Osteomalacia potentially induced among treated epileptic children

ABSTRACT

Anticonvulsants osteomalacia is a problem which is growing up with the wide use of different types of AEDs. We aimed to evaluate the effect of AEDs on calcium metabolism in epileptic children. This study included 40 well diagnosed epileptic children who were attending regularly neurology outpatient clinic. - Ain Shams University hospitals at a period from May 1995 to August 1996. They were receiving anti-epileptic drugs for more than 18 months either carbamazepin or valproic acid or both. Their ages ranged between 6 and 10 years [mean age 8.5 +/- 1.1 years]. Another 20 apparently healthy children in the same cohort were chosen to serve as control [mean age 8.1 +/- 1.5 years]. The results of this study showed that there was a highly significant decrease in weight and height percentiles [P< 0.001]. In addition, there was a highly significant decrease in mean calcium metabolism parameters [25 [OH] D3, calcium, and phosphorus] with increase in mean alkaline phosphatase [p < 0.001] among treated epileptic children compared to controls. This finding was strongly evident not only in monotherapy but also in polytherapy treated epileptics compared to controls. However, there was no statistical significant difference between monotherapy Vs polytherapy treated epileptic children. According to the duration of treatment, there was significant decrease in mean weight and height percentiles [p < 0.05] and a highly significant decrease in 25 [OH] D3 in epileptic children treated for a period more than 3years [p <0.001] but there was no statistical significant difference in other parameters of calcium metabolism [p > 0.05]. We could conclude that AEDs had a negative effect on weight and height percentiles in which are aggravated by longer duration of treatment and number of drugs used to control fits. This was accompanied by a state of biochemical osteomalacia in the form of decreased serum 25 [OH] D3, calcium, phosphorus and increased serum alkaline phosphatase. Lastly, regular check up of calcium metabolism parameters for early detection of their alteration is recommended and using monotherapy is advisable especially in growing children. Evaluation of the effect of new AEDs on calcium metabolism is essential