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

Abstract

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.

Blount Disease, Vitamin D deficiency, and Associated Comorbidities: A review and Meta-analysis

“…However, the small number of the study included and considerable heterogeneity limited our results (I 2 =93%, Chi-square, 28.79, and df=2). Also, we compared vitamin D status with that in the general population in the studies countries when no face-toface comparison is available (Mastala et al, 2013;Kija et al, 2019).…”

Prescribing patterns of vitamin D and analogues in a private healthcare patient population in South Africa

“…39 This notwithstanding that 8.8% of non-epileptic children with no history of bone metabolism disorders in the control group were also vitamin D deficient. 39 A study conducted among hypertensive adults in an urban black community in Mangaung found that, despite the relationship between body mass index (BMI) and hypertension, vitamin D status appeared to have a protective effect, and those with an adequate vitamin D status appeared to be less vulnerable to hypertension despite an elevated BMI. 40 There appears to be a requirement for increased vitamin D among those with darker skin due to the decreased conversion of vitamin D from sunlight and a reciprocal relationship between vitamin D status and the rate of sputum culture conversion, 41 and seasonal reporting of TB, with higher incidences of TB in the winter months of reduced sunlight.…”

“…Adequate blood levels of vitamin D for children in South Africa are considered to be =/> 30 ng/ml acquired through a combination of sunlight and food intake. 39 A study conducted in the Western Cape of South Africa found that 16.2% of children on antiepileptic medication required additional vitamin D, due to the possible destruction of vitamin D as a side effect of their treatment. 39 This notwithstanding that 8.8% of non-epileptic children with no history of bone metabolism disorders in the control group were also vitamin D deficient.…”

“…39 A study conducted in the Western Cape of South Africa found that 16.2% of children on antiepileptic medication required additional vitamin D, due to the possible destruction of vitamin D as a side effect of their treatment. 39 This notwithstanding that 8.8% of non-epileptic children with no history of bone metabolism disorders in the control group were also vitamin D deficient. 39 A study conducted among hypertensive adults in an urban black community in Mangaung found that, despite the relationship between body mass index (BMI) and hypertension, vitamin D status appeared to have a protective effect, and those with an adequate vitamin D status appeared to be less vulnerable to hypertension despite an elevated BMI.…”

Association of long term sodium valproate monotherapy and vitamin D3 levels in epileptic children

“…Reduced bone mineral density is also one of the factors responsible for increased frequency of fractures in epileptic patients. 8 Low levels of vitamin D3 in the body result in aggravation of seizures as it down-regulates cytokine IL-6, which is a proconvulsant. 9 Consequently many treating physicians increase the dose of AEDs to control the seizures which further aggravates deficiency of vitamin D3 in the body and this vicious circle continues.…”