Vitamin D Status in Epileptic Children on Valproic Acid; a Case-Control Study
Archives of Academic Emergency Medicine,
Vol. 8 No. 1 (2020),
7 January 2020
Introduction: Much attention has been paid to the association between valproic acid treatment and bone health. The objective of this study is to compare the serum vitamin D3 level in the epileptic children under valproic acid treatment with the healthy control group.
Methods: A case-control study has been carried out to compare vitamin D3 levels in 50 epileptic children who were treated with valproic acid with 50 healthy children selected from children visiting the hospital for routine checkup as control group.
Results: 100 cases with the mean age of 7.57Â± 3.62 years (range: 2 â€“ 15 years) were studied (44% boys). Among the 50 epileptic cases; 41 (82%) had generalized and 9 (18%) had partial seizure (56% well controlled and 44% poorly controlled). 15 (30%) of epileptic cases were using anti-epileptic drugs for 6-12 months, 36% for 12-24 months, and 34% for more than 24 months. The case and control groups were similar regarding gender (p =0.99), age (p = 0.24), and BMI (p = 0.64). 49 (49%) patients had some grade of vitamin D3 deficiency. There was a significant difference between case and control groups regarding vitamin D3 levels (p = 0.001). None of the controls had severe vitamin D3 deficiency, while 14% of cases did. 36 (72%) individuals in control group had sufficient or optimal vitamin D3 levels; while only 15 (30%) case patients had such levels. Generally, the control group had higher vitamin D3 levels in comparison to case group (p = 0.001).
Conclusions: The study revealed that there was a higher prevalence of vitamin D3 insufficiency in epileptic children receiving valproate monotherapy compared with healthy children. Vitamin D3 supplementation should be given to all epileptic children even before initiation of anti-epileptic drugs.
- valproic acid
- cholecalciferol (vitamin D3)
How to Cite
Friedman MJ, Sharieff GQ. Seizures in children. Pediatric clinics of North America. 2006;53(2):257-77.
Abbott MB, Vlasses CHJJ. Nelson textbook of pediatrics. 2011;306(21):2387-8.
Hunter J, Maxwell JD, Stewart DA, Parsons V, Williams R. Altered calcium metabolism in epileptic children on anticonvulsants. British medical journal. 1971;4(5781):202-4.
Dent CE, Richens A, Rowe DJ, Stamp TC. Osteomalacia with long-term anticonvulsant therapy in epilepsy. British medical journal. 1970;4(5727):69-72.
Erbayat Altay E, Serdaroglu A, Tumer L, Gucuyener K, Hasanoglu A. Evaluation of bone mineral metabolism in children receiving carbamazepine and valproic acid. Journal of pediatric endocrinology & metabolism : JPEM. 2000;13(7):933-9.
Xu Z, Jing X, Li G, Sun J, Guo H, Hu Y, et al. Valproate decreases vitamin D levels in pediatric patients with epilepsy. Seizure. 2019;71:60-5.
Wagner CL, Greer FR. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122(5):1142-52.
Valsamis HA, Arora SK, Labban B, McFarlane SI. Antiepileptic drugs and bone metabolism. Nutrition & Metabolism. 2006;3(1):36.
Nettekoven S, StrÃ¶hle A, Trunz B, Wolters M, Hoffmann S, Horn R, et al. Effects of antiepileptic drug therapy on vitamin D status and biochemical markers of bone turnover in children with epilepsy. European journal of pediatrics. 2008;167:1369-77.
Bartl R. [Antiepileptic drug-induced osteopathy. Subtypes, pathogenesis, prevention, early diagnosis and treatment]. Deutsche medizinische Wochenschrift (1946). 2007;132(27):1475-9.
Zhu Z, Zhan J, Shao J, Chen W, Chen L, Li W, et al. High prevalence of vitamin D deficiency among children aged 1 month to 16 years in Hangzhou, China. BMC public health. 2012;12:126.
Khor GL, Chee WS, Shariff ZM, Poh BK, Arumugam M, Rahman JA, et al. High prevalence of vitamin D insufficiency and its association with BMI-for-age among primary school children in Kuala Lumpur, Malaysia. BMC public health. 2011;11:95.
Holick MF. Vitamin D deficiency. The New England journal of medicine. 2007;357(3):266-81.
Fitzpatrick LA. Pathophysiology of bone loss in patients receiving anticonvulsant therapy. Epilepsy & behavior : E&B. 2004;5 Suppl 2:S3-15.
Petty SJ, O'Brien TJ, Wark JD. Anti-epileptic medication and bone health. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2007;18(2):129-42.
Drezner MK. Treatment of anticonvulsant drug-induced bone disease. Epilepsy & behavior : E&B. 2004;5 Suppl 2:S41-7.
Cansu A, Yesilkaya E, SerdaroÄŸlu A, Hirfanoglu T, Camurdan O, GÃ¼lbahar O, et al. Evaluation of Bone Turnover in Epileptic Children Using Oxcarbazepine. Pediatric neurology. 2008;39:266-71.
Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. The American journal of clinical nutrition. 2000;72(3):690-3.
Killingsworth CR, Wei C-C, Dellâ€™Italia LJ, Ardell JL, Kingsley MA, Smith WM, et al. Short-acting Î²-adrenergic antagonist esmolol given at reperfusion improves survival after prolonged ventricular fibrillation. Circulation. 2004;109(20):2469-74.
Bozzetto S, Carraro S, Giordano G, Boner A, Baraldi E. Asthma, allergy and respiratory infections: the vitamin D hypothesis. Allergy. 2012;67(1):10-7.
Habeeb S, Hameed R. 25-hydroxy vitamin D in children with epilepsy in Basra. International Journal of Current Research. 2017;9:INTERNATIONAL JOURNAL OF CURRENT RESEARCH.
Rafiq M, Bano S, Tariq PATAJPJoP. EFFECTS OF ANTIEPILEPTIC DRUG THERAPY ON 25OH VITAMIN D LEVELS. 2015;11(4):24-6.
Menon B, Harinarayan CV. The effect of anti epileptic drug therapy on serum 25-hydroxyvitamin D and parameters of calcium and bone metabolism--a longitudinal study. Seizure. 2010;19(3):153-8.
Pack AM. The Association Between Antiepileptic Drugs and Bone Disease. Epilepsy currents. 2003;3(3):91-5.
Baek JH, Seo YH, Kim GH, Kim MK, Eun BL. Vitamin D levels in children and adolescents with antiepileptic drug treatment. Yonsei medical journal. 2014;55(2):417-21.
- Abstract Viewed: 167 times
- PDF Downloaded: 99 times
- HTML Downloaded: 15 times