Vitamin D Insufficiency in Children with Chronic Neurological Diseases: Frequency and Causative Factors
Iranian Journal of Child Neurology,
Vol. 17 No. 2 (2023),
16 Esfand 2023
,
Page 31-38
https://doi.org/10.22037/ijcn.v17i2.35938
Abstract
Objective
Vitamin D insufficiency/rickets is a metabolic bone disease that leads to insufficient mineralization of bone. Chronic neurological diseases, including cerebral palsy (CP), convulsive disorders, neural tube defects, myopathy, immobility, lack of sun exposure, inadequate nutrition, and antiepileptic drugs (AEDs) can cause vitamin D insufficiency and osteopenia in children.
Materials & Methods
In this study, the authors searched the frequency and causative factors of vitamin D insufficiency in children with chronic neurological diseases such as CP, hypoxic-ischemic encephalopathy, mental motor retardation, epilepsy, neurodegenerative and neuromuscular diseases, meningitis-encephalitis sequelae, neural tube defects, paralysis, and paresis. This cross-sectional study included 108 children (forty-five [41.6%] females; sixty-three [58.4%] males), aged between one and 18 years with chronic neurological diseases, and a control group of thirty age-matched healthy children (16 [53.3%] females; 14 [46.7%] males.
Results
Vitamin D levels were significantly lower, and parathyroid hormone (PTH) levels were significantly higher in the patient group than in the control group (p<0.05). The patient group was divided into four subgroups: (i) Epilepsy (n=41; 38%), (ii) Neural tubedefects (n=14; 13%), (iii) CP (n=21; 19%), and (iv) other diseases (neurodegenerative and neuromuscular diseases, meningitis sequelae, intracranial hemorrhage, psychomotor retardation, hypoxic-ischemic encephalopathy) (n=32; 30%) to identify any differences in the measured levels. In the patient group, eighty-three (76.9%) had vitamin D deficiency, and 17 (15.7%) had vitamin D insufficiency, while in the control group, twenty-one (70%) had vitamin D insufficiency. The use of AEDs had no significant effect on serum Ca, P, ALP, PTH, orvitamin D levels (p>0.05), and serum Ca levels were significantly higher in ambulant patients than in non-ambulant patients (p<0.05). Vitamin D levels were significantly higher in the non-ambulant than in the ambulant patients (p<0.05). No rickets was determined in the control group, while in the patient group, nine (8.3%) had level-1 rickets, six (5.6%) had level-2 rickets, and two (1.9%) had level-3rickets.
Conclusion
Children with chronic neurological diseases have low serum vitamin D levels, and vitamin D prophylaxis is essential in this group
- Vitamin D Levels; Chronic Neurological Diseases; Pediatrics; Antiepileptic Treatment; Prophylaxis
How to Cite
References
El-Hajj Fuleihan Vieth R. Vitamin D Insufficiency and Musculoskeletal Health in Children and Adolescents. International Congress Series 1297;2007: 91-108.
Gokcay G., Neyzi O., Ertugrul T. Avitaminosis and Hypervitaminosis. Pediatrics. Volume 1. Istanbul 2010: 265-276.
Henderson RC., Lark RK. Gurka MJ. Bone density and metabolism in children and adolescents with moderate to severe cerebral palsy. Pediatrics 2002; 110: 5-6.
Giray T, Vitrinel A, Comert S, Deniz NC, Ciler G, Kesler E, et al. Evaluation of the effects of antiepileptic drugs on bone metabolism. Turkish Archives of Pediatrics 2005; 40: 221-226.
Farhat G, Yamout B, Mikati MA, Demirjian S, Sawaya R, El-Hajj Fuleihan G. Effect of antiepileptic drugs on bone density in ambulatory patients. Neurology 2002; 58: 1348-1353.
Caksen H, Dulger H, Cesur Y, Odabas D, Tuncer O, Atas B. No effect of long-term valproate therapy on thyroid and parathyroid functions in children. Int J Neurosci 2002; 112: 1371- 1374.
Tsukahara H, Kimura K, Todoroki Y. Bone mineral status in ambulatory pediatric patients on long-term antiepileptic drug therapy. Pediatr Int 2002; 44: 466.
Jung-Hyun Baek. Young-Ho Seo. Gun-Ha Kim. Mi-Kyung Kim. and Baik-Lin Eun. Vitamin D Levels in Children and Adolescents with Antiepileptic Drug Treatment. Yonsei Med J 55(2):417-421. 2014
Chaudhuri IR, Mridula KR, Rathnakishore Ch, Balaraju B, Bandaru VCS. Association of 25-Hydroxyvitamin D Deficiency in Pediatric Epileptic Patients. Iran J Child Neurol. Spring 2017; 11(2):48-56.
George AS, Mathew MC, Mathew A, Jacob SS, Raj JM. The prevalence and risk factors of hypovitaminosis-D in children with cognitive and movement disorders. Indian J Pediatr. 2019.
- Abstract Viewed: 302 times