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

•Young individuals on therapy with more than one antiepileptic drug represent an important part of epilepsy-treated patients.•Long-term polytherapy seems to have an adverse effect on bone biochemical markers.•Vitamin D supplementation even at the dose of 400 IU/d has some beneficial effect on bone b...

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Published in:Epilepsy & behavior 2021-02, Vol.115, p.107708-107708, Article 107708
Main Authors: Papassava, Margarita, Siomou, Ekaterini, Nakou, Iliada, Cholevas, Vasileios, Challa, Anna, Tzoufi, Meropi
Format: Article
Language:English
Subjects:
Adolescent
Anticonvulsants - therapeutic use
Antiepileptic drugs
Biomarkers
Child
Dietary Supplements
Epilepsy
Humans
Polytherapy
Prospective Studies
RANK Ligand
Vitamin D
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Summary:•Young individuals on therapy with more than one antiepileptic drug represent an important part of epilepsy-treated patients.•Long-term polytherapy seems to have an adverse effect on bone biochemical markers.•Vitamin D supplementation even at the dose of 400 IU/d has some beneficial effect on bone biochemical markers.•All routine biochemical markers do not seem to be reliable for assessing bone metabolism in children with epilepsy on therapy and even more on polytherapy. 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. 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. 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 
ISSN:1525-5050
1525-5069
DOI:10.1016/j.yebeh.2020.107708