key to developing therapies to improve BMD and reduce fracture risk.

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Section: Resultsmentioning

confidence: 99%

Bone Density in Adolescents and Young Adults with Autism Spectrum Disorders

Ekhlaspour

Baskaran

Campoverde

et al. 2016

J Autism Dev Disord

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“…Fourteen studies [11][12][13][14][15][16][17][18][19][20][21][22][23] published between 1998 and 2017 with a total 978 children were included in this meta-analysis (Table 1). Studies ranged in size from 37 [14] -126 cases [21] with 467 in the valproate group and 511 cases in the control group.…”

Section: Included Studies Show Good Homogeneity and Comparabilitymentioning

confidence: 99%

Effects of valproic acid on skeletal metabolism in children with epilepsy: a systematic evaluation and meta-analysis based on 14 studies

Li¹,

Wang²,

Biaoxue

2020

BMC Pediatr

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Background: Previous studies have reported that long-term use of valproic acid can cause changes in bone metabolism in children. We conducted this meta-analysis to determine the effects of valproic acid on bone metabolism and bone mineral density (BMD) in children with epilepsy. Methods: Studies were searched from the databases of PubMed, Embase, Ovid, Cochrance Library, Springer Link and Web of Science. The effects of valproic acid on bone metabolism indicators and BMD were assessed through calculating the standardized mean difference (SMD) with 95% confidence interval (CI). Results: Fourteen studies with 987 individuals were included in this analysis. The long-term use of valproic acid did not affect the levels of serum calcium (p = 0.99), phosphorus (p = 0.28), ALP (p = 0.76), PTH (p = 0.36) and osteocalcin (p = 0.72), but it led to a decrease in 25-OH-VitD (p = 0.01) and BMD (p = 0.002 for the vertebra; p = 0.004 for the femur) in treating children with epilepsy. Conclusion: Long-term use of valproic acid in treating children with epilepsy can lead to a reduction in 25-OH-VitD and BMD. Measurements of 25-OH-VitD and BMD should be performed regularly in children taking the drug to detect early osteopenia caused by the drug.

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“…Conflicting study methodologies have challenged comparison across studies such that meta-analyses conclude that ASMs may be associated with decreased bone mineral density (BMD) in children with epilepsy [16,17]. But studies have also reported no ASM effect on BMD or vitamin D levels [12,18,19], and others found no variance in the effect of enzyme-inducing ASMs compared to non-inducing ASMs on BMD [20][21][22]. Some specifically highlight the increased impact from monotherapy with sodium valproate, carbamazepine and levetiracetam [23][24][25][26].…”

Section: Retrospective Longitudinal 172mentioning

confidence: 99%

Vitamin D abnormalities and bone turn over analysis in children with epilepsy in the Western Cape of South Africa.

Kija

Gidal

Shapson-Coe

et al. 2019

Seizure

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A B S T R A C TPurpose: The effects of antiseizure medications (ASMs) on bone metabolism is inconsistent. Most studies are in high income settings and none from sub-Saharan Africa.Methods: A hospital based cross-sectional study in a paediatric epilepsy service with a comparison group assessed vitamin D metabolism.Results: Seventy-five children with epilepsy and 75 comparison group were recruited. Median age for children with epilepsy was 9 years (range 1-17 years) and controls 3 years (range 1-12 years). Vitamin D deficiency occurred in 11(16.2%) children with epilepsy versus 6 (8.8%) control group (p = 0.29). Vitamin D insufficiency occurred in 30 (44.1%) children with epilepsy compared to 27(39.7%) control group. Children on ASMs had lower mean vitamin D levels than the control group (p = 0.02). Children on enzyme-inducing ASMs had lower mean vitamin D levels (p = 0.08), vitaminD 2 (p = 0.0018), vitaminD 3 (p = 0.004), serum phosphate levels (p = 0.000), and higher mean parathyroid hormone levels (p = 0.03) compared to controls. There was no difference in dietary intake and ancestry, although the dietary content of both groups was low in vitamin D products.Conclusions: Low vitamin D levels were common in children from both groups, but statistically lower for the children on ASMs. Children on enzyme-inducing ASMs need screening for vitamin D deficiency. The literature supports extending this for all children on ASMs. This is the first study to report that children on enzymeinducing ASMs have lower levels of Vitamin D 2 and D 3 levels, probably as result of increased destruction of vitamin D. Improved vitamin D intake for children in vulnerable settings is important.in the liver to form 25-hydroxyvitamin D 3 and subsequently 1α hydroxylation in the kidneys to form 1α, 25 dihydroxy-vitamin D 3 . The degradation of Vitamin D 3 in the kidneys occurs through an enzyme CYP24 to form the metabolites 24, 25 dihydroxy-vitamin D 3 and 1α, 24, 25 trihydroxy-vitamin D 3 [6,7]. In vitro studies support that CYP3A4 catalyzes the hydroxylation of 125 dihydroxy vitamin D 3 into inactive metabolites in the liver and small intestines, where CYP24A1 is nearly absent, which results in decreased intestinal calcium uptake. Notably, CYP3A4 also contributes to the catabolism of 25 hydroxy vitamin D 3 by catalyzing its hydroxylation into 425 dihydroxy vitamin D 3 [8].ASMs induce hepatic cytochrome P450 enzymes, especially https://doi.

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The bone mineral content alterations in pediatric patients medicated with levetiracetam, valproic acid, and carbamazepine

Cited by 45 publications

References 21 publications

Bone Density in Adolescents and Young Adults with Autism Spectrum Disorders

Bone Density in Adolescents and Young Adults with Autism Spectrum Disorders

Effects of valproic acid on skeletal metabolism in children with epilepsy: a systematic evaluation and meta-analysis based on 14 studies

Vitamin D abnormalities and bone turn over analysis in children with epilepsy in the Western Cape of South Africa.

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