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Chronic antiepileptic monotherapy, bone metabolism, and body composition in non‐institutionalized children
Author(s) -
RAUCHENZAUNER MARKUS,
GRIESMACHER ANDREA,
TATARCZYK TOBIAS,
HABERLANDT EDDA,
STRASAK ALEXANDER,
ZIMMERHACKL LOTHARBERND,
FALKENSAMMER GERDA,
LUEF GERHARD,
HÖGLER WOLFGANG
Publication year - 2010
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/j.1469-8749.2009.03402.x
Subject(s) - medicine , endocrinology , vitamin d and neurology , bone remodeling , bone resorption , leptin , rankl , receptor , obesity , activator (genetics)
Aim The aim of this study was to determine the influence of chronic monotherapy with antiepileptic drugs (AEDs) on vitamin D levels, bone metabolism, and body composition. Method Eighty‐five children (38 males, 47 females; mean age 12y 5mo, SD 3y 4mo) were treated with valproate and 40 children (28 males, 12 females; mean age 11y 10mo, SD 3y) were treated with other AEDs (lamotrigine, sulthiame, or oxcarbazepine), comprising the non‐valproate group. Forty‐one healthy children (29 males 12 females; mean age 12y 1mo, SD 3y 5mo) served as a comparison group. Height, weight, body impedance analysis, 25‐hydroxyvitamin D, calcium, phosphate, two bone resorption markers (receptor activator of nuclear factor κB ligand [RANKL] and tartrate‐resistant acid phosphatase 5b [TRAP5b]), osteoprotegerin, and leptin were measured. Results No child was vitamin D deficient as defined by a 25‐hydroxyvitamin D (25OHD) level of less than 25nmol/l (<10ng/ml). Leptin, body fat, weight standard deviation score (SDS), and body mass index (BMI) SDS were all significantly higher (each p <0.001) in valproate‐treated children than in the non‐valproate group, as were calcium ( p =0.027) and RANKL ( p= 0.007) concentrations. Similarly, leptin was significantly higher in the valproate group than in control participants ( p <0.001), as were body fat ( p= 0.023), weight SDS ( p =0.046), BMI SDS ( p =0.047), calcium ( p< 0.001), and RANKL ( p< 0.001), whereas TRAP5b concentrations were significantly lower in the valproate‐treated group ( p= 0.002). Furthermore, calcium and RANKL levels were significantly higher in the non‐valproate group than in comparison participants ( p< 0.001 and p= 0.016 respectively). Interpretation Non‐enzyme‐inducing or minimal enzyme‐inducing AED monotherapy does not cause vitamin D deficiency in otherwise healthy children with epilepsy. Valproate therapy is associated with increases in weight, body fat, and leptin concentration, as well as with a bone metabolic profile that resembles slightly increased parathyroid hormone action.