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Tekin E, Gül ÜŞ, Aydın SK, Köksoy AY. Evaluation of Bone Metabolism in Children Using Antiseizure Drugs: A Single-Center Experience and Review of the Literature. Journal of Pediatric Epilepsy 2022. [DOI: 10.1055/s-0042-1749343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AbstractThe effect of anti-seizure drugs (ASDs) on bone mineral density (BMD) is a controversial topic. This study investigated the effect of monotherapy and polytherapy drugs separately. Patients with a history of epilepsy treated with the same ASDs for more than 6 months were included in the study. Data regarding patient demographics, biochemical markers related to bone metabolism (calcium, phosphorus, alkaline phosphatase, parathyroid hormone, vitamin D), and BMD with dual-energy X-ray absorptiometry (DXA) were collected and compared. In total, 104 children with epilepsy using valproic acid (VPA), levetiracetam (LEV), carbamazepine (CBZ) alone or in combination and 22 healthy controls were evaluated. The ages of the children (64 boys, 62 girls) ranged between 2 and 17, with a mean of 9.50 ± 4.03 years. BMD or Z-scores did not differ among the monotherapy groups or between them and the polytherapy group. The lowest mean Z-score was in the VPA group but without statistical significance. Alkaline phosphatase levels were significantly higher in the group using CBZ. Calcium levels significantly differed between the groups (p = 0.001). The CBZ and LEV groups had the lowest calcium levels. However, phosphorus and vitamin D measurements did not significantly differ by ASDs used. Unfortunately, low vitamin D levels were evident in all children with epilepsy and even among controls. Physical activity, sun exposure, and calcium intake might be recommended in children treated with ACDs and in combination with additional risk factors monitoring via DXA should be considered. Further studies in a large population are necessary to judge which ASDs are more at risk to reduce bone mineralization than others.
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Affiliation(s)
- Emine Tekin
- Pediatric Neurology Division, Faculty of Medicine, Giresun University, Maternity and Children Hospital, Giresun, Turkey
| | - Ülkü Şiraz Gül
- Department of Pediatric Endocrinology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Sultan Köker Aydın
- Division of Pediatric Hematology, Department of Pediatrics, Antalya Training and Research Hospital, Antalya, Turkey
| | - Adem Yasin Köksoy
- Division of Pediatric Nephrology, Department of Pediatrics, Van Training and Research Hospital, Van, Turkey
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Fu Y, Wang G, Liu J, Li M, Dong M, Zhang C, Xu R, Liu X. Stimulant use and bone health in US children and adolescents: analysis of the NHANES data. Eur J Pediatr 2022; 181:1633-1642. [PMID: 35091797 DOI: 10.1007/s00431-021-04356-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/03/2022]
Abstract
UNLABELLED Stimulants have become the most popular psychopharmacologic drugs used in therapy for attention-deficit/hyperactivity disorder (ADHD). Childhood and adolescence are crucial periods for optimizing bone health to prevent osteoporosis-related fractures in old age. However, controversy remains regarding the relationship between stimulant use and bone health. The present study was designed to examine the bone mineral content (BMC) and bone mineral density (BMD) of 5472 individuals aged 8-16 years with or without stimulant use based on National Health and Nutrition Examination Survey (NHANES) 2011-2018 data and to further assess the association between stimulant use and bone health. Among these, 284 (5.2%) participants were using stimulants. In analyses stratified by sex, the BMC and BMD at the level of the lumbar spine, pelvis, and total body were generally lower among stimulant users than among nonusers in males (all P < 0.001), while the differences were not statistically significant in females. In multivariable linear regression models, the increasing range of BMCs and BMDs with age was lower in participants using stimulants than in those not using stimulants after fully adjusting for potential confounding factors. Compared to participants not using stimulants, stimulant use ≥ 3 months was associated with significantly lower BMCs [lumbar spine: β = - 1.35, (95% CI: - 2.56, - 0.14); pelvis: β = - 9.06, (95% CI: - 15.21, - 2.91); and total: β = - 52.96, (95% CI: - 85.87, - 20.04)] and BMDs [pelvis: β = - 0.03, (95% CI: - 0.04, - 0.01), total: β = - 0.01, (95% CI: - 0.02, - 0.00)]. CONCLUSIONS Children and adolescents using stimulants exhibited reductions in BMC and BMD at the lumbar spine, pelvis, and total body compared to those who were not using stimulants, especially among males. WHAT IS KNOWN • Childhood and adolescence are crucial periods for optimizing bone health to prevent osteoporosis-related fractures in old age. • Controversy remains regarding the relationship between stimulant use and bone health. WHAT IS NEW • The bone mineral content and bone mineral density at the level of the lumbar spine, pelvis, and total body were generally lower among stimulant users than among nonusers in males, while the differences were not statistically significant in females. • Body mass index and serum alkaline phosphatase may be predictors for loss of bone mineral content and bone mineral density in stimulant users.
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Affiliation(s)
- Yanan Fu
- Department of Medical Engineering, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong Province, 250012, China
| | - Guan Wang
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong Province, 250012, China.,NHC Key Laboratory of Otorhinolaryngology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 44 West Wenhua Road, Jinan, Shandong Province, 250012, China
| | - Junhui Liu
- School of Medicine, Shandong University, No. 44 West Wenhua Road, Jinan, Shandong Province, 250012, China
| | - Meng Li
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong Province, 250012, China
| | - Meng Dong
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong Province, 250012, China
| | - Chen Zhang
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong Province, 250012, China
| | - Rui Xu
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong Province, 250012, China
| | - Xinjie Liu
- Department of Pediatrics, Qilu Hospital of Shandong University, No. 107 West Wenhua Road, Jinan, Shandong Province, 250012, China.
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Berkvens JJL, Mergler S, Beerhorst K, Verschuure P, Tan IY, Majoie HJM, van den Bergh JPW. Bone mineral density and fractures in institutionalised children with epilepsy and intellectual disability. J Intellect Disabil Res 2021; 65:962-970. [PMID: 34472148 DOI: 10.1111/jir.12880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Long-term use of antiseizure drugs is associated with a low bone mineral density (BMD) and an increased fracture risk. The literature regarding institutionalised children on chronic antiseizure drugs is limited. Therefore, the aim of this cross-sectional study is to evaluate the prevalence of low BMD and the history of fractures in institutionalised children with epilepsy and intellectual disability (ID). METHODS A dual-energy X-ray absorptiometry of lumbar spine (L1-L4) and hip was performed in 24 children, residing in a long-stay care facility in the Netherlands. Additionally, serum concentrations of albumin, calcium and 25-hydroxyvitamin D were determined. Data on fractures were retrospectively extracted from the medical files. RESULTS Ages of the children (14 male and 10 female) ranged from 5 to 17 years with a mean age of 13.0 (±3.2). The criteria of the International Society for Clinical Densitometry (ISCD) were used for classification of bone mineral disorders. Eight (33.3%) children had a normal BMD (Z-score > - 2.0). Of the 16 children with a low BMD (Z-score ≤ - 2.0), three were diagnosed as osteoporotic, based on their fracture history. Ten children (41.7%) were reported to have at least one fracture in their medical history. Serum concentrations of albumin-corrected calcium (2.28-2.50 mmol/L) and (supplemented) vitamin D (16-137 nmol/L) were within the normal range. CONCLUSIONS This study demonstrated that 67% of institutionalised children with epilepsy and ID had low BMD and 42% had a history of at least one fracture, despite supplementation of calcium and vitamin D in accordance with the Dutch guidelines.
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Affiliation(s)
- J J L Berkvens
- Department of Residential Care, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
| | - S Mergler
- Medical Department, ASVZ, Care and Service Centre for People with Intellectual Disabilities, Sliedrecht, The Netherlands
- Department of General Practice and Intellectual Disability Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - K Beerhorst
- Department of Neurology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - P Verschuure
- Laboratory for Clinical Chemistry and Pharmacology, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
| | - I Y Tan
- Department of Residential Care, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
| | - H J M Majoie
- Department of Neurology, Academic Centre for Epileptology Kempenhaeghe, Maastricht University Medical Centre, Heeze, The Netherlands
- MHeNs School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - J P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
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Papassava M, Siomou E, Nakou I, Cholevas V, Challa A, Tzoufi M. Effects of long-term antiepileptic polytherapy on bone biochemical markers in ambulatory children and adolescents and possible benefits of vitamin D supplementation: a prospective interventional study. Epilepsy Behav 2021; 115:107708. [PMID: 33472116 DOI: 10.1016/j.yebeh.2020.107708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/13/2020] [Accepted: 12/13/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Our aim was to investigate any adverse effects of long-term polytherapy (VPA and add-on-therapy) on bone biochemical markers in ambulatory children and adolescents with epilepsy and the possible benefits of vitamin D supplementation on the same markers. METHODS In this prospective interventional study, the levels of 25(OH)D and the bone turnover markers of CrossLaps (CTX), total alkaline phosphatase (tALP), osteoprotegerin (OPG), and the receptor activator for nuclear factor kB (RANK) ligand (sRANKL) were determined in forty-two ambulatory children with epilepsy on polytherapy (valproic acid + one or more other from levetiracetam, topiramate, lamotrigine, or rufinamide). The same markers were assessed after a year's supplementation of vitamin D (400 IU/d) and were compared with those of clinically healthy controls. The respective mean (±SD) ages were 11.9 ± 4.6 and 11.4 ± 4.4 yrs. RESULTS The basal mean 25(OH)D levels in the patients did not differ from controls (23.9 ± 11.5 vs 27.4 ± 13.3 ng/ml), but increased significantly after the vitamin D intake (31.1 ± 13.3 ng/ml, p < 0.01). In parallel, basal serum CTX levels were found to be significantly lower in the patients than controls (0.89 ± 0.63 vs 1.22 ± 0.58 ng/ml, p < 0.02), but not tALP. Osteoprotegerin was higher in the patients (5.7 ± 7.7 pmol/L vs 2.6 ± 1.0 pmol/L, p < 0.03), while sRANKL did not differ. After vitamin D, the CTX levels increased to comparable levels in controls (0.99 ± 0.57 ng/ml), and those of OPG decreased to levels that did not differ from controls (4.9 ± 5.1 pmol/L). The ratio of OPG/sRANKL was higher in patients than controls before treatment (0.030 ± 0.045 vs 0.009 ± 0.005, p < 0.03), but decreased (0.026 ± 0.038) to comparable values in controls later. CONCLUSIONS These findings imply a lower bone turnover in the young patients on long-term polytherapy (VPA and add-on-therapy), but after one year's vitamin D intake, bone biochemical markers improved.
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Affiliation(s)
| | - Ekaterini Siomou
- Division of Pediatric Nephrology, Department of Pediatrics, University Hospital of Ioannina, Ioannina 451 10, Greece
| | - Iliada Nakou
- Division of Pediatric Neurology, University Hospital of Ioannina, Ioannina 451 10, Greece
| | - Vasileios Cholevas
- Pediatric Research Laboratory, University of Ioannina, Ioannina 451 10, Greece
| | - Anna Challa
- Pediatric Research Laboratory, University of Ioannina, Ioannina 451 10, Greece
| | - Meropi Tzoufi
- Division of Pediatric Nephrology, Department of Pediatrics, University Hospital of Ioannina, Ioannina 451 10, Greece
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Girish M, Mehan A, Venkatesh A. Should children on prolonged antiepileptic drug therapy undergo DEXA scanning to assess bone mineral density? Arch Dis Child 2021; 106:92-95. [PMID: 33032995 DOI: 10.1136/archdischild-2020-319695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Milind Girish
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Aman Mehan
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ashwin Venkatesh
- University of Cambridge School of Clinical Medicine, Cambridge, UK
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Abstract
Neurological diseases, particularly in the context of aging, have serious impacts on quality of life and can negatively affect bone health. The brain-bone axis is critically important for skeletal metabolism, sensory innervation, and endocrine cross-talk between these organs. This review discusses current evidence for the cellular and molecular mechanisms by which various neurological disease categories, including autoimmune, developmental, dementia-related, movement, neuromuscular, stroke, trauma, and psychological, impart changes in bone homeostasis and mass, as well as fracture risk. Likewise, how bone may affect neurological function is discussed. Gaining a better understanding of brain-bone interactions, particularly in patients with underlying neurological disorders, may lead to development of novel therapies and discovery of shared risk factors, as well as highlight the need for broad, whole-health clinical approaches toward treatment.
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Affiliation(s)
- Ryan R. Kelly
- Research Services, Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Sara J. Sidles
- Research Services, Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Amanda C. LaRue
- Research Services, Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
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Junges C, Machado TD, Nunes Filho PRS, Riesgo R, Mello EDD. Vitamin D deficiency in pediatric patients using antiepileptic drugs: systematic review with meta‐analysis. Jornal de Pediatria (Versão em Português) 2020. [DOI: 10.1016/j.jpedp.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Junges C, Machado TD, Nunes Filho PRS, Riesgo R, Mello EDD. Vitamin D deficiency in pediatric patients using antiepileptic drugs: systematic review with meta-analysis. J Pediatr (Rio J) 2020; 96:559-568. [PMID: 32171475 PMCID: PMC9432023 DOI: 10.1016/j.jped.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/06/2019] [Accepted: 01/17/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To measure the prevalence of vitamin D deficiency (through the 25-hydroxyvitamin D metabolite) in pediatric patients using antiepileptic drugs. SOURCE OF DATA Meta-analysis of studies identified through search in the PubMed, Embase, LILACS, and Cochrane Library databases, on February 19, 2019. SUMMARY OF DATA A total of 748 articles were identified, 29 of which were relevant to the objectives of this study. The prevalence of vitamin D deficiency found was 0.32 (95% CI=0.25-0.41; I2=92%, p<0.01). In the subgroup analyses, the most significant results were observed in the group of patients using cytochrome P450-inducing antiepileptic drugs, with a prevalence of 0.33 (95% CI=0.21-0.47; I2=86%, p<0.01) and, considering the study design, in the subgroup of cohort studies, with a prevalence of 0.52 (95% CI=0.40-0.64; I2=76%, p<0.01). CONCLUSIONS Taking into account the deleterious effects of vitamin D deficiency on the bone health of individuals using antiepileptic drugs, it is suggested to include in their care 25-hydroxyvitamin D monitoring, cholecalciferol supplementation, and treatment of the deficiency, when present.
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Affiliation(s)
- Cíntia Junges
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil.
| | - Tania Diniz Machado
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil
| | | | - Rudimar Riesgo
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil
| | - Elza Daniel de Mello
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil
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Kong AN, Fong CY, Ng CC, Mohamed AR, Khoo TB, Ng RL, Jalaludin MY, Nadarajaw T. Association of common genetic variants with vitamin D status in Malaysian children with epilepsy. Seizure 2020; 79:103-11. [PMID: 32464532 DOI: 10.1016/j.seizure.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 04/27/2020] [Accepted: 05/08/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Children with epilepsy (CWE) are at risk of vitamin D deficiency. Single nucleotide polymorphisms (SNPs) affecting the vitamin D pathway are potentially important risk factors for serum 25-hydroxyvitamin D [25(OH)D] concentration. The aims of our study were to evaluate the association of vitamin d-related SNPs to serum 25(OH)D concentrations in Malaysian CWE. METHODS Cross-sectional study of Malaysian ambulant CWE on antiseizure medication for >1 year. Sixteen SNPs in 8 genes (GC, VDR, CYP2R1, CYP24A1, CYP27B1, CYP27A1, CYP3A4, NADSYN1/DHCR7) were genotyped. Linear and logistic regression models and co-variates adjusted analyses were used. SNPs with significant associations were further analysed in a group of ethnically-matched healthy Malaysian children. RESULTS 239 CWE were recruited (52.7% Malay, 24.3% Chinese and 23.0% Indian) with mean serum 25(OH)D of 58.8 nmol/L (SD 25.7). Prevalence of vitamin D deficiency (≤37.5 nmol/L) was 23.0%. Minor allele of GC-rs4588-A was associated with lower serum 25(OH)D in the meta-analysis of both CWE (β -8.11, P = 0.002) and Malaysian healthy children (β -5.08, P < 0.001), while VDR-rs7975232-A was significantly associated with reduced odds of vitamin D deficiency in Malay subgroup of CWE (OR: 0.16; 95% CI: 0.06-0.49; P = 0.001) and this association was not found in the healthy children group. CONCLUSIONS Our results suggest that GC-rs4588 is associated with lower serum 25(OH)D concentration in both Malaysian CWE and healthy children, while VDR-rs7975232A is associated with lower risk of vitamin D deficiency in Malaysian CWE of Malay ethnicity. Our findings may assist in the genetic risk stratification of low vitamin D status among CWE.
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Abstract
Epilepsy is considered a major serious chronic neurological disorder, characterized by recurrent seizures. It is usually associated with a history of a lesion in the nervous system. Irregular activation of inflammatory molecules in the injured tissue is an important factor in the development of epilepsy. It is unclear how the imbalanced regulation of inflammatory mediators contributes to epilepsy. A recent research goal is to identify interconnected inflammation pathways which may be involved in the development of epilepsy. The clinical use of available antiepileptic drugs is often restricted by their limitations, incidence of several side effects, and drug interactions. So development of new drugs, which modulate epilepsy through novel mechanisms, is necessary. Alternative therapies and diet have recently reported positive treatment outcomes in epilepsy. Vitamin D (Vit D) has shown prophylactic and therapeutic potential in different neurological disorders. So, the aim of current study was to review the associations between different brain inflammatory mediators and epileptogenesis, to strengthen the idea that targeting inflammatory pathway may be an effective therapeutic strategy to prevent or treat epilepsy. In addition, neuroprotective effects and mechanisms of Vit D in clinical and preclinical studies of epilepsy were reviewed.
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Kija E, Gidal BE, Shapson-Coe A, Cader S, van der Watt G, Delport S, Wilmshurst JM. Vitamin D abnormalities and bone turn over analysis in children with epilepsy in the Western Cape of South Africa. Seizure 2019; 69:186-192. [DOI: 10.1016/j.seizure.2019.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 04/25/2019] [Accepted: 04/28/2019] [Indexed: 01/24/2023] Open
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Abstract
PURPOSE OF REVIEW Psychotropics are prescribed to youth at rapidly growing rates and may negatively impact bone health. Little awareness exists of this association among prescribing providers. Childhood and adolescence are critical times for bone development. Understanding these effects and their management is important to informed psychotropic use. RECENT FINDINGS Through a variety of mechanisms, antidepressants, benzodiazepines, mood stabilizers, neuroleptics, and stimulants may all negatively impact pediatric bone health. This confers added risk of osteoporosis in a population already at high risk for suboptimal bone health. Awareness of psychotropic-mediated effects on pediatric bone development is clinically relevant to the use and monitoring of these agents. Clinicians can manage these effects through informed consent, vitamin D supplementation, lifestyle modifications, and reducing polypharmacy. For mood stabilizers, vitamin D level monitoring and secondary prevention is indicated. Future longitudinal studies and development of monitoring guidelines regarding psychotropic impact on bone health are necessary.
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Affiliation(s)
- Jessie N Rice
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, SPC 5766, Ann Arbor, MI, 48109-2700, USA.
| | - Carrie B Gillett
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, SPC 5766, Ann Arbor, MI, 48109-2700, USA
| | - Nasuh M Malas
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, SPC 5766, Ann Arbor, MI, 48109-2700, USA.,Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA
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