ABSTRACT
La epilepsia es una enfermedad neurológica frecuente que afecta a cerca de 50.000 millones de personas en el mundo. En Chile, la prevalencia estimada es de 10.8 a 17 por 1.000 habitantes. La primera opción para su tratamiento son los fármacos antiepilépticos (FAE) los cuales logran un aceptable control de enfermedad en la mayoría de los casos, sin embargo, tienen la potencialidad de desencadenar una serie de efectos adversos destacando entre ellos el desarrollo de hipocalcemia (HC) secundaria a hipovitaminosis D (HD), alteración que por lo general es leve y asintomática. Presentamos el caso de una mujer perimenopausica con antecedente de epilepsia en tratamiento con anticonvulsivante que desarrolla hipocalcemia severa. Además revisamos los mecanismos descritos a través de los cuales los FAE afectan el metabolismo de esta vitamina.
Epilepsy is a common neurological disease that affects about 50,000 million people in the world. The estimated prevalence is 10.8 to 17 per 1.000 inhabitants in Chile. The first option for its treatment are antiepileptic drugs (AEDs) which achieve an acceptable control of the disease in most cases, however, they have the potential to trigger a series of adverse effects (AE) highlighting among them the development of hypocalcemia (HC) secondary to hypovitaminosis D (HD), an alteration that is generally mild and asymptomatic. We present the case of a perimenopausal woman with a history of epilepsy under treatment with an anticonvulsant who develops severe hypocalcemia. We also review the mechanisms described through which AEDs affect the metabolism of this vitamin.
Subject(s)
Humans , Female , Middle Aged , Vitamin D Deficiency/complications , Vitamin D Deficiency/chemically induced , Epilepsy/drug therapy , Anticonvulsants/adverse effects , Vitamin D/metabolism , Epilepsy/metabolism , Hypercalcemia/etiologyABSTRACT
Introduction: epilepsy is defined as the presence of recurring unprovoked crisis, and whose treatment is typically an antiepileptic drug regimen taken daily for a long time. About 1 in 200 pregnant women develop epilepsy (0.5%). Women with epilepsy have a higher risk of poor outcomes of pregnancy, although most of their children will be normal. In pregnancy, the main risks for the mother and child are the result of poor control of their epilepsy and an elevated risk of major congenital malformations after to antiepileptic treatment. Treatment should be given to control crisis during pregnancy, despite its teratogenic potential, since the effects of epilepsy crisis are much more harmful to both mother and fetus. The treatment has to be administered as monotherapy, with minimal and effective doses able to control the crisis. In addition to the antiepileptic treatment, it is essential for the pregnant woman to be treated with folic acid at prophylactic doses of 0.4 mg daily and vitamin K with dose of 20 mg daily for the last month of pregnancy in order to prevent neural tube defects and maternal and fetal bleeding. It should also be given to the newborn immediately with a dosage of 1mg IM. The objective of this study was to determine treatment regimens that can be used to control epilepsy in pregnant women, and other measures to be taken in order to minimize the risks to the mother and fetus.
Subject(s)
Humans , Female , Pregnancy , Congenital Abnormalities , Therapeutics , Pregnancy , Risk Assessment , Epilepsy , Anticonvulsants , Pathology , Teratogens , Global Health , Risk FactorsABSTRACT
La vitamina D (VD) y sus acciones en el ser humano son objeto de una activa investigación en años recientes, ligada a la descripción de nuevos roles metabólicos, además de su conocida participación en el metabolismo del calcio y del hueso. En niños, algunas enfermedades neurológicas crónicas, como la parálisis cerebral, presentan un riesgo aumentado de deficiencia de VD, explicándose por una ingesta deficiente de ella, una menor exposición solar, requerimiento asociado al proceso de crecimiento, enfermedades intercurrentes y al uso frecuente de drogas antiepilépticas. En esta revisión se analizan los factores asociados a la deficiencia de VD y se plantea la necesidad de evaluar sistemáticamente el estado nutricional de esta vitamina en pacientes con enfermedades neurológicas de riesgo, sus posibles efectos metabólicos, implicancias clínicas y la necesidad de usar alimentos fortificados o suplementación con VD.
Vitamin D (VD) has been object of an active research in the last years, especially in relation with the findings of its new roles, besides its well known participation in calcium and bone metabolism. In children, some chronic neurologic diseases, like cerebral palsy, show an increased risk of VD deficiency, which could be explained by low intake, reduced sun exposure, requirements associated to growth process, intercurrent diseases and frequent use of antiepileptic drugs. In this review, factors associated to VD deficiency are analyzed, pointing to the need of a systematic assessment of the VD nutritional status in patients with neurological diseases associated to this deficiency, its possible metabolic effects, clinical implications and the need of fortified foods or VD supplementation.