Chronic antiepileptic monotherapy,bone metabolism,and body composition in non‐institutionalized children |
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| Authors: | MARKUS RAUCHENZAUNER ANDREA GRIESMACHER TOBIAS TATARCZYK EDDA HABERLANDT ALEXANDER STRASAK LOTHAR‐BERND ZIMMERHACKL GERDA FALKENSAMMER GERHARD LUEF WOLFGANG HÖGLER |
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| Affiliation: | 1. Department of Paediatrics IV, Division of Neuropaediatrics, Medical University Innsbruck, Innsbruck, Austria;2. Central Institute of Medical and Chemical Laboratory Diagnostics, Medical University Innsbruck, Innsbruck, Austria;3. Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria;4. Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria;5. Department of Paediatrics I, Medical University Innsbruck, Innsbruck, Austria;6. Department of Neurology, Medical University Innsbruck, Innsbruck, Austria;7. Department of Endocrinology and Diabetes, Birmingham Children’s Hospital, Birmingham, UK. |
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| Abstract: | Aim The aim of this study was to determine the influence of chronic monotherapy with antiepileptic drugs (AEDs) on vitamin D levels, bone metabolism, and body composition. Method Eighty‐five children (38 males, 47 females; mean age 12y 5mo, SD 3y 4mo) were treated with valproate and 40 children (28 males, 12 females; mean age 11y 10mo, SD 3y) were treated with other AEDs (lamotrigine, sulthiame, or oxcarbazepine), comprising the non‐valproate group. Forty‐one healthy children (29 males 12 females; mean age 12y 1mo, SD 3y 5mo) served as a comparison group. Height, weight, body impedance analysis, 25‐hydroxyvitamin D, calcium, phosphate, two bone resorption markers (receptor activator of nuclear factor κB ligand [RANKL] and tartrate‐resistant acid phosphatase 5b [TRAP5b]), osteoprotegerin, and leptin were measured. Results No child was vitamin D deficient as defined by a 25‐hydroxyvitamin D (25OHD) level of less than 25nmol/l (<10ng/ml). Leptin, body fat, weight standard deviation score (SDS), and body mass index (BMI) SDS were all significantly higher (each p<0.001) in valproate‐treated children than in the non‐valproate group, as were calcium (p=0.027) and RANKL (p=0.007) concentrations. Similarly, leptin was significantly higher in the valproate group than in control participants (p<0.001), as were body fat (p=0.023), weight SDS (p=0.046), BMI SDS (p=0.047), calcium (p<0.001), and RANKL (p<0.001), whereas TRAP5b concentrations were significantly lower in the valproate‐treated group (p=0.002). Furthermore, calcium and RANKL levels were significantly higher in the non‐valproate group than in comparison participants (p<0.001 and p=0.016 respectively). Interpretation Non‐enzyme‐inducing or minimal enzyme‐inducing AED monotherapy does not cause vitamin D deficiency in otherwise healthy children with epilepsy. Valproate therapy is associated with increases in weight, body fat, and leptin concentration, as well as with a bone metabolic profile that resembles slightly increased parathyroid hormone action. |
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