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IMPACT OF LONG TERM ANTIEPILEPTIC THERAPY ON BONE MINERAL DENSITY

Khaled Taman1, Nevine Mostafa2 and Azza A. Hashim3
1 Medical department- Institute Of Postgraduate Childhood Studies- Ain Shams University - Cairo
2 Radiology Department Ain Shams University - Cairo
3 Clinical Pathology Department - Ain Shams University - Cairo

 

Objective:-The objective of our study was to study biochemical and radiological changes of bone mineral density (BMD) during the long-term use of antiepileptic drugs (AEDs).

Methods:- This study was conducted on 60 patients with primary epilepsy attending regularly the Outpatient Neurology Clinic, Children's Hospital, Ain Shams University. Estimation of serum Ca, P and alkaline phosphatase by colorometric methods (Elitech Diagnostic kits for Ca and P; and Randox diagnostic kits for alkaline phosphatase). Estimation of serum 25 (OH) D3 by radioimmune assay (Medgenix Diagnostic kits). Also, Lumbar spine osteodensitometry by dual energy X- ray absorptiometry.

Results:- study showed that epileptic children had significant decrease of weight, height centiles, mean serum level of vit. D, phosphorus and Z score. While, there was significant increase of mean serum level of alkaline phosphatase. But, there was significant increase of mean serum level of alkaline phosphatase. Prolonged duration of treatment showed significant correlation with decrease of weight, height centiles and mean serum level of vit.D, Ca, P and Z score with  significant increase of  mean serum level of alkaline phosphotase. The results of a group treated with valporic acid (VPA) had the worst effect on BMD. While, the group treated with carpamzepine (CBZ) had the worst effect on biochemical markers.

Conclusion:- long term use of AEDs has serious impact on bone mineralisation. Abnormal BMD is positive in a high percentage of patients compared to biochemical osteomalacia. Serial bone densitometry is superior to biochemical markers and is recommended for accurate determination of changes in bone mass especially in epileptic children on long-term medication. Vitamin D and calcium supplementation is recommended and encouraging weight-bearing exercises to increase BMD.