Original ArticleEffect of Carbamazepine Therapy on Vitamin D and Parathormone in Epileptic Children
Introduction
The cumulative lifetime incidence of epilepsy is 3%, and more than half of these cases begin in childhood. Partial seizures account for up to 40% of childhood seizures [1]. Carbamazepine is the most commonly used drug in the management of epilepsy in India [1]. Long term antiepileptic therapy is known to alter bone metabolism in children, and vitamin D deficiency is frequently cited as a cause of decrease in bone mineral density in these patients. Carbamazepine, which induces a liver enzyme (CYP 450), has the potential to affect bone metabolism and vitamin D status. Reports of hypovitaminosis D associated with carbamazepine in children have been conflicting. Various studies indicated that carbamazepine therapy can cause hypovitaminosis D [2], [3], [4], [5], whereas a few studies reported that carbamazepine therapy is not associated with alterations in bone mineral metabolism and hypovitaminosis D [6], [7], [8], [9]. Most of these studies were conducted in a mixed population of epileptic children. Hence, this study prospectively evaluated changes in vitamin D level and other biochemical markers of bone mineralization (calcium, phosphorus, alkaline phosphatase, and parathyroid hormone) in ambulatory children with partial epilepsy, receiving carbamazepine monotherapy.
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Materials and Methods
This prospective study was performed in a tertiary care referral hospital. Children aged 2-12 years, and presenting with partial seizures and motor signs at pediatric emergency departments, were enrolled in the study and followed for 6 months. This study was approved by the Ethics Committee of the University College of Medical Sciences.
After obtaining written consent from patients' parents or guardians, we collected detailed histories regarding types of seizure, any previous drug intake, any
Results
Of 47 children, the comparative data of 32 children (18 boys and 14 girls) followed for 6 months were analyzed. Fifteen children were excluded, 11 children were lost to follow-up, one child died in a traffic accident, two children developed drug reactions and shifted to valproate, and one child was diagnosed with tuberculoma and commenced antitubercular therapy.
The weight, height, and body mass index of all patients fell between the 10th and 90th percentiles. The clinical characteristics of the
Discussion
With current estimates of 50 million people worldwide manifesting epilepsy, together with a rapid increase in the use of antiepileptic medications for other indications, the bone disease associated with the use of antiepileptic medications is emerging as a serious health threat for millions of people, especially in childhood, which is the most critical period of bone development [11]. Both parathormone and vitamin D play important roles in the development and maintenance of bone mass by
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