Prospective study on effect of new antiepileptic drugs on bone metabolism in children with epilepsy / 中华实用儿科临床杂志

ABSTRACT

Objective:To study the effects of new antiepileptic drugs (AEDs), including Topiramate (TPM), Oxcarbazepine(OXC), Lamotrigine(LTG), and Levetiracetam (LEV) monotherapy on bone metabolism in children with epilepsy aged 4-12.Method:s One hundred and sixty children with epilepsy who were diagnosed for the first time at Shanxi Children′s Hospital from July 2016 to June 2017 were selected and given oral TPM (40 cases), OXC (40 cases), LTG (40 cases) and LEV (40 cases) respectively according to the type of seizure.The changes of bone mineral density (BMD) and bone metabolism indexes including serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), osteocalcin (OC), parathyroid hormone (PTH), 25 hydroxyvitamin D [25-(OH)D] before treatment and at 3, 6 and 12 months after treatment were observed.Result:s (1) Bone metabolism indicators and BMD had no significant difference among groups before treatment (all P>0.05). (2) After 6 and 12 months of treatment in OXC group, Ca was lower than before treatment[2.38(0.08) mmol/L vs.2.47(0.17) mmol/L, 2.44(0.10) mmol/L vs.2.47(0.17) mmol/L], PTH was higher than before treatment[37.64(17.52) ng/L vs.34.23(20.53) ng/L, 40.74(16.15) ng/L vs.34.23(20.53) ng/L]; Ca in TPM group decreased after 6 and 12 months of treatment[2.40(0.11) mmol/L vs.2.42(0.10) mmol/L, 2.41(0.09) mmol/L vs.2.42(0.10) mmol/L], and the differences were statistically significant(all P<0.05). (3) After 6 and 12 months of treatment, Ca in the OXC group was lower than that in the LEV group[2.38(0.08) mmol/L vs.2.44(0.10) mmol/L, 2.44(0.10) mmol/L vs.2.44(0.12) mmol/L] and LTG group[2.38(0.08) mmol/L vs.2.44(0.13) mmol/L, 2.44(0.10) mmol/L vs.2.42(0.13) mmol/L], and PTH in the OXC group was higher than that in the LEV group[37.64(17.52) ng/L vs.36.52(20.71) ng/L, 40.74(16.15) ng/L vs.31.89(14.84) ng/L] and LTG group[37.64(17.52) ng/L vs.39.39(24.03) ng/L, 40.74(16.15) ng/L vs.33.01(12.20) ng/L], Ca in TPM group after 12 months of treatment was lower than that in the LEV group[2.41(0.09) mmol/L vs.2.44(0.12) mmol/L] and LTG group[2.41(0.09) mmol/L vs.2.42(0.13) mmol/L], and the differences were statistically significant(all P<0.05). Conclusions:In the new AEDs, LEV and OXC have no significant effect on bone metabolism.TPM may affect bone metabolism by reducing Ca in children with epilepsy, and OXC may cause the decrease of Ca and the increase of PTH, thereby leading to increased bone turnover in children with epilepsy.